.

Medication Routes &

Delivery Systems
Administration & Safety
Considerations

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Table of Contents
Routes of Administration ......................... 1
Medication Delivery Responsibilities ........ 2
Safety Considerations for
Medication Administration ....................... 3
Transdermal ............................................ 4
Oral ........................................................ 5
Sublingual/Buccal ................................... 8
Pulmonary .............................................. 9
Injection ................................................ 10
Rectal ................................................... 11
Topical:
Skin, Mucous Membranes, Eyes............ 12
References............................................ 13
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1
Routes of Administration
1,2
A route of drug administration is
the path by which a drug or other
substance is brought into contact with
the body. There is often a choice of the
route by which a medication may be
given. A route may be chosen

for convenience

to maximize drug concentration at

the site of action

to minimize drug absorption

elsewhere

to prolong drug absorption, or

to avoid rst-pass metabolism

Different dosage forms of the
same drug may have different drug
absorption rates, times of onset, and
durations of action.

Oral (Enteral)
Enteral feeding tubes
Modied release
(continued)
.

Sublingual/buccal

Pulmonary/inhalation

Injection

Rectal

Topical
Skin
Mucous membranes
Ophthalmic
Otic

Transdermal
.
2
Medication Delivery
Responsibilities
2,3

Concentrate fully when preparing
and administering medications

Be familiar with patients medical
condition/history
Allergies
Acute/chronic disease states
(contraindications)

Never give a medication if you have
questions or concerns about the
order

Be knowledgeable about the
medications you administer
Refer to Full Prescribing
Information and/or up-to-date
drug handbook
Consult with prescriber or
pharmacist

Only administer medications that
you have prepared or that have
been prepared by the pharmacy

Inspect medication and packaging
Expiration dates
For compromise or tampering
Never give a drug if its normal
appearance or packaging is
altered in any way
(continued)
.

DO NOT leave medications
unattended or unsecured

Gather pre- and post-administration
assessment data as appropriate for
the medication (eg, blood glucose
level, pulse rate, pain level)

Evaluate response including
effectiveness or any adverse
reactions

Respond promptly and
appropriately to adverse reactions,
interactions, and complications

Document immediately all actions
related to the patients drug therapy
.
3
Safety Considerations
for Medication
Administration
2,4
Factors, often referred to as rights,
should be addressed before, during,
and after medication administration to
help promote safety.
RIGHT PATIENT:

Verify by checking ID bracelet and
room number
RIGHT DRUG:

Compare the name of drug on
record with the drug on hand

Know general purpose/action,
dosage, and route of drug

Compare drug order with drug
label:
At time of initial contact
Before preparing the drug
Just before administering the drug
RIGHT DOSE:

Compare ordered dose with the
dose on hand
(continued)
.

When dispensing an unfamiliar
drug or in doubt about a dosage,
check the prescribed dose against
the range specied in a reliable
reference, such as the drugs Full
Prescribing Information (package
insert) or an up-to-date drug
handbook
RIGHT TIME:

Administer drugs at times specic to
medication

Consider factors that can affect
timing of administration, such as
meals and other drugs

Before administering a prn
medication, check to ensure:
No one else has administered it
Specied time interval has passed
RIGHT ROUTE:

Verify labeling of drug to ensure it
matches prescribed route

Never substitute one administration
route for another without an order

Administer drugs at appropriate site

Assess ability to swallow before
giving oral meds

Do not crush or mix in other
substance before consultation with
prescriber or pharmacist
.
4
Transdermal
1,5,6
TRANSDERMAL SYSTEMS ARE
DESIGNED TO:

Apply to the skin for the purpose of

delivering drugs to the local site or
into systemic circulation
ADMINISTRATION CONSIDERATIONS
7,8

System adhesion to skin is
important for proper drug delivery

Remove system from protective
pouch and remove protective liner
Place transdermal system on
appropriate body location per Full
Prescribing Information
Document the medication
administration and location of
patch per facility policy

