Oral Drug Administration

(Adult & paediatric)

February 2019

Oral drug administration guideline; 2019 version 6 Page 1 of 26

Validation Grid
Title Oral Drug Administration Guidelines (version 5)
Meera Thacker Pharmacist
Primary author Iris Samuel Pharmacist
Helen Atkinson Pharmacist
Naomi Walsh & Becky Lawson Lead nurses practice development
Associate author
Jan 2019 update
NMC Registered nursing and midwifery staff
Target audience Student nurses and trainee nursing associates
Pharmacy
Commissioning
body Nursing guidelines group
Nursing guidelines group
Drugs and Therapeutics committee
Stakeholders Pharmacy
consulted Infection prevention and control
Paediatrics
Clinical Divisions via Divisional Nurse Directors
Clinical Practice /
Advanced Practice Clinical Practice
Enteral Drugs Administration Guidelines for adults
Controlled Drug safe management & administration
Medicines policy
Safe prescribing, handling and administration of cytotoxic drugs
Associated Policies
(North London Cancer Network Guideline)
/ Documents
Trust waste policy
Acute pain management guidelines (Opioid section)
Cytotoxic chemotherapy for non-cancer indications
Patient identification policy
Guideline
Oral Drugs Administration Guidelines April 2016
Replacement
Date of Submission February 2019
Date of approval DTC: 15 Feb 2019
Date for review February 2022
There are no significant changes to practice; this is a periodic
Significant change
review of an existing guideline across all trust sites; however
to practice
further detail has been added on electronic administration
Implementation plan
(including dissemination Updated guideline distributed electronically to clinical areas
plan and audit plan if
significant change to Updated guideline available on Freenet
practice)

Key words Oral, drug administration, medicines, drug

Oral drug administration guideline; 2019 version 6 Page 2 of 26

Version control
Version Date Author Comment
1 2004 Unknown Periodic review and update
2 Aug 2008 Meera Thacker Pharmacist Periodic review and update
Iris Samuel Pharmacist
Helen Atkinson Pharmacist
Naomi Walsh Practice
Development
3 Sept 2011 Meera Thacker Pharmacist Periodic review and update
Iris Samuel Pharmacist
Helen Atkinson Pharmacist
Naomi Walsh Lead nurse
Practice Development
4 April 2013 Meera Thacker Pharmacist Periodic review and update
Iris Samuel Pharmacist
Helen Atkinson Pharmacist
Naomi Walsh practice
development
Reyon Yan Clinical Facilitator
5 Feb 2016 Meera Thacker , Helen Atkinson Periodic review and update
Becky Lawson, Naomi Walsh Harmonisation of practice
Michael Clift, Chloe Benn across all trust sites for adults
and paediatrics
6 Feb 2019 Naomi Walsh; Mary Ann Periodic review and update
Escalante; Helen Atkinson; Greater detail on electronic
Hannah Heales; Wendy Irving; medicines administration in
section 11

Oral drug administration guideline; 2019 version 6 Page 3 of 26

Contents

1. Abstract Page 5
2. Aim/purpose of Page 5
3. Scope Page 5
4. Responsibility Page 5
5. Definitions Page 6
6. Staff who may undertake this procedure Page 6
7. Specific training required Page 7
8. Information about oral drug preparations Page 8
9. Use of syringes when measuring oral drug medications Page 15
10. General points Page 16
11. Administration procedure Page 17
12. Risk assessment Page 21
13. Patient information Page 21
14. Audit Page 22
15. References Page 22
Appendix 1 Equality Assessment Page 24
Appendix 2 Oral cytotoxic guidance for non SACT trained nurses Page 26

Royal Free London Equality and Diversity Statement

“The Royal Free London NHS Foundation Trust is committed to creating a positive culture of
respect for all individuals, including job applicants, employees, patients, their families and
carers as well as community partners. The intention is, as required by the Equality Act 2010,
to identify, remove or minimise discriminatory practice in the nine named protected
characteristics of age, disability (including HIV status), gender reassignment, marriage and
civil partnership, pregnancy and maternity, race, religion or belief, sex or sexual orientation.
It is also intended to use the Human Rights Act 1998 to treat fairly and value equality of
opportunity regardless of socio-economic status, domestic circumstances, employment
status, political affiliation or trade union membership, and to promote positive practice and
value the diversity of all individuals and communities.

This document forms part of the Trusts commitment, you are responsible for ensuring that
the Trust’s policies, procedures and obligation in respect of promoting equality and diversity
are adhered to in relation to both staff and service delivery.”

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1. Abstract

These guidelines are to replace the previous guidelines dated 2016. It is intended to give an
overview on the administration of oral drugs. In conjunction with this, please refer to the
other policies listed in the validation grid, the latest edition of British National Formulary for
adults and children (BNF and BNFC), Summary of Product Characteristics (SPC) of drugs
and Patient Information Leaflet (PIL) SPC and PIL are available on the internet at
www.medicines.org.uk.

These guidelines were developed to standardise guidance for oral drug administration and to
assist nurses & midwives to administer drugs correctly.

2. Aim / purpose of the procedure to be undertaken

These guidelines aim to standardise practice across all trust sites and to ensure the
prescribed drug is given to the intended patient via the oral route at the most appropriate
time, in the most appropriate way by competent staff, to achieve maximum absorption for
maximum efficacy with minimal adverse effects and interactions and minimise distress to the
patient.

Its objectives are to provide equitable care across the trust for all patients requiring oral
drugs and provide a resource for all staff involved in the procedure.

The policy promotes principles of good care and safety for all groups and aims to promote
patient safety.

The administration of medicines is an important aspect of the professional practice of

persons whose names are on the NMC register. It is not solely a mechanistic task to be
performed in strict compliance with the written prescription of a medical practitioner.
Registrants are accountable for their actions and omissions; administration of medicines
requires thought and the exercise of professional judgement

3. Scope

These guidelines apply to all nursing and midwifery staff employed by the Royal Free
London NHS Foundation Trust, or working on sites where the trust provides services.

Adherence to the principles of this guideline is the responsibility of any member of the multi-
professional team directly involved in clinical care. The individual is accountable for their
practice and should always act in the best interest of patient.

4. Responsibility

The Director for Nursing has overall responsibility for ensuring nursing guidelines are
implemented. There is corporate responsibility for ensuring these guidelines are supported
by distribution and awareness and teaching to support implementation.

