TRANSDERMAL PATCH CMAR/MAR before taking it to the pt.

This will be our third check to ensure

1. Gather equipment and check medical
accuracy and prevent errors. In some
record against the original order in the
facility they require third check at the
medical record to identify errors that
bedside table after identifying the pt.
have possibly occurred when the
10. Lock the medication chart before
ordered is transcribes. Clarify any
leaving it, this is to safeguard the pt’s
inconsistencies and check the pt for
medication and some accredited
allergies.
hospital requires this.
2. Know the action, special nursing
11. Transport the medication to the pat
consideration, safe dose ranges,
carefully and keep the medication in
purpose of administration and adverse
your sight at all times to prevent
effects of the medication, also check
accidental disarrangement of the
the appropriateness of it to the pt. This
medications.
will help us know the therapeutic effect
12. Ensure that the pt receives the
of the medication in relation to the pt
medication at the right time, check
disorder and also helps us in health
agency’s policy, if they allow
teaching.
administration 30 mins before or 30
3. Perform hand hygiene to deter the
mins after designated time.
spread of microorganisms.
13. Perform hand hygiene and put on PPE if
4. Move the medication cart outside or
required, to prevent spread of
prepare for administration in the
microorganism and ppe is required
medication are. Organization facilitates
based on transmission precautions.
error free administration and saves
14. Identify the patient, usually the pt can
time.
be identified in two methods, its either
5. Unlock the medication drawer or cart,
to check the name on the identification
enter passcode or scan employee id,
band [most reliable based on taylor’s]
some facilities require this system to
or let the pt state his/her name and
safeguard medications.
birthday or if the pt can’t tell
6. Prepare medication for one pt at a time
[sometimes pt is confused bcs they are
to prevent error.
sick], verify the pt identification with a
7. Read the CMAR/MAR (Computerized
staff member who knows the pt for 2nd
Medication Administration Record),
source [double check]. This will ensure
select the proper medication the
the right pt receives the right
medication drawer, this is the first
medication.
check of the label.
15. Complete necessary assessment before
8. Compare label with the CMAR/MAR.
administration and check if the pt have
Check expiry date and do calculations if
any allergies and explain the purpose of
needed, then scan the bar code of the
the medication. Assessment is a
package if needed. This is our second
prerequisite to administration of
label check, also verify the drug
medications.
calculation with other nurses to make
16. Scan the pt bar code in the
sure its correct.
identification band as this provides an
9. When all medications are prepared for
additional check to ensure that we are
one pt, recheck the label again on the
 giving the right medication to the right
pt.
17. Put on gloves, this protects the nurse
when doing transdermal patch.
18. Assess the pt skin when the patch is to
be placed, look for any signs of irritation
or breakdown because transdermal
patch is not placed on this area. Site
should be clean, dry and free of hair
because hair prevents the patch from
sticking to the skin. Rotate application
sites to reduce risk for skin irritation.
19. Remove any old transdermal patch
because leaving it while applying a new
one will deliver toxic level of the drug.
Fold the patch in half with the adhesive
sides sticking together to prevent
contact to the remaining medication,
discard according to facility policy.
Wash that are with soap and water to
remove all traces of medication.
20. Remove the patch from its protected
covering, initial and write the date and
time of administration on the label side
of the patch for easy identification of
application date and time.
21. Remove the covering of the patch
without touching the medication
surface because touching it may alter
the amount of medication on the patch.
Apply the patch to the pt’s skin and use
the palm of your hand to press firmly
for about 10 secs, to ensure that the
patch will stay on the pt skin. Do not
massage because this will increase
absorption of the medication.
INSTILLING EYE DROPS
18. offer tissue to the pt, this protects the nurse
from potential contact with mucous
membranes and body fluids.
19. clean the eyelids and eyelashes for any
drainage with wash cloth, cotton balls or gauze
squares moistened with NSS, debris can enter
the eye when the conjunctival sac is exposed.
Clean each side from inner canthus to outside
and repeat, this prevents debris from entering
