Chapter 10: Principles of Drug Administration

The safe and effective administration of medications across various routes is governed by meticulous protocols, beginning with adherence to the Ten Rights of Drug Administration, which include ensuring the right drug, dose, time, route, patient, reason, documentation, evaluation (assessment), patient education, and the patient’s right to refuse. Comprehensive preparation requires healthcare providers to perform hand hygiene, confirm patient identification using two identifiers, assess allergies, and check the medication label against the transcribed order at least three times—upon removal, during preparation, and at the patient’s bedside. For enteral drugs, strict guidelines exist regarding positioning to prevent aspiration, managing swallowing difficulties by crushing tablets (with caveats for extended-release or enteric-coated formulations), and utilizing specific techniques for administering liquids to infants using oral-dosing syringes. Administration through nasogastric or gastrostomy tubes necessitates checking placement and gastric residual volumes, positioning the patient in a semi- or high Fowler’s position, and diluting crushed tablets or liquid drugs with warm water, followed by sufficient flushing. Specialized instructions are provided for topical routes, such as rectal administration, requiring the patient to be in the modified left lateral recumbent position and the suppository to be inserted beyond the internal sphincter, or the precise method for instilling eye drops into the conjunctival sac, followed by pressure on the nasolacrimal duct to limit systemic absorption. Parenteral administration dictates specific needle angles for Intradermal (5 to 15 degrees), Subcutaneous (45 or 90 degrees), and Intramuscular (90 degrees) injections, with the ventrogluteal site preferred for IM injections in adults. Essential safety procedures for parenteral drug preparation involve using a filter needle when drawing medication from an ampoule, injecting air into a vial before withdrawal, and utilizing techniques like the Z-track method for irritating IM drugs. For intravenous (IV) drugs, rapid onset necessitates close monitoring, careful compatibility checks, proper activation of IV piggyback (IVPB) systems, and the mandatory timing of IV push medications, often requiring dilution.