Matrons, sisters, charge nurse and practice educators are responsible for reading and
following trust policies and guidelines and maintaining current practice to meet NMC
registration requirements and to maintain patient safety. They are also responsible to

Oral drug administration guideline; 2019 version 6 Page 5 of 26

ensure policies and guidelines are followed and implemented by their staff and for reporting
any incidence relating to practice in this area.

NMC registered nursing and midwifery staff are responsible for reading and following trust
policies and guidelines and maintain current practice to meet NMC registration requirements
and to maintain patient safety.

5. Definitions

Competence: Relates to the need for a staff member to demonstrate their “capability” in
certain skill areas to a required standard at a point in time.

Oral drug administration: Relates to the route of administration where a substance is

taken through the mouth. Many medications are taken orally because they are intended to
have a systemic effect, reaching different parts of the body via the bloodstream.

6. Staff who may undertake this procedure

Within this Trust oral drug administration is regarded as a clinical practice. A clinical practice
may be defined as an aspect of care which may be undertaken by NMC registered staff who
accept accountability for their actions and feel competent to undertake the procedure.
Clinical supervision can assist practitioners in providing support and education in the
development of their knowledge and overt assessment of competence.

The NMC Code (2018) clearly states that the fundamentals of care must be delivered
effectively, and patients care needs are recognised, assessed and responded to. It also
states that NMC registered staff should only delegate tasks and duties that are within the
scope of the other person’s competence, ensuring that staff who have had a task delegated
to them have fully understood your instructions. The Code (2018) requires staff that have
had tasks delegated to them, be adequately supervised and supported to ensure safe and
compassionate care and to monitor the task has met the required standard.

The NMC Code (2018) specifies that NMC registered staff must maintain their knowledge
and skills for safe and effective practice and complete the necessary training before carrying
out a new role. Nurses and midwives are accountable and responsible for providing
optimum care for their patients. It is essential that nursing staff objectively examine the
information gathered from assessments and observations. Professional accountability
demands more than solely being able to perform the procedure correctly, it requires nurses
to act on and understanding the clinical relevance of the results (NICE 2007 & Kisiel and
Perkins 2006).

All newly registered nurses (RN) and newly registered nursing associates must work
through the drug administration workbook to gain core medicines management theory
relevant to their area of practice prior to competency assessment in medicines
administration and management. In addition to completing the workbook, each new NMC
registrant must undertake supervised practice in administering drugs by working through the
assessment criteria to ensure competence is achieved. This should form part of newly
qualified staffs’ preceptorship.

The workbook may be completed whilst new registrants are waiting to take up post, so
supervised practice and competency assessment can be undertaken during their 2 week
supernumerary period upon commencement of their post.

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Student nurses/student midwives / trainee nursing associates may undertake this practice
under direct supervision of a registered nurse/midwife who is competent in this aspect of
care and in the supervisory role (see medicines policy).

NB: It is important to remember that the NMC registrant always remains accountable for the
safe administration of medicines. If you have concerns regarding the competence of a
learner it is your responsibility to address these concerns and stop the learner from
involvement in medicines administration if you consider them unsafe. Poor and / or unsafe
practice should be addressed via the Practice Assessment Tool and the Skills Workbook.
All serious concerns should be documented and raised with the link lecturer.

Staff with prior medicines administration experience but new to the trust may be required to
undertake a general drug administration competency assessment if they are unable to
demonstrate prior learning and assessment in medicines administration, or if practice is
called into question to assure the trust of their competency.

Nursing assistants have no role in oral drug administration.

Table 1: Summary of who can administer oral drugs

Registered Can administer to all patients - single nurse administration (SNA)
nurses and
Midwives All newly registered nurses/midwives must work through the drug
administration workbook to gain competency in medicine
management. In addition to completing the workbook, each nurse
must undertake supervised practice in administering drugs by
working through the assessment criteria to ensure competence is
achieved.

NB: If the medicine to be administered is a controlled drug please

note this is a two registrant checking procedure including completion
of the controlled drug register and electronic/paper prescription chart
(you will require a co-sign account in order to witness a CD
administration on EPR). Please refer to the Controlled drugs, safe
management and administration policy.

NB: in paediatrics all medicines including oral medication is a two

registrant checking process
Nursing Can administer to all patients - single nurse administration (SNA)
associates
All newly registered nursing associates must work through the drug
administration workbook to gain competency in medicine
management. In addition to completing the workbook, each nursing
associate must undertake supervised practice in administering drugs
by working through the assessment criteria to ensure competence is
achieved.

NB: If the medicine to be administered is a controlled drug please

note nursing associates are not permitted to check or administer the
medication. Please refer to the Controlled drugs, safe management
and administration policy.
Student nurse & Can administer oral medication under direct supervision of a
Student midwife Registered Nurse, midwife or registered children’s nurse who has
completed the required competency assessments.

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 Trainee nursing Can administer oral medication under direct supervision of a
associates Registered Nurse, midwife or registered children’s nurse who has
completed the required competency assessments

NB: If the medicine to be administered is a controlled drug please

note trainee nursing associates are not permitted to be involved in
checking or administration
Nursing Not permitted to check or administer any drugs
assistants
ODPs registered Permitted to check and administer oral drugs
with HPC Duthie Report 'The Safe and Secure Handling of Medicines 2005
This is a nursing and midwifery guideline, however, it is acknowledged that other
healthcare professionals may be required to administer oral medication as part of their role
e.g. medical staff, radiographers (not an exhaustive list) and the administration process
should be the same for all professions; these professionals are able to use this guideline
as the trust standard practice for administration providing they have had appropriate
training and assessment as part of their professional training prior to registration with their
professional body.

7. Specific training required

There is no specific post registration training; however, supervised practice in administration

of oral drugs prior to competency assessment is advocated. All nursing & midwifery staff are
accountable for their own professional practice (NMC 2015) and should only administer oral
drugs when they have been competency assessed (see section 6) prior to independent
administration of medicines.

If using EPR you will be required to attend classroom training, read the Quick Reference
Guide (QRG) and watch the video for gold standard medication administration prior to
administering medications on EPR.

7.1 Oral cytotoxic agents for non-cancer indications e.g. methotrexate and
cyclophosphamide
If a patient is admitted to a ward and found to be on oral cytotoxic agents the team
responsible for initially prescribing the agent must be contacted.

If the team is happy for the patient to continue on the prescribed drug then, after consultation
with pharmacy, this can then be prescribed on the standard drug chart / EPR.

Nursing staff can administer these drugs only once they have completed the relevant section
of the drug administration workbook and passed the competency assessment. These
medicines must be double checked / signed by 2 registrants who have completed the above
workbook and the details recorded in the oral cytotoxic record book which should be
available on all wards.

