1. General medication administration considerations (review in the room, with the patient).

1. Upon first entering the patient's room, wash hands with soap and warm water, and apply vigorous friction for at least 20 s. Hand sanitizers may be used if the hands are not visibly soiled, but vigorous friction should also be applied.
2. At the bedside computer, log into the patient's electronic health record and review the patient's medical history and previous administration times. Verify with the patient any medication allergies and discuss his/her physical allergic responses and reactions.
3. At the bedside computer, pull up the Medication Administration Record (MAR).
   1. Review the medications that are due to be administered, and clarify with the patient if he/she has a preference or concerns prior to acquiring and preparing the medication.
   2. Some patients may have difficulty swallowing whole tablets or capsules. This may require cutting the tablet into smaller doses or opening the capsule to release the powder or granules. Before splitting a tablet or opening a capsule, you must ensure that that it is safe to do so. Enteric-coated medication and extended/sustained-release medications should never be broken.
   3. There are many medications that can be given in liquid form if swallowing partial tablets or granules is still difficult. Consult with a pharmacist to determine liquid preparation availability.
4. Leave the patient's room and wash hands as described above (step 1.1)
5. The nurse must now maintain a distraction/disruption-free environment while dispensing and administering medications to prevent medication errors.
6. Acquire the oral tablet medication from the medication dispensing device, using the five "rights" during the first safety check.

2. Go to the medication preparation area (this area may be in a secured room or in a secured portion of the nurses' station) and complete the first safety check using the five "rights" of medication administration. Refer to the "Safety Checks and Five Rights of Medication Administration for Acquiring Medications from a Medication Dispensing Device" video.

3. In the medication preparation area, prepare the oral medication according to the MAR, pharmacy instructions, nurse drug guide, patient preference, best practices, and institutional policies/procedures. Pre-packaged oral tablets or capsules that do not require preparation should remain in the original packaging.

1. Open oral medication packaging and prepare for medication preparation if difficulty swallowing, patient preference, or partial dosing requires it.
2. Partial tablet administration may be required by the oral tablet medication dose or patient preference. Some prescribed doses require splitting a tablet to obtain the desired dose of the medication (e.g., half of a tablet or 1.5 tablets).
   1. Divide a large, scored tablet into two equal pieces by grasping both sides of the tablet and breaking at the scored line.
   2. For un-scored tablets, place the tablet evenly into a pill cutter and quickly close the device to ensure that the tablet cuts evenly.
   3. Dispose of remaining partial doses according to institutional policy if partial dosing is required. If cutting and/or breaking tablets for patients with difficulty swallowing, place all medication pieces into a medication cup.
3. Oral capsule preparation for patients who are unable to swallow a capsule will require obtaining a soft food (i.e., puree or pudding) from the nutrition room.
   1. 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 medication.
   2. Carefully spoon 2-3 tablespoons of soft food into the medication cup containing the capsule contents. This will facilitate administration and will help to mask the taste of the medication.
4. Premixed liquid oral medications will require gentle shaking of the medication for a few seconds to ensure the equal distribution of the medication within the liquid.
   1. Obtain an oral syringe and medication cup from the medication drawer in the medication preparation room. Intravenous syringes can easily be mistaken for oral syringes. You should always use oral syringes when dispensing oral medications to avoid medication errors.
   2. Calculate the appropriate volume to withdraw given the concentration provided on the liquid medication label. If the MAR indicates a dose of 30 mg and the concentration provided is 30 mg/15 mL, withdraw 15 mL from the container.
   3. Place the medication cup on a level surface and crouch until you are at eye level with the volume measurement. Pour premixed liquid medication into the medication cup until it reaches the correct volume. Pouring the liquid while standing and looking down at the medication cup will cause an insufficient volume to be dispensed, constituting a medication error.
   4. If a medication, such as liquid digoxin, requires a precise measurement, an oral syringe should be used to withdraw the medication from the mediation cup.
   5. Place a medication cup on a level surface and pour a volume greater than needed for the prescribed dose. Keep a multi-dose container clean by pouring out the volume to be used before withdrawing with an oral syringe. If a single-dose container is used, you may withdraw directly from the container and dispose of the remaining volume.
   6. Place the tip of the oral syringe within the liquid medication and withdraw slightly more than the prescribed volume.
   7. Turn the tip of the syringe up and move it to eye level. Slowly push the plunger until all air is dispensed and the top of the plunger seal (i.e., the bottom of the plunger seal cone) reaches the desired volume.
   8. Return the multi-dose container to the medication dispensing device. If a single-dose liquid medication container is used, dispose of the remaining volume according to institutional policy.
5. Dispose of all medication packaging in a trash receptacle.

4. All medications that have been removed from original packaging must be labeled with the medication and medication dose prior to leaving the medication preparation room. Using tape or a pre-printed medication label (if available), write the medication name and dosage amount on the label, and place the label on the syringe. Some institutions may require more information, depending upon their medication labeling policy.

5. In the medication preparation area, complete the second safety check using the five "rights" of medication administration. Refer to the "Safety Checks and Five Rights of Medication Administration for Acquiring Medications from a Medication Dispensing Device" video.

6. Gather the necessary supplies, including a cup of water, a straw, non-sterile gloves, oral medication, and medication cups. Take the supplies into the patient's room.

Administration

7. Upon first entering the patient's room, set the medications down on the counter and wash hands with soap and warm water; apply vigorous friction for at least 20 s. Hand sanitizers may be used if the hands are not visibly soiled, but vigorous friction should also be applied.

8. In the patient's room, complete the third and final medication safety check, adhering to the five "rights" of medication administration. Refer to the "Safety Checks and Five Rights of Medication Administration for Acquiring Medications from a Medication Dispensing Device" video.

1. Verify that the patient is wearing the correct name band by asking him/her to state his/her name and birthdate. Compare this information with what is provided on the name band

9. Teach the patient about the oral medication. Tell the patient the medication name, indication, and action.

1. Review with the patient any side effects or adverse effects associated with the medication.
2. Discuss any patient concerns regarding the medication and address them prior to administering the medication. Should the patient refuse the medication, ensure that he/she is aware of the potential physiological/psychological impact of the refusal on his/her health and recovery.

10. Administer the oral medication.

1. Ask the patient to take a small sip of water to ensure he/she is able to swallow without difficulty.
2. Open any pre-packaged medications and place it in a medication cup.
3. Give the medications to the patient according to patient preference and ability.

11. Document the medication administration in the electronic MAR.

1. In the patient's electronic MAR, record 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.

12. Prior to leaving the room, remind the patient about any side effects/adverse effects or considerations for which he/she should notify the nurse.

13. Leave the patient room. Upon exiting the room, wash hands with soap and warm water, applying vigorous friction for at least 20 s. Hand sanitizers may be used if the hands are not visibly soiled, but vigorous friction should also be applied.