출처: 매들린 래쉬, MSNEd, RN 및 케이티 바라키, MSN, RN, 간호 대학, 유타 대학, UT
경구 약물은 환자가 가장 선호하는 경로이며 공급자가 약물 투여의 가장 일반적으로 사용되는 경로 중 하나입니다. 대부분의 경구 제제는 입으로 채취하고, 액체로 삼켜지고, 위장관을 통해 흡수됩니다. 경구 약물은 고체형태(예: 정제, 캡슐, 카플렛 및 장용 코팅 정제)와 액체형태(예: 시럽, 용해, 증류주 및 현탁액)에서 사용할 수 있습니다. 대부분의 경구 약물은 행동의 느린 발병을 가지고 있으며, 액체와 삼킨 경구 약물의 경우, 또한 더 긴 효과를 가질 수있다. 장코팅 된 정제는 태블릿이 소장에 도달 할 때까지 용해 및 흡수를 방지하는 재료로 덮여 있습니다. 추가 경구 약물 경로 (이 비디오에 표시되지 않음)는 충동할 준비가 혀 아래에 배치되는 감하 투여, 그리고 용해하는 잇몸과 점액 막 사이의 뺨 부위에 약물을 배치하는 것을 포함하는 buccal 투여를 포함한다.
경구 정제 및 액체 약물을 준비하고 투여 할 때 간호사는 환자의 건강 상태, 약물 알레르기 및 현재 임상 상태와 약물의 이전 복용량이 투여 된 경우 약물이 적절한지 여부를 고려해야합니다. 변경된 위장 기능을 가진 환자는(예를 들면, 구토와 구역질) 경구 약물을 주어서는 안됩니다, 그(것)들을 유지할 수 없을 것이기 때문에. 경구 약물은 의식이 없거나 비협조적이거나 의학적 문제로 인해 삼킬 수 없는 환자에서 금기됩니다. 약물 투여는 또한 간호사가 약물 목적, 부작용 및 환자 선호도에 대해 잘 알고 있어야 합니다. 이 데모는 5개의 “권리”를 포함하여 정제및 액체 양식 (가장 일반적인)에서 경구 약물을 준비하고 관리하는 방법을 제시하고 약물 문서화에 대해 논의 할 것입니다.
This video demonstration presented the verification and administration of oral medication, including tablets, capsules, and liquid preparations. Because dosage variations in the institutional pharmacy may be limited, it is important for the nurse to verify that the correct medication dose is obtained from the medication dispensing device and is prepared according to the dose indicated in the patient's MAR. For example, if a patient had been ordered a dose of 30 mg, but the institutional pharmacy only had 20-mg tablets, the nurse would need to prepare and give 1.5 tablets. If the action of an oral liquid medication's requires precise measurement, an oral syringe should be used instead of a medication cup. A medication cup provides an approximate volume, while a syringe will deliver exact volumes if the correct technique is used during preparation. A common oral liquid medication error would be to pour a liquid medication without holding it at eye level or placing it on a level surface. In both cases, this would result in an administration dosing error, with under-dosing resulting in effects potentially as harmful as over-dosing, depending upon the medication administered and the desired effects. Adherence to the five "rights" and three checks of safe medication administration ensure that the patient receives the intended and safe dose of the medication.
Oral medication administration is one of the most preferred and commonly used routes for patients by providers. Most oral meds are given in a solid or liquid form. Like for any medication administration procedure, a nurse must follow and complete the five “rights” at the three safety checkpoints. In addition, before administration, the nurse must also know the indication, purpose, and possible side effects of the specific medicine being given to the patient.
This video will illustrate the essential steps on how to prepare and administer solid and liquid forms of oral medications.
Before delving into the administration process, let’s take a look at the different types of oral medications commonly encountered in a hospital setting. Solid forms include tablets, capsules, caplets, and enteric-coated tablets. Liquid forms include syrups, elixirs, spirits, and suspensions.
Some forms have unique medication administration qualities. For example, enteric-coated tablets are covered with material that only is absorbed once in the small intestine. These tablets should not be broken or altered in the preparation stages. There are two other oral forms that are less common: sublingual and buccal. In the sublingual form, the patient is given the medication to place under the tongue to dissolve. With buccal, the medication is placed in the cheek areas to dissolve.
Now that you know about the different types, let’s review the oral medication preparation procedure. Upon entering the patient’s room, wash your hands with soap and warm water for at least 20 seconds, or apply hand sanitizer using vigorous friction. Next, walk to the bedside computer and log into the electronic health record, or EHR. Review the patient’s medical history and any recorded allergies to confirm potential adverse reactions.
In the EHR, review the electronic medication administration record, or MAR. On the MAR, find the meds to be administered at that time. Ask the patient if there are preferences for how to prepare the meds. Note that some patients cannot swallow pills, and some may prefer pills crushed. The nurse must know these details before preparing the meds. After confirming with the patient, exit out of the EHR and leave the room and perform hand hygiene as described previously.