There is a guide/checklist for administering oral cytotoxic drugs that should be completed
and kept in the patient nursing notes; this is available on Freenet and in appendix 2. This
provides further guidance and advice on safe handling of oral cytotoxic agents.

Covert administration of medicines

As a general principle, by disguising medication in food or drink, the patient or client is being
led to believe they are not receiving medication, when in fact they are. The NMC would not
consider this to be good practice. The registrant would need to be sure what they are doing

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is in the best interests of the patients, and that they are accountable for this decision.
Please refer to the Covert Administration of Medicines section of the Medicines Policy for
further detail and information.

8. Information on oral drug preparations

There are many different types of dosage forms and various different drug formulations and
preparations. Dosage form is a form of drug delivery such as tablets, capsules, sprays, etc.
By altering the physical/chemical and biopharmaceutical/pharmacokinetic properties of the
dosage form, different types of drug formulations can be manufactured.

The following page shows the different types of oral dosage forms and their various drug
formulations available. The tables on the following pages describe the types of oral dosage
forms and the various formulations and give rationale for their uses, with some examples.

Types of oral medications

8.1 Tablets
 Plain/Regular tablets (8.1.1)
 Effervescent / water-soluble tablets (8.1.2)
 Orodispersible tablets (8.1.3)
 Chewable tablets (8.1.4)
 Lozenges (compressed tablets) (8.1.5)
 Coated tablets (8.1.6)
 Buccal tablets (8.1.7)
 Sublingual tablets (8.1.8)
 Modified release tablets (8.1.9)
8.2 Capsules
 Plain/regular capsules (8.2.1)
 Modified release capsules (8.2.2)
8.3 Liquids (solutions and suspensions)
 Aqueous solutions (8.3.1)
 Elixirs (8.3.2)
 Linctus’s (8.3.3)
 Suspensions (8.3.4)
 Mouthwashes and gargles (8.3.5)
8.4 Oral powders
 Bulk powders (8.4.1)
 Divided powders (8.4.2)
 Powders for oral liquids (8.4.3)
8.5 Granules
 Bulk granules (8.5.1)
 Divided granules (8.5.2)
8.6 Oral sprays

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 8.1 Tablets
 Tablets are the most common oral dosage form for adult patients
 Pharmaceutical tablets are drug particles or powder compressed with tablet fillers.
 There are many different types of tablet formulations available.
 Tablets can be split to give half or quarter the dose provided the tablet is scored, as the
tablet is a uniform final product.
Section Drug Descriptions and uses Examples
formulations
8.1.1 Plain / regular Most tablets are plain – i.e. drug Bisoprolol
tablets compressed with fillers to form Thiamine
the tablets. These are the Paracetamol
cheapest and easiest to make as
they are not modified or specially
formulated to give them any
special characteristics. They
disintegrate quickly in the gastric
fluid, rapidly releasing the drug
8.1.2 Effervescent / To be dissolved in water before Sando K - soluble oral
water-soluble administration. potassium tablets
tablets Use a small amount of drinking Solvazinc - soluble zinc
water and gently swirl around to tablets
ensure the tablet is properly Aspirin soluble tablets
dissolved. Paracetamol soluble tablets
Each tablet is a defined dose
therefore provides an accurate,
easy to administer dose.
An alternative to liquid
preparations.
8.1.3 Orodispersible New approach to drug delivery – Zoton (lansoprazole)
tablets is more expensive compared to Fastabs
the conventional formulations Zyprexa (olanzapine)
e.g. effervescent / water-soluble velotabs
tablets or chewable tablets.
To be dissolved in the mouth
(sucked) and then swallowed.
Often flavoured and sweetened
making them an attractive option
for patients who have difficulty
swallowing whole
tablets/capsules.
Swallowing reflex must be
present to use these tablets.
8.1.4 Chewable Effective alternative for patients Calcichew tablets
tablets who have difficulty in swallowing Gaviscon tablets
whole large tablets or capsules.
Easy to transport and can be
taken without water.
Often flavoured to make them
more palatable.
8.1.5 Lozenges To be sucked, allowing them to Amphotericin lozenge
(compressed dissolve in the mouth. Nystatin lozenges
tablets) Produce a local effect in the
mouth or throat.

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 8.1.6 Coated tablets Three types of coating exist:
Enteric Coated (EC) tablets - to
protect the stomach from coming
into contact with the drug, (to
reduce the irritant effect of the
drug on the stomach) or to
prevent the drug from being
inactivated by the gastric acid in
the stomach.
Film coated (FC) tablets – to
prevent contact with the active
ingredient during normal handling
to reduce exposure to the active
ingredient.
Sugar coated (SC) tablets are
coated in sugar, often to make
them more palatable or to mask
odours
8.1.7 Buccal tablets Tablets to be dissolved between
the upper lip and gum.
Drug is absorbed via the oral
mucosa directly into the blood
stream producing an immediate
effect.
8.1.8 Sublingual Tablets to be placed under the
tablets tongue to allow them to slowly
dissolve.
The drug is absorbed via the oral
mucosa directly into the blood
stream producing an immediate
effect.
8.1.9 Modified Preparations are produced either
release tablets to prolong the release pattern of
the drug to reduce the frequency
of administration or altered to
target specific sites in the gut.
Various names refer to altering
the release pattern of a drug,
depending on how the tablet is
formulated. See examples.
Oral drug administration guideline; 2019 version 6
Prednisolone (EC) tablets
Aspirin (EC) tablets
Pantoprazole (EC) tablets
Proscar (Finasteride)
(FC) can cause teratogenic
effects
Metformin (FC) tablets
Ferrous sulphate (SC)
tablets
Buccastem
(prochlorperazine) tablets
Suscard (glyceryl trinitrate)
tablets
Glyceryl trinitrate tablets
Slow K (potassium)
sustained release (SR)
tablets
Adalat (nifedipine) retard
tablets
Adalat (nifedipine) long
acting (LA) tablets
Isosorbide mononitrate
modified release (MR)
tablets
Morphine Sulphate tablets
M/R (MST)
Oxycodone M/R tablets
(Oxycontin)
Page 11 of 26
 8.1.10 Transmucosal Absorption of the drug through Fentanyl lozenge. In this
lozenges the oral mucosa case the lozenge should be
The drug is absorbed rapidly into rolled in the inside of the
the blood stream producing an cheeks, rather than sucked
immediate effect
Usually used for analgesics