Conrm previous transdermal
system was removed


Follow disposal procedures per Full
Prescribing Information and facility
policies
(continued)
.
SAFETY CONSIDERATIONS
2,8

Do not use oils, lotions, alcohol, or
other agents that might irritate or
damage the skin site

Conrm that skin is intact, non-
irradiated, and not irritated

Avoid hairy areas if possible; clip (do
not shave) excessive hair

Do not expose the application site to
direct external heat source, such as
heating pads
.
5
Oral
1,2

Absorption pattern
Absorbed by the gastrointestinal
(GI) tract

Oral ingestion is the most common

route of administration
May also include administration of
medication via feeding tube

Variety of formulations
Includes tablets, capsules,
chewables, liquids
ADMINISTRATION AND SAFETY
CONSIDERATIONS

Conrm that patient can swallow
and remain upright

Conrm specic recommendations
with the Full Prescribing Information
Food and other drugs in the
digestive tract may affect how
much of and how fast the drug is
absorbed
Most tablets and capsules should
be swallowed whole with an
adequate amount of water
Some medications may not be
crushed or chewed
Liquids may require special
storage precautions to maximize
drug stability
.
.
6
Oral: Enteral Feeding
Tubes
9
ADMINISTRATION AND SAFETY
CONSIDERATIONS

Administer each medication
separately

Use liquid dosage forms when
available and appropriate
Solid dosage forms may be
used in some situations; consult
the Full Prescribing Information
to determine feasibility of
administering medications via
enteral tube

Do not add medication directly to an
enteral feeding formula

Prior to medication administration,
stop the tube feedings
.
.
7
Oral: Modified-Release
Delivery System
1,2

SR, ER, or CR formulations are

examples of modied-release
dosage formulations
Sustained release (SR)
Extended release (ER or XR)
Controlled release (CR)
Delayed release

Extended-release pharmaceutical
preparations are designed to
produce slow, uniform absorption of
a drug for an extended period of time

Modied-release preparations are

offered for medications in all major
drug categories

Absorption pattern will vary based

on preparation used
Verify drug information in Full
Prescribing Information
(continued)
.
ADMINISTRATION AND
SAFETY CONSIDERATIONS

Tablets usually should not be split

Some capsules may be opened,
but contents may not be crushed
or chewed. Verify in Full Prescribing
Information

With few exceptions, modied-
release preparations should be
swallowed whole, preferably with a
glass of water

Damage to the extended-release
preparation can result in unintended
rapid release which can lead to
serious side effects
.
8
Sublingual/Buccal
2,7
ABSORPTION PATTERN

Drug is absorbed across the

epithelial lining of the mouth

May provide a rapid onset of action

ADMINISTRATION AND SAFETY
CONSIDERATIONS
7

Medication should generally not be
administered if the gums or mucous
membranes have open sores or
irritations

Have the patient sit to prevent
accidental aspiration of the
medication

Should not be used if the patient is
unconscious or uncooperative

The patient should not eat or
drink, chew or swallow until the
medication has been absorbed
.
.
9
Pulmonary
1,2,8
ABSORPTION PATTERN

Medications are inhaled as gas,

droplets, or aerosolized powder
2

Large lung surface area allows

for rapid absorption and local
application of the drug at the desired
site of action
1
ADMINISTRATION AND SAFETY
CONSIDERATIONS

Place patient in a comfortable,
upright position

Use nebulizers to conrm that a
steady mist is owing, and t the
mask or application device correctly
on the patient

Canister devices: Hold device 1 to
2 inches from the patients mouth.
Educate the patient to breathe in
deeply while drug is administered

Consult Full Prescribing Information
for additional information
.
.
10
Injection
1,2,4
ROUTES OF ADMINISTRATION

Intravenous (IV)

Subcutaneous

Intramuscular (IM)