Next, acquire the oral tablet medication from the medication dispensing device using the five “rights,” as described in the first video of this collection. This completes the first of the three safety checks. Now, in the medication preparation area, prepare the medication as indicated in the patient’s MAR, pharmacy instructions, nurse drug guide, patient preference, and according to the best practices and institutional policies and procedures. Pre-packaged oral tablets or capsules that do not require preparation will remain in the original packaging.
Open tablet packaging if there is difficulty in swallowing, partial dosing required, or if the patient prefers divided tablets. Some prescribed doses require splitting a tablet to obtain the desired dose of the medication. For splitting, first determine if the tablet is scored-with a visible line where it can be broken in half-or un-scored. Divide large scored tablets into two equal pieces by grasping both sides of the tablet and breaking at the scored line. For un-scored tablets, place the tablet evenly into a pill cutter and quickly close the device to ensure the tablet cuts evenly. If partial dosing is required, dispose of the remaining partial doses according to institutional policy. If cutting and/or breaking tablets for patients with difficulty swallowing, place all medication pieces into a medication cup.
Oral capsule preparation for patients who are unable to swallow a capsule will require obtaining a soft food, like puree or pudding, from the nutrition room. To empty the contents of the oral capsule medication, grasp both ends of the capsule, twist and pull gently, and empty the contents into a medication cup. Be careful not to lose any of the contained medications.
For premixed liquid oral medications, gently shake the medication for a few seconds to ensure equal distribution of the medication within the liquid. Next, calculate the appropriate volume to withdraw given the concentration provided on the liquid medication label. If the MAR indicates a dose of 200 mg and the concentration provided is 32 mg/mL, then you need to withdraw 6.25 mL from the container. To do that, place a medication cup on a level surface and crouch until you are at eye level with the volume measurement. Then pour the premixed liquid medication into the medication cup until it reaches the correct volume. Liquid poured while standing and looking down at the medication cup will cause an insufficient volume to be dispensed and a medication error.
If the medication indicates a precise measurement, such as liquid digoxin, then obtain an oral syringe from the medication drawer. Always use an oral syringe to withdraw oral medication, as an intravenous syringe can easily be mistaken for intravenous use, and may lead to medication errors. If withdrawing from a multi-dose container, place a medication cup on a level surface and pour a volume greater than needed for the prescribed dose. Pouring out the volume to be used before withdrawing keeps the multi-dose container clean, if not using a sterile oral syringe.
If using a sterile oral syringe, you may draw directly from the container. Always withdraw slightly greater than the prescribed volume. Then turn the tip of the syringe up and move it to eye level. Now slowly push the plunger until all air is dispensed and the top of the plunger seal reaches the desired volume. If a single-dose container is used, the nurse may withdraw directly from the container and dispose of the remaining volume according to institutional policy. Dispose of all medication packaging in the trash receptacle.
Next, using tape or a pre-printed medication label, write the medication name and dosage amount on the label, and place it on the syringe. Note that all medications that have been removed from the original packaging must be labeled prior to leaving the medication preparation room.
In the medication preparation area, complete the second safety check using the five “rights” of medication administration. After the second safety check, gather the needed supplies, including a cup of water, straw, non-sterile gloves, oral medication, and medication cups, and walk to the patient’s room.
Upon first entering the patient’s room, set the medications down on the counter and perform hand hygiene as described before, with vigorous friction for at least 20 seconds. In the patient’s room, complete the third, and final, medication safety check, adhering to the five “rights” of medication administration. Verify the patient is wearing the correct name band by asking them to state their name and birthdate. Compare this information with what is provided on the name band.
At this point, provide the patient teaching regarding the oral medication. Tell the patient the medication name, indication, and action. Review any side effects associated with the medication. Discuss any concerns that the patient might have regarding the medication. Should the patient refuse the medication, ensure that they are aware of the potential physiological or psychological impact of their refusal on their health and recovery.
Before giving the medication, ask the patient to take a small sip of water to ensure they are able to swallow without difficulty. Now, open any packaged medications, place them in a medicine cup, and give them to the patient according to his or her preferences and abilities.
After administration, document the following in the patient’s MAR: the dose of the medication, route of administration, date, and exact time administered, with your initials. Any assessments required prior to administration should be included in the documentation. Prior to leaving the room, remind the patient about any side effects or considerations for which they should notify the nurse. Leave the patient room, and upon exiting, remember to perform hand hygiene as described previously.
“Because dosage variations in the institutional pharmacy may be limited, it is important for the nurse to verify the correct medication dose is obtained from the medication dispensing device and prepare the medication according to the dose indicated in the patient’s medication administration record.”
“A common oral liquid medication error would be to pour a liquid medication without it being at eye level or on a level surface. In both cases, this would result in an administration dosing error, with under-dosing resulting in potentially as harmful effects as over-dosing, depending on the medication administered and the desired effects.”
You’ve just watched JoVE’s video on verification and administration of oral medication, including tablets, capsules, and liquid preparation. You should now understand the different forms of oral medications, how to prepare the medications for administration, and the safe practices of medication administration using the five “rights.” As always, thanks for watching!