8.2 Capsules
 Capsules are drugs encapsulated in a gelatine capsule with other inert fillers e.g.
lactose.
 Capsules provide an alternative method of drug delivery.
 Patients often prefer capsules as they find these easier to swallow compared to tablets.
Section Drug Descriptions and uses Examples
formulations
8.2.1 Plain/regular Drugs encapsulated in a gelatine Zoton (lansoprazole)
capsules capsule, sometimes with other capsules
inert fillers. Cymevene (ganciclovir)
Some drugs are light sensitive, capsules
so the gelatine capsule protects Nifedipine capsules
the drug from light.
8.2.2 Modified Preparations are produced either Persantin (dipyridamole)
Release to prolong the release pattern of modified release (MR)
capsules the drug to reduce the frequency 200mg capsules
of administration or altered to Tildiem (diltiazem) long
target specific sites in the gut. acting (LA) capsules
Various names refer to altering Adizem (diltiazem)
the release pattern of a drug, sustained release (SR)
depending on how the capsule is capsules
formulated. See examples. Efexor (venlafaxine)
extended release (XL)
capsules
Dipentum (olsalazine)
capsules – altered release
with the desired aim to
deliver a high local
concentration of the drug to
the colon.

8.3 Liquids (solutions and suspensions)

 Liquid preparations are used in situations where solid dose forms e.g. tablets or
capsules cannot be swallowed but these are usually a more expensive alternative. This
is the most common form of drug used for infants and children.
 Doses should be prepared using an oral syringe to accurately measure the volume
required. The dose should then be emptied into a medicine pot for adult patients to
swallow, but is commonly left in the syringe to be administered to infants and children,
slowly and in stages. The medicine should never be left unattended in the syringe as
there have been documented incidents where oral drugs in syringes have been
mistaken for IV medication (see enteral syringe section 9).
 In cases where drugs are administered via a dropper directly into the mouth, a separate
bottle and dropper should be used for each patient.
Section Drug Descriptions and uses Examples
formulations
8.3.1 Aqueous Aqueous solutions are drugs Amitriptyline oral solution
solutions dissolved in water and specially Chlorpheniramine oral

Oral drug administration guideline; 2019 version 6 Page 12 of 26

 prepared to remove solution
contaminations e.g. bacteria Risperdal (risperidone)
Often water-based and liquid
sweetened and flavoured to Prozac (fluoxetine) liquid
make them more palatable.
Many solutions are called liquids,
which describes the preparation
but it is not strictly a drug
formulation.
8.3.2 Elixirs Elixir refers strictly to a solution Digoxin Elixir
of a potent or nauseous drug but Phenobarbital Elixir
the terminology is often confused
with the term mixtures. They
often have a high content of
sucrose and ethanol
Some elixirs need to be
reconstituted before use. Please
refer to section 8.4.3 for more
information.
8.3.3 Linctuses Linctus is a viscous preparation Codeine linctus
/Syrups usually prescribed for cough.
Usually consists of a simple
solution of active drug ingredient
in a high concentration of
sucrose often with other
sweetening agents.
Linctuses should be sipped
slowly and not be diluted
beforehand.
8.3.4 Suspensions Insoluble drugs are suspended in Diazepam suspension
a carrier to form a suspension so Ibuprofen suspension
all suspensions should be Co-amoxiclav suspension
vigorously shaken to ensure the Fluconazole suspension
drug is redistributed evenly
throughout before administering.
Some suspensions, like elixirs
need to be reconstituted. Please
refer to section 8.4.3 for more
information.
8.3.5 Drops Oral drops are prepared to Dalivit drops
administer a small quantity of Citalopram drops
liquid. A dropper is usually
provided to aid administration
8.3.6 Mouthwashes These are used to rinse the Chlorhexidine
mouth, used for their local Difflam
effects. Mouthwashes should be Nystatin
gargled or swirled around the
mouth.
Some mouthwashes must be
diluted with water before use
Most mouthwashes are then spat
out after use (e.g. chlorhexidine)
however, some may need to be
swallowed (e.g. nystatin)

Oral drug administration guideline; 2019 version 6 Page 13 of 26

 therefore manufacturers’
guidance must be followed.

8.4 Oral powders

 Oral powders are drug mixed with other ingredients (depending on the use) to produce
the final product.
Section Drug Descriptions and uses Examples
formulations
8.4.1 Bulk powders The mixed ingredients are Pancreatin (Pancrex V)
packed into a suitable bulk powder
container such as a wide Betaine oral powder (for
mouthed glass jar. treatment of
The constituents are usually homocystinuria)
relatively non-toxic.
Very few products exist in this
form.
8.4.2 Divided Divided powders are similar Questran -
powders formulations to bulk powders but cholestyramine
individual doses are separately Movicol - macrogol (plus
packed. some electrolytes)
Most divided powders should be
mixed with water before
administration.
Divided powders are portable
and have a longer shelf life
compared to liquids.
8.4.3 For oral liquids Many antibiotics are physically or Floxapen (flucloxacillin)
(Solutions and chemically unstable when elixir
suspensions) formulated into solutions or Augmentin (co-
suspensions therefore the amoxyclav) suspensions
preparation is manufactured as a Diflucan (fluconazole)
dry powder. When required for suspension
use, the dry powder must be
reconstituted with a stated / given
quantity of water prior to use.
(Once reconstituted, they have a
short shelf life).

8.5 Granules
 Granules consist of powder particles aggregated to form larger particles.
Section Drug Descriptions and uses Examples
formulations
8.5.1 Bulk Bulk granules contain similar Normocol - sterculia
ingredients as powders i.e. those Ispagel - ispaghula husk
with a relatively large dose. Pancrexgranules
Oral granules can either be pancreatin BP
washed down with plenty of liquid
without chewing or mixed with
liquid (water or juice) and
swallowed immediately.
Many bulk-forming laxatives are
granules. Some bulk granules
are flavoured (e.g. Normacol)
making them more palatable.

Oral drug administration guideline; 2019 version 6 Page 14 of 26

 Bulk granules cannot be
dissolved in water so check
manufacturers’ recommendations
before use.
8.5.2 Divided There are granulated products in Fybogel - ispaghula husk
which sufficient for one dose is Colestid - colestipol
individually wrapped.
Effervescent granules can be
formulated and presented in this
manner (e.g. Fybogel)

8.6 Oral sprays

 Drug is available as a sublingual or oral spray.
Section Drug Descriptions and uses Examples
formulations
8.6.1 Oral Sprays Drug is available as an oral Glyceryl trinitrate (GTN)
spray, which allows very rapid spray
effect from oral mucosal Difflam (benzydamine)
absorption. spray
Easy to transport.
Generally oral sprays have a
longer shelf life than sublingual
or buccal tablets.