Epidural

Intra-arterial

Intrathecal
ABSORPTION PATTERN

Generally fast

Generally more predictable than with

enteral administration
ADMINISTRATION AND SAFETY
CONSIDERATIONS

Asepsis must be maintained

Closely monitor for response and/or
reaction

For continuous and intermittent IV
administration, venous access must
be maintained

Rotation of injection sites is required

Safely dispose of contaminated
needles

Refer to Full Prescribing Information
for specic administration and
safety recommendations
.
.
11
Rectal
2
ABSORPTION PATTERN

Drug is readily absorbed into the

wall of the rectum for systemic or
local effect

FORMULATIONS INCLUDE ENEMAS
(LIQUID/SOLUTIONS), SUPPOSITORIES,
CREAMS, AND OINTMENTS

Suppositories soften, melt, or

dissolve, releasing the active
medication

ADMINISTRATION AND SAFETY
CONSIDERATIONS

Remove outer wrapper prior to
administration


Introduce suppository, catheter, or
applicator gently to avoid tearing or
bleeding of the tissue
.
.
12
Topical: Skin, Mucous
Membranes, Eyes
2,4
ABSORPTION PATTERN

Targeted drug action is the skin

surface or area of medication
administration
TOPICAL FORMULATIONS ARE
DESIGNED TO:

Target drug action to the surface

(systemic effect not desired)

Be administered to the skin, otic,

ophthalmic, or mucous membranes
Mucous membranes may include
the conjunctiva, nasal passages,
oropharynx, vagina, colon,
urethra, and urinary bladder
ADMINISTRATION AND SAFETY
CONSIDERATIONS

Wear gloves and use aseptic
technique to minimize
contamination of medication and
possibility of infection

When applying medication to the
skin, clean the skin and assess for
breaks or skin damage

Administer medication as directed
by Full Prescribing Information
.
.
REFERENCES
1. Buxton IL. Pharmacokinetics and
pharmacodynamics: the dynamics of drug
absorption, distribution, action, and elimination. In:
Brunton LL, Lazo JS, Parker KL, eds. Goodman &
Gilmans The Pharmacological Basis of
Therapeutics, 11th ed. http://www.accessmedicine.
com/content.aspx?aID=935800.
2. Jones and Bartlett Learning. 2011 Nurses Drug
Handbook, 10th ed. Sudbury, MA: Jones and
Bartlett Publishers; 2011.
3. Medication administration. Nurses Notes The
Black Book website. http://nurseskit.blogspot.
com/2009/02/medication-administration.html.
Accessed August 4, 2010.
4. Administration of Medication. In: Krapp K, ed.
Encyclopedia of Nursing & Allied Health. eNotes.
com. http://www.enotes.com/nursing-
encyclopedia/administration-medication.
Accessed July 8, 2010.
5. Schulmeister L. Stuck on you: Transdermal drug
patches. Nursing Made Incredibly Easy! 2007:5 (2):
17-19.
6. Wokovich AM, Prodduturi S, Doub WH,
Hussain AS, Buhse LF. Transdermal drug
delivery system (TDDS) adhesion as a critical
safety, efficacy and quality attribute. Eur J Pharm
Biopharm. 2006; 64:1-8.
9. Bankhead R, Boullata J, Brantley S, et al. A.S.P.E.N.
Enteral Nutrition Practicem Recommendations.
JPEN J Parenter Enteral Nutr 2009; 33:122-167.
7. Martelli ME. Sublingual and buccal medication
administration. Gale Encyclopedia of Nursing and
Allied Health. Healthline.com. http://www.healthline.
com/galecontent/sublingual-and-buccal-medication-
administration. Accessed July 26, 2010.
8. Aerosol drug administration. In: Krapp K, ed.
Encyclopedia of Nursing & Allied Health. eNotes.
com. http://www.enotes.com/nursing-encyclopedia/
aerosol-drug-administration. Accessed July 12,
2010.
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