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This article, the second in a two-part series, provides an overview of the principles of medicines administration and a guide to the administration via the oral route; it was originally an early online publication and was updated on 22/06/2020
The administration of medicines can be a complex and time-consuming procedure that requires knowledge of the medicine being administered and its intended therapeutic effect. This second article in a two-part series outlines the principles of medicine administration and the procedure for doing so using the oral route. Part 1 provided an overview of the routes of administration.
Citation: Shepherd M, Shepherd E (2020) Medicines administration 2: procedure for administration of oral medicines. Nursing Times [online]; 116: 7, 42-44..
Authors: Martin Shepherd is clinical director of pharmacy and therapy, Chesterfield Royal Hospital NHS Foundation Trust; Eileen Shepherd is clinical editor, Nursing Times.
The administration of medicines is one of the most common procedures nurses undertake and the process is often complex and time consuming. Organisations will have their own policies and procedures that govern the administration of medicines and nurses should be familiar with these; staff who administer medicines should receive appropriate training and have a competency assessment before carrying out the procedure.
The administration of prescribed medicines can be carried out by any suitably trained and competent member of staff in health or social care. Registered health professionals, such as nurses and doctors, are accountable for tasks they delegate to non-registered staff and must ensure that non-registered staff who administer medicines are competent. It is important to remember that when a task is delegated, non-registered staff are also accountable for their own practice (Royal Pharmaceutical Society and Royal College of Nursing, 2019; Specialist Pharmacy Services, 2018).
The procedure for the administration of medicines involves a number of risks. If they are to avoid error, nurses need to be familiar with the medicines they are administering – the information they are required to know is outlined in Box 1.
Box 1. Knowledge needed for medicines being administered
Several systems have been devised to help health professionals consider the key aspects of medicines administration in which an error(s) can occur. These are often referred to as ‘rights’; one commonly used version – ‘the five rights’ – is given in Box 2.
Box 2. The ‘5 rights’ of medicine administration
Medicine administration errors occur for a number of reasons. In a systematic review, Keers et al (2013) noted that understanding the causes of these errors can help minimise their occurrence and guide interventions. They identified several reasons why errors occur, including:
When an error or a near miss occurs, it is important that nurses report it immediately, in line with local policy. This will:
Although the term ‘compliance’ was previously used to describe patients taking medicines as prescribed, the term is now considered paternalistic and the term ‘adherence’ is more commonly used (Aronson, 2007). The National Institute for Health and Care Excellence (2009) suggests that adherence relates to an agreement about prescribed medicines between prescriber and patient and “defines the extent to which the patient’s action matches the agreed recommendations”.
Adherence is difficult to measure; however, it has been estimated that between a third and a half of all medicines for long-term conditions are not taken as intended (NICE, 2009). Non-adherence can be:
The causes of non-adherence are complex and include:
If a patient is non-adherent, the medicine should be reviewed to assess its:
Medicines that are required should be given in the smallest appropriate dose and in a form that reduces the number of daily doses to a minimum.
Concordance describes a shared process leading to an agreement between the patient and prescriber about the aims of their treatment and how these can be achieved (Aronson, 2007). An important part of this process is the quality of the information patients are given to inform their decisions. Patient information leaflets (PILs) must be given with every medicine supplied to patients – however, research that examined the content of 100 PILs suggests that many of these leaflets do not communicate information about the rationale and benefits of treatment (Dickenson et al, 2017). As such, it is essential that when patients are given information they have an opportunity to discuss it with a knowledgeable health professional.
All medicines are evaluated to assess their safety, but no medicine is entirely risk free. Nurses should be aware of:
In the UK, the Yellow Card Scheme collects and monitors information on suspected safety concerns or incidents involving medicines and medical devices. The scheme is run by the Medicines and Healthcare products Regulatory Authority and relies on voluntary reporting of suspected adverse drug reactions by health professionals and patients; it aims to provide an early warning that the safety of a product may require further investigation.
Nurses should also be aware of local reporting systems.
The oral route is the most frequently used route of medicine administration, as well as being the most convenient and cost-effective (Dougherty and Lister, 2015). Many oral medicines are given in solid-dose forms such as tablets and capsules, which have a high degree of stability and provide accurate dosage. However, the oral route can be problematic because of the unpredictable nature of gastrointestinal absorption (see Part 1).
Some patients find tablets and other solid-dose forms difficult to take and, on occasion, a liquid formulation might be more appropriate or an alternative medicine may need to be considered. This should be discussed with the prescriber and pharmacist. If a patient finds oral doses difficult to tolerate, it can be tempting to crush tablets. However, this is usually outside of the product licence and nurses must seek advice from a pharmacist or the prescribing doctor to ascertain whether it is safe to do so (Dougherty and Lister, 2015). Modified-release tablets must not be crushed or broken as the medicine – which should be released over a period of time – may be absorbed immediately, leading to toxicity, or not absorbed at all, leading to suboptimal treatment.
Non-sterile gloves are not required routinely for this oral administration procedure. Nurses need to assess individual patients for the risk of exposure to blood and body fluids (Royal College of Nursing, 2018) and to be aware of local policies for glove use.
This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.
Aronson JK (2007) Compliance, concordance, adherence. British Journal of Clinical Pharmacology; 63: 4, 383-384.
Dickenson R et al (2017) How much information about the benefits of medicines is included in patient leaflets in the European Union? A survey. International Journal of Pharmacy Practice; 25: 2, 147-158.
Dougherty L, Lister S ( 2015) The Royal Marsden Manual of Clinical Nursing Procedures. Wiley-Blackwell.
Keers RN et al (2013) Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug Safety; 36: 11, 1045-1067.
National Institute for Health and Care Excellence (2009) Medicines Adherence: Involving Patients in Decisions about Prescribed Medicines and Supporting Adherence. London: NICE.
Royal College of Nursing (2018) Tools of the Trade: Guidance for Health Care Staff on Glove Use and the Prevention of Contact Dermatitis. London: RCN.
Royal Pharmaceutical Society and Royal College of Nursing (2019) Professional Guidance on the Administration of Medicines in Healthcare Settings. London: RPS.
Specialist Pharmacy Services (2018) Medicines Matters: A Guide to Mechanisms for the Prescribing, Supply and Administration of Medicines (in England). SPS.
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