9. Use of syringes when measuring oral medicines

The national patient safety agency (NPSA) issued safer practice recommendations on how
to safely measure and administer oral and enteral liquid medicines: For administration of
enteral medicines, refer to the enteral drug administration guideline.
 Syringes are commonly used for infants and children. An appropriate oral/enteral
syringe should be used to measure oral liquid medicine if a medicine spoon or
graduated measure cannot be used. Regarding oral/enteral syringes and low dose
syringes available for neonates/small children see: http://stayconnected.org/wp-
content/uploads/2016/04/GEDSA-Low-Dose-Syringe-End-User-LDT-Preso-
FINAL.pdf
 Oral/enteral syringes are colour coded purple, are labelled ‘ORAL/ENTERAL’ in
bold type, they are all sterile and single use only.
 The female luer lock syringe is available in several sizes from 1ml to 50ml. This
syringe can be used to administer oral liquid medicines. The catheter tip syringe
comes in a 50 ml size only.
 Do not use intravenous syringes to measure and administer oral liquid
medicines
 Only well labelled ‘ORAL/ENTERAL’ oral/enteral syringes that do not allow
connection to intravenous catheter or port should be used
 In this Trust medicines must never be left unattended, however the NPSA advised
that, any enteral syringe with liquid medication in it that may need to be left
unattended for any length of time, must be labelled with the drug name, dos e, data
and time of preparation and nurses’ signature. Syringes of medicine must not be left
unattended in paediatric and neonatal clinical areas in any circumstances.
 Remember to write the date the bottle was opened and the expiry date on the bottle

Alert: If your patient has a degree of dysphagia and you are using a syringe to give them
medication orally, make sure you follow the Speech and Language Therapist’s guidelines.

Oral drug administration guideline; 2019 version 6 Page 15 of 26

Reference: NPSA 19 guidance Promoting safer measurement and administration of liquid
medicines via oral and other enteral routes.

10. General points

 If a member of staff is unfamiliar with a drug, it is important to read the

manufacturer’s instructions and other information available e.g. BNF/BNFC, local
formulary before administration.
 The timing of administration of some drugs can affect compliance or effectiveness of
the drug e.g. loop diuretics (furosemide or bumetanide) should be avoided at night as
can cause nocturnal diuresis; simvastatin should be given at night for maximum
effectiveness.
 Registrants should observe the administration of all drugs and sign the prescription
chart when administration is completed. Drugs should not be left at the bedside for
patients who are not present as this may lead to drugs being forgotten or taken by
the wrong patient.
 Food can also protect the stomach from drugs that irritate the gastric mucosa e.g.
aspirin, prednisolone, ibuprofen should be taken with food.
 Drugs that interact with food or are destroyed by digestive enzymes should be given
between meals or on an empty stomach.
 Do not break a tablet unless it is scored and appropriate to do so. Break scored
tablets with a file or tablet cutter and wash the cutter after use.
 Advice should be sought from pharmacy prior to crushing any tablets. If crushing is
advised, appropriate equipment should be used and be thoroughly cleaned between
each medicine crushed.
 Do not interfere with time release capsules and enteric coated tablets. Ask patients
to swallow these whole and not to chew them.
 Sublingual tablets must be placed under the tongue and buccal tablets between the
gum and cheek.
 When administering gargling medication, throat irrigations should not be warmer than
body temperature.
 Caution should be taken when converting tablets or capsules to liquid preparations,
advice must always be sought from pharmacy; for example: preparations containing
phenytoin sodium are not bioequivalent to those containing phenytoin (such as
Epanutin infatabs and phenytoin suspension); 100 mg of phenytoin sodium is
approximately equivalent in therapeutic effect to 92mg phenytoin. The dose is the
same for all phenytoin products when initiating therapy, however if switching between
these products the difference in phenytoin content may be clinically significant BNF
(P399)
 There are also some medicines that should never be missed/omitted unless
specified by a doctor; the following is a summary produced by the medicines safety
committee (Sept 2018):


Oral drug administration guideline; 2019 version 6 Page 16 of 26

11. Administration procedure

Equipment required:
 Current and valid prescription chart (paper or electronic)
 Current and valid smart card & access
NB only staff who have been trained and have passed the electronic administration
eLearning package may administer via EPMA
 Pen (for paper charts)
 Administration equipment (where applicable)
o Disposable medicine pots (plastic or paper)
o Tablet splitters
o Tablet crushers
o Oral syringes
o Quill
 Drugs required
 Glass of water
 Supporting literature e.g. British National Formulary

Pre-administration considerations (Marsden manual 2015):

Before administering any oral medication the nurse should assess for:
 The patient’s ability to understand the medication being administered
 Any medication allergies or hypersensitivities
 Nil by mouth status
 Patient’s ability to swallow the medication
 Patients cough and gag reflexes
 Contraindications to oral medicines including nausea and vomiting, absence of bowel
sounds/reduced peristalsis, nasogastric suctioning or any circumstance affecting
bowel motility e.g. surgery
 The possibility of drug-drug or food-drug interactions
 Any pre-assessment for specific medication e.g. pulse or blood pressure checks

With infants and children the nurse or midwife should work closely with the family to
establish the best time and approach to use to administer the medication, play specialists
can also be involved to alleviate the child’s anxieties regarding receiving medication.

Action Rationale
NB if a controlled drug is to be given, ensure correct procedures are followed. Refer
to other associated policies / documents listed in the validation grid.
Check the prescription: (paper / electronic) To comply with RFH Medicines Policy
 Correct patient name, hospital number,
date of birth If any of these pieces of information are
 Patients weight is stated / available missing are unclear or illegible then the
 Is legible nurse should not proceed with administration
 Is written and signed and dated by the and should consult with the prescriber
prescribing doctor (legibly)
 Uses the approved name of the drug NB: With electronic prescribing staff also
 States the date and time of prescription must take additional care to ensure the
prescription is valid e.g. dose, time
 States an appropriate dose, frequency
and route of therapy frequency etc.
 States any diluent if required
Staff should review the electronic drug chart
as a whole before administering any
medications via the medicines administration