lacrimal ducts.
20. Tilt the pt head slightly if sitting or place pt
head over a pillow if lying down, this will make
it easy for us to reach the conjunctival sac. Head
may be slightly turned to the affected side to
prevent the solution of tear from flowing
toward the opposite side.
21. remove the cap from the medication bottle,
be careful not to touch the inner side of the cap
to prevent contamination.
22. Invert mono drip plactic container that is
commonly used for instill eye drop and have the
pt look up and focus on something else, to
make the procedure less traumatic and keeps
eyes still.
23. Place thumb or 2 fingers near margin of
lower eyelid immediately below eyelashes,
exert pressure downward over the prominence
of the cheek. Lower the conjunctival sac is
exposed as lower eyelid is pulled down, cuz the
eye drop should be placed in the conjunctival
sac, not directly on the eyeball.
24. Hold the dropper close to eye, but avoid
touching eyelids or lashes, cuz this will
contaminate the medication. Squeeze the
container and allow prescribe number of drops
to fall in lower conjunctival sac. Startle the pt
will cause blinking or injure the eye, don’t let
the medication to fall ono cornea to prevent
injury or unpleasant sensation.
25. Release lower lid after eye drops are
instilled, and ask the pt to gently close eye to
allow medication to be distributed in the entire
eye.
26. Gently apply pressure over the inner
canthus to prevent eye drops flowing into tear
ducts, this minimizes the risk of systematic
effects of the medication.
27. instruct the pt not to rub eye to prevent
injury and irritation.
INSTILLING NOSE DROPS
18. Provide the pt with paper tissue and ask to
blow his nose to clear the nasal mucosa prior to
medication.
19. have pt sit up with head tilted or if lying
down , tilt head back over a pillow. This allow
the solution to flow well back into the nares. Do
not tilt the head if patient has a cervical spine
injury.
20. Draw sufficient solution into dropper for
both nares. Do not return excess solution to a
stock bottle. This increase risk for
contamination.
21. Ask the pt to breathe through the mouth,
this prevent aspiration of solution. Hold tip of
nose up and place dropper just above the naris,
about ½ inch. Instill the prescribed number of
drops. other. Protect dropper with a piece of
soft tubing if patient is an infant or young child
to prevent injury. Avoid touching naris with
dropper, this will cause the pt to sneeze and
contaminate the container.
22. Have patient remain in position with head
tilted back for a few minutes to prevent the
escape of medication.
INSTILLING EAR DROPS
18. Clean external ear for any drainage with
cotton balls or wash cloth with NSS because
drainage prevent medication from entering the
ear canal.
19. Place the pt on his or her unaffected side of
the bed, or if the pt is ambulatory ask pt to sit
up and tilted to the side so that the affected
side is uppermost , this prevents the solution to
escape.
20. Draw up amount of solution needed in the
dropper, do not return excess as this increase
the risk for contamination. A prepackaged,
mono drip plastic container may be used.
21. Straighten the auditory canal by pulling the
pinna up and back for adults and down and
back for children. Pulling the pinna can help
straightening the auditory canal for ear drop
instillation.
22. Hold dropper in the ear with its tip above
the auditory canal, so most medication will
enter the ear canal. Do not touch the dropper
to avoid contamination. ear. For an infant or an
irrational or confused patient, protect the
dropper with a piece of soft tubing to help
prevent injury to the ear since the hard tip can
damage the tympanic membrane once it is
jabbed into the ear.
23. allow the drops to fall on the side of the
canal, since it is uncomfortable if the drops will
fall directly to the ear canal.
24. release pinna after instilling ear drop, ask
the main to stay in that position for some
minutes since the medication should stay at the
ear canal for atleast 5 minutes.
25. gently press the tragus a few times to let the
medication move toward the tympanic
membrane.
26. if ordered, loosely insert a cotton ball into
the ear canal to prevent the medication from
leaking out.
27. remove gloves, assist the pt in a
comfortable position to ensure pt comfort.
28. Remove PPE if used, perform hand hygiene,
to reduce risk for infection transmission and
contamination, and prevent the spread of
microorganism.
29. Document the administration of the
medication immediately after administration, to
ensure pt safety.

30. Evaluate the pt response with the

medication within appropriate time frame, to
see therapeutic and adverse effect of the
medication.