Guidelines for Oral Medication Administration
The safe administration of oral medications requires strict adherence to the "rights" of medication administration to ensure patient safety and therapeutic efficacy. 1
The "Rights" of Medication Administration
The following framework establishes guidelines for safe oral medication administration:
1. Right Patient
- Dispense medication directly from the student's/patient's prescription bottle in real-time
- Have patients identify themselves
- Use photo verification of patient identity when available
2. Right Medication
- Verify twice that the pharmacy prescription label and prescriber medication order match
- Cross-reference prescribed medication with patient allergies
- Check medication expiration date
- Ensure medication and dosage are appropriate for the health condition
- Store according to manufacturer's guidance
- Review current contraindications and drug interactions
3. Right Dose
- Weigh patient in kilograms before first administration and periodically throughout therapy
- Verify weight-based correct dose and contact pharmacist or prescriber with questions
- Record medication dosage using "leading 0s before a decimal amount and avoiding trailing zeros after a decimal"
- Accept medication order changes only as prescribed by the authorized healthcare provider
4. Right Route
- Confirm route of administration on prescription (oral, sublingual, gastrostomy tube, etc.)
- For oral medications, ensure proper administration technique based on formulation (tablets, capsules, liquid)
5. Right Time
- Administer medication as ordered
- May be administered 30 minutes before or after the scheduled time unless otherwise specified
- Locate patients who do not present for scheduled medication
- Identify missed doses as medication errors
6. Right Documentation
- Maintain current medication list (both at-home and facility-administered)
- Document indications, effectiveness, side effects, and adverse reactions
- Record consent by guardian for administration (when applicable)
- Document administration at time of delivery
- Record medication errors, lost or wasted medication
- Maintain inventory of medication delivered and returned 1
Special Considerations for Oral Medications
Medication Formulations
- Consider patient's ability to swallow when selecting between tablets, capsules, or liquid formulations
- For patients with swallowing difficulties, determine if crushing tablets or opening capsules is appropriate and safe
- Some medications should not be crushed or opened (e.g., extended-release formulations) 2
Administration with Food
- Some medications require administration with food to improve gastrointestinal tolerability
- Others must be taken on an empty stomach to ensure proper absorption
- For example, oseltamivir (Tamiflu) can be administered without regard to meals, though administration with meals may improve gastrointestinal tolerability 1
Timing Considerations
- Certain medications require specific timing relative to meals or other medications
- For example, oral bisphosphonates must be taken on an empty stomach and the patient must remain upright 1
- Medications with potential drug interactions should be scheduled appropriately to avoid decreased efficacy
Patient Education
- Patients should be informed about:
- Potential side effects and adverse reactions
- Importance of adherence to dosing schedule
- Any specific administration requirements
- Potential interactions with alcohol or other medications 3
Medication-Specific Guidelines
Controlled Substances
- Storage of schedule II controlled substances must be limited to authorized personnel
- Documentation of administration should be reviewed regularly 1
Emergency Medications
- Rapid access to emergency rescue medications should be provided in accordance with state law 1
Conversion Between Routes
When converting between intravenous and oral routes:
- Consider bioavailability differences
- Adjust dosing appropriately
- For example, when converting from IV to oral opioids, specific conversion protocols should be followed 1
Common Pitfalls and How to Avoid Them
Medication errors due to look-alike/sound-alike medications
- Always verify medication name and dose twice
- Use tall-man lettering for similar medication names
Improper crushing of extended-release formulations
- Verify whether a medication can be crushed before administration
- Consider alternative formulations when crushing is not appropriate
Poor adherence with complex regimens
- Simplify medication regimens when possible
- Provide clear written instructions
- Consider medication timing relative to patient's daily routine
Inadequate documentation
- Document administration immediately
- Include all required elements in documentation
- Report and document any medication errors promptly
Failure to adjust for patient-specific factors
- Consider age, weight, renal function, and other patient factors
- Make appropriate dose adjustments for special populations
By following these guidelines for oral medication administration, healthcare providers can ensure safe and effective medication delivery while minimizing the risk of adverse events and maximizing therapeutic outcomes.