Oral drug administration guideline; 2019 version 6 Page 17 of 26

 screen. This will ensure all special
instructions are visible and highlight any
previous dose administrations or omissions.
Accessing electronic medicines
administration on Cerner:
 Open Cerner and log-in/use smart card
 Access PowerChart,
 Access your specific clinical area
 Identify the patient you wish to
administer medicines to
 Click on the patients name
 Click on the medication administration
button on the toolbar
 The medication administration screen
will pop up.
Scanning the patient’s wristband will ensure
 Scan the patient ID band (If you are
only the medications for that patient will
unable to scan the wristband click the
display within the medication administration
next button).
window.
 If the next button was clicked an
Override reason box will pop up, select a
reason from the drop down choices then
click Yes
Check for any known drug allergies. To prevent administration of inappropriate
Ask the patient as well as checking relevant drugs.
paper or electronic documentation and
notes.
Select the correct medication. The expiry date indicates when a drug is
Check the expiry date of the selected drug. deemed no longer pharmacologically
 Electronic administration only: Scan efficacious.
the bar code of the medication box, this
will place a tick in the checkbox to the Scanning the medication will ensure the right
left of the medication. drug, route, dose and formulation are given
Note: If you are unable to scan the to the right patient at the right time.
medication box, click the checkbox next
to the medication
 Select reason from the drop down
options and click yes.
Note: If the dose strength of the
medication box e.g. 100mg and the
required dose is 200mg, the bar code on
the medication must be scanned twice
Check the drug has not already been To prevent double dosing or overdosing.
administered (including the “as required” If a ‘dose too close’ alert is fired on EPR,
section of the paper / electronic chart). check the drug chart and read the
prescription and administration times
carefully. If the same drug is prescribed at a
different dose on two different prescriptions
this alert may need to be overridden. Use
your clinical judgment to determine whether
the next dose is safe to be administered at
this time.
Check the time is appropriate for the drug To ensure maximum absorption.
e.g. should the drug be given with food or on
empty stomach.

Oral drug administration guideline; 2019 version 6 Page 18 of 26

Wash hands.
Without touching the drug, empty the
required dose into a clean medicine
container.
If a liquid medicine is used then assess
whether a graduated medicine cup, a
medicine spoon or an oral/enteral syringe
would be best to measure the correct dose.
If the liquid medicine is drawn up in an
oral/enteral syringe, then use a quill to reach
the liquid, administer the medicine as soon
as you draw it up, and discard the syringe
after use.
NB: NEVER leave a quill in the medicine
bottle always use a new quill for each
administration
If you are measuring a medication less than
1ml in volume, then you must use an
appropriate size female luer lock oral/enteral
syringe.
 Take the drug and the prescription chart
to the patient. If using EPR wheel the
workstation on wheels (WOW) to the
patient bedside
 Check the patient’s identity: Ask the
patient their name or check with the
parent/guardian
 Ask the patient their date of birth or
check with the parent/guardian
 Check these details and the patient’s
hospital number match the patients ID
band and paper / electronic prescription
 Check any allergies with the patient or
check with the parent guardian
Evaluate the patient’s understanding and
knowledge of the drug to be given, what it is
for and any likely side effects.
Ensure patient knows how to take drug e.g.
swallow unscored tablets whole.
Supervise infants, children & any patient
where compliance with treatment may be an
issue.
Assist patient as appropriate i.e. sitting
position to administer the drug via the
prescribed route providing appropriate drink
Oral drug administration guideline; 2019 version 6
To prevent cross infection.
To prevent cross infection and protect the
nurses/midwife from exposure (& possible
absorption) of the active ingredient.
To ensure the correct dose of medication is
measured in a convenient way that is easy
for the patient to take.
If a syringe used to measure medicines, it
should be an oral/enteral syringe (NPSA
SPN 19 2007). Medication in an oral /
enteral syringe should be administered
immediately and should not leave the hand
of the person who has drawn it up.
Using a quill prevents medication wastage.
Never leave a syringe full of medication
unattended in case it is administered
inappropriately or tampered with (NPSA
SPN 19 2007).
All syringes & quills are single use and must
not be re-used.
Do not use a catheter tip oral/enteral syringe
as you will lose 0.2ml of the medication in
the tip.
To ensure the patient receives the correct
drug.
For positive patient identification
NB scanning an ID band does not remove
the requirement to follow correct patient
identification procedures as in the patient
identification policy
To ensure patient has information of risks &
benefits regarding treatment and therefore
giving informed consent and that the drug
will be taken correctly.
Offer explanations where patient’s lack
relevant knowledge.
To ensure medicine has been taken to
ensure efficacy.
To ensure the drug is taken to maximise
effectiveness and minimum adverse effects.
Page 19 of 26
if required.
In infants and children apply therapeutic
holding, only if required and according to
recommended guidelines (RCN, 2010).
Ensure the family are fully engaged and
involved in administering the drug and utilise
the play specialists in alleviating the child’s
fears.
Stay with the patient until the drug has been
taken.
If your patient has a degree of dysphagia
and you are using a syringe to give them
medication orally, make sure you follow the
speech and language therapist’s guidelines.
Record the administration by annotating the
prescription chart (paper or electronic) as
appropriate for each dose.
When a drug is taken, nurses should initial
paper prescription chart with his/her initials
or click “sign” in the electronic record to
confirm administration has occurred.
Check the entries in every section of the
prescription chart during each drug round.
If a drug is not administered at the correct
time, record the reason on the prescription
chart (paper or electronic) by the appropriate
number in the nurse administration box and
initial (paper) or using the drop down
selection for electronic:
1. Patient away from ward
2. Patient unable to receive drug e.g. NBM,
vomiting
3. Patient refused
4. Drug not available (check emergency
drug cupboard & on call pharmacist)*
5. Other document in nursing notes.
Appropriate staff should be informed.
Any unused drug should be disposed of
safely.
Any adverse effect should be documented
and promptly reported to the medical staff.
Complete a clinical incident form (Datix) &
report (if appropriate) to MHRA (Medicines &
Healthcare products Regulatory Agency)
using Yellow Card in BNF or
online:www.yellowcard.gov.uk
Note any relevant details in the nursing
Oral drug administration guideline; 2019 version 6
To alleviate the patients fears and optimise
the chances of successful administration of
the medicine.
To ensure the patient takes the drug on time
Patients with dysphagia have varied
individual needs when syringes are used to
place fluids into the patients’ mouth.
Following SLT guidelines will prevent
aspiration of medication.
To meet legal requirements.
For accurate documentation.
To avoid drug treatment omissions.
Maintain record and prevent potential
problems caused by omission.
*every effort should be made to ensure
medicines should be obtained from
pharmacy in hours/emergency drug
cupboard out of hours
NB with EPMA it is essential to record a
reason for any medicine not administered
otherwise “pop ups” will continue indefinitely
requesting a reason until this is documented.
Prevent contamination of other medicines.
Medicines that are prepared but not
subsequently administered to the patient
must be disposed by placing into the “plastic
sharp’s bin container”. This can be identified
by having a yellow lid and body. See Trust
waste policy for more details.
Provide any treatment required and prevent
recurrence.
Unrecognised hazards are identified
promptly and appropriate regulatory action is
taken to ensure that medicines are used
safely.
Maintain on-going evaluation and accurate
Page 20 of 26
record (paper or electronic). documentation.

You must make a clear, accurate and

immediate record of all medicine
administered, intentionally withheld or
refused by the patient, ensuring the
signature is clear & legible (NMC 2018).

12. Risk assessment

An NMC registrant can only oral administer drugs to patients after the manager deems
him/her competent, and is aware of the responsibility and accountability.

If at any time a NMC registrant is not confident or is uncertain about the administration of
any drugs, they must consult the ward charge/senior nurse, practice educator a pharmacist
or the prescriber, as the person administering the drugs is accountable for all drugs given.

In the event that a drug administration error or near miss occurs, a Datix incident report must
be completed. The error/near miss must be discussed with the charge/senior nurse on the
ward immediately to assess the consequences to the patient. It is recommended that the
nurse/midwife involved in the incident complete Datix themselves, as this may contribute
towards refection and learning from the incident.

12.1 Infants and children: special considerations

Off-label and unlicensed use of medicines is common and necessary with infants and
children due to the ethical considerations in carrying out clinical trials in children (WHO,
2007; RCPCH, 2013). Licensed medicines should be used where possible and the BNFC
should be used routinely to ensure safe drug administration.

Varying drug doses and volumes are given in infants and children titrated to actual weight,
ideal weight, surface area or banded by age. This is just one reason why infants and
children are exposed to up to three times as many potential drug errors as adults (WHO,
2007). Nurses and midwives should double-check drugs with a more senior and
experienced colleague if in doubt.

Drug abuse in the teenage population occurs with both non-medical use of legal medicines
and illegal drugs and nurses play a role in developing relationships where disclosure of drug-
taking is encouraged to promote medicines safety and avoid overdose and unforeseen drug
interactions.

Therapeutic holding (RCN, 2010) may be necessary in the younger population who are
unable to give informed consent. Involving the parents in this is essential so that consent is
ongoing at all stages and they can improve co-operation with the procedure. Play specialists
can also play an important role in relieving child anxiety in this drug administration.

13. Patient information

“Patient Information leaflets (PILs)” should be supplied for all medicines dispensed against
prescriptions for patients to take away (TTA). If a patient requests further information, these
can either be obtained from the pharmacy department or the manufacturer of the drug.

Oral drug administration guideline; 2019 version 6 Page 21 of 26

Medicines for children (2015) is a partnership of three national organisations who use expert
guidance to provide accurate and user-friendly medicines information leaflets for parents and
carers which may be of use to nurses and midwives administering drugs to children.

14. Audit

An audit should be conducted on administration of drugs at ward level at least once every 2
years to ensure drugs are given correctly. The audit should address whether basic
documentation requirements have been met. For example:
 Is there a current and valid prescription chart? (paper or electronic)
 Has the allergy box been completed and reaction documented on the
paper/electronic drug chart?
 Is the ID band (name, DOB, hospital number; NHS number) checked before
administration of drug/s to each patient?
 Is the expiry date checked for each drug administered?
 Are the drugs prescribed given at times indicated on the drug chart?
 Are the drugs given according to the recommendations stated on the drug chart?
(Example - with food, dissolved in water etc).
 Has the registered nurse/midwife signed on the drug chart (paper or electronic)
against each drug administered?
 If a drug was not administered, was this noted on the drug paper or electronic chart?

Further information about auditing is outlined in the Medicines Policy

15. References

 Bray, Lucy, Snodin, Jill and Carter, Bernie (2014) Holding and restraining children for
clinical procedures within an acute care setting: an ethical consideration of the
evidence. Nursing Inquiry, 22 (2). pp. 157-167
 Dougherty, L and Lister, S (Eds.) (2015). The Royal Marsden Manual of Clinical
Nursing Procedures, Professional Edition, 9th Edition
 Duthie Report (2005) The Safe and Secure Handling of Medicines Hopkins. S J
(1995) Drugs and Pharmacology for Nurses - 12th Ed. Churchill Livingstone
 Kisiel, M Perkins C (2006) Nursing observations: knowledge to help prevent critical
illness British journal of nursing 15(19) 1052-1056
 Medicines for children (2016) Medicines for children [Online]
http://www.medicinesforchildren.org.uk/ [Accessed on 8th February 2016]
 National Institute for Clinical Evidence (NICE)(2007) Acutely ill patients in hospital.
NICE clinical guideline 50.
 National patient safety agency (NPSA) 19 guidance Promoting safer measurement
and administration of liquid medicines via oral and other enteral routes
 Nursing and Midwifery Council (NMC) (2015) The Code: Professional Standards of
Practice and Behaviour for Nurses and Midwives. NMC, London
 Pharmaguidelines.com. Different types of oral dosage form
 Royal College of Nursing (RCN) (2010) Restrictive physical intervention and
therapeutic holding for children and young people: Guidance for nursing staff RCN,
London
 Royal College of Paediatrics and Child Health (RCPCH)(2013) The use of unlicensed
medicines or licensed medicines for unlicensed applications in paediatric practice
RCPCH, London
 Royal Free London NHS Trust Medicines Policy

Oral drug administration guideline; 2019 version 6 Page 22 of 26

  Royal Pharmaceutical Society (2018) Professional guidance on the safe and secure
handling of medicines available at: https://www.rpharms.com/recognition/setting-
professional-standards/safe-and-secure-handling-of-medicines/professional-
guidance-on-the-safe-and-secure-handling-of-medicinesWorld Health Organization
(WHO)(2007) Promoting safety of medicines for children WHO

Oral drug administration guideline; 2019 version 6 Page 23 of 26

Appendix 1: Royal Free London NHS Foundation Trust Equality Analysis
Name of the policy / function / service Oral Drug administration guidelines
development being assessed
Briefly describe its aims and objectives:  These guidelines aim to standardise practice across all trust sites and to ensure the prescribed drug is
given to the intended patient via the oral route at the most appropriate time by competent staff, to achieve
maximum absorption for maximum efficacy with minimal adverse effects and interactions.
 Its objectives are to provide equitable care across the trust for all patients requiring oral drugs and provide
a resource for all staff involved in the procedure.
 The policy promotes principles of good care and safety for all groups and aims to promote patient safety.
Directorate and Lead: Naomi Walsh Corporate nursing & Pharmacy department
Evidence sources: DH, legislation. JSNA, audits, See section 15
patient and staff feedback
Is the Trust Equality Statement present? Yes
Equality Group Identify negative What evidence, How will you Identifies who will Please list positive impacts and
impacts engagement or address the issues lead the work for existing support structures
audit has been identified? the changes
used? required and
when?
Age Possible negative Procedural clinical The trust has Senior nursing & Each patient is assessed on
impact; understanding guideline based on support structures in pharmacy leads in admission for their communication
would have been national best place to support association with the needs. Assessment takes into
previously assessed and practice – see communication & guideline author account the patient’s physical and
appropriately supported reference list physical access communicated sensory status.
Disability Possible negative needs of patients. through the nursing
impact; understanding guidelines group It is essential patients understand
would have been Should any their treatment and patients/relatives
previously assessed and additional issues who do not speak English as a first
appropriately supported arise where none language or who have specific
Gender None identified have been identified, communication needs are offered the
reassignment the clinical lead will support of an interpreter/advocate or
Marriage and civil None identified respond to ensure communication aide to explain the
partnership appropriate access process, facilitate understanding,
Pregnancy and None identified & support cooperation, gain consent and the
maternity implications of taking/not taking
Race Possible negative medications and be able ask
impact; understanding appropriate questions and is
would have been comfortable with receiving treatment

Oral drug administration guideline; 2019 version 6 Page 24 of 26

Equality Group Identify negative
impacts
previously assessed and
appropriately supported
Religion or belief A patient may have
preferences in relation to
their cultural, spiritual or
religious beliefs and
customs. Possible
negative impact;
understanding would
have been previously
assessed and
appropriately supported
Sex None identified
Sexual orientation None identified
Carers Some carers may wish
to support the patient
with taking their
medicines, therefore
possible negative
impact; understanding
would have been
assessed and
appropriately supported
What evidence, How will you Identifies who will Please list positive impacts and
engagement or address the issues lead the work for existing support structures
audit has been identified? the changes
used? required and
when?
Procedural clinical The trust has Senior nursing & in this manner in the future.
guideline based on support structures in pharmacy leads in
national best place to support association with the Language and advocacy support is
practice – see communication & guideline author covered within the trust policies for
reference list physical access communicated PALS and interpreting services.
needs of patients through the nursing
guidelines group Staff are made aware of the need for
Should any good communication for all nursing
additional issues interventions as part of induction and
arise where none on-going training in the Trust.
have been identified,
the clinical lead will Patient preferences, religious,
respond to ensure spiritual and cultural beliefs/customs
appropriate access are observed and recorded as part of
& support a comprehensive admission
assessment.
This aspect of training is covered as
part of the corporate and local
induction processes.

Equality Analysis completed by: Organisation Date

Naomi Walsh lead nurse practice development Royal Free London January 2019
Pharmacy: Helen Atkinson, Meera Thacker, Hannah Heales Royal Free London January 2019
Nursing guidelines group (approx. 30 members; register on request) Royal Free London Jan-Feb 2019
Drugs and Therapeutics committee Royal Free London 15 Feb 2019
Naomi Walsh on behalf of Equality and diversity operational manager Royal Free London January 2019

Oral drug administration guideline; 2019 version 6 Page 25 of 26

Appendix 2: Oral cytotoxic guidance for non *SACT trained nurses
Non chemotherapy trained nurses on general wards CAN administer oral cytotoxic drugs if
they have completed the medication administration workbook/competency assessment.
Please ensure that the guidance below is followed:
 Inform team that prescribed the oral cytotoxic agent (may be different to the admitting
team) that this patient is in and ensure that they have documented the oral cytotoxic
drug can continue as prescribed
 Contact ward pharmacist to inform them that the patient is on an oral cytotoxic
 Oral cytotoxics must be checked by 2 nurses who meet the above requirement.
 They must be recorded in the oral cytotoxic record book available in treatment room
on all wards.
 As with every medication you administer please first ensure you are aware of the
potential side effects caused by these medications.
 Please follow the health and safety advise below when handling and administrating
oral cytotoxics.
 Ensure that you have a purple lidded bin available in case of dropped/spilt doses.

Health and safety considerations when administering oral cytotoxic drugs

 If an oral dose is dropped, wear gloves to pick it up and dispose of it in a cytotoxic
waste bin with a purple lid.
 Damp dust the area with a wet paper towel to ensure all the fragments have been
collected.
 Dispose of the towel in a cytotoxic waste bin with a purple lid.
 Document lost dose in the patient’s healthcare record and on the prescription, as
appropriate
 Oral doses can be stored in a locked drug trolley, cupboard or refrigerator, as long as
they are clearly labelled as cytotoxic.

Oral anti-cancer medicines can be potentially hazardous if handled carelessly.

 Accidental exposure which may arise from handling uncoated tablets, loose capsules
or oral liquids should be minimised.
 Hands should be washed thoroughly after handling any oral anti-cancer medicine.
 In exceptional circumstances, if crushing of tablets or capsule opening is deemed
essential disposable gloves, apron, mask and protective eye wear must be worn.
Crushing should take place in a controlled area, using commercially available
devices that are specifically designed for this purpose. Care must be taken in
cleaning or disposing of such devices, which will contain fine powder of the oral anti-
cancer medicine.

Personal Protective Equipment (PPE) to be Used When Handling Cytotoxic Drugs.

It is important to ensure PPE offers adequate protection and is designed specifically for
handling cytotoxics. PPE with ‘CE’ marking (in accordance with Directive 93/68/EEC)
satisfies the essential requirements of the relevant European health, safety and
environmental protection legislation. The correct use of PPE can shield staff from exposure
to cytotoxic drugs and minimise the health risks but only if the following criteria are met, the
PPE is:
 Suitable for the task
 Suited to the wearer and the environment
 Compatible with other PPE in use
 In good condition
 Worn correctly
For further advice please email Nicola.macfarlane4@nhs.net Lead nurse for SACT or seek
advice from 11 East oncology ward or 2NA Oncology day unit.
*Systemic anti-cancer therapy

Oral drug administration guideline; 2019 version 6 Page 26 of 26