The right route

Care staff should assess, monitor, administer and review medication to ensure that the resident receives medication in an appropriate form and route.

Some medications can be administered via multiple routes. It is important to ensure that you use the right route for the medication that is being administered.

You must:

• Ensure medicines administration is safe
• Identify and report any refusal to take medicines
• Record any changes to the resident’s status which may be related to medicines
• Identify and report any residents with swallowing difficulties
• Ensure awareness of their own responsibilities with respect to medicines review
• Undertake regular training and attend update courses

Medicines can be administered systemically or topically:

• Systemic administration means that medicine enters into the circulation and the entire body is affected by the action of the medicine.
• Topical administration means that medicine is applied to body surfaces, such as the skin, lungs or eye. There may be some systemic absorption of the medicine.

Let’s go through some of the common types of medicines that are administered via different routes.

Inhalation of medicines is via the nose or lungs using a nasal spray or inhaler. There are lots of different types of inhalers therefore it is important that you refer to the patient information leaflet (PIL) for specific guidance on how to administer the inhaler(s) your resident has been prescribed. Some inhalers will require the use of a spacer device. These make it easier to administer medicine from the inhaler.

Instillation of eye, ear or nose drops. When administering eye drops, refer to the PIL for instructions as there are multiple ways in which this can be done. There is a compliance aid called AutoDrop® that prevents residents blinking, allowing the drop to be successfully delivered at the first attempt.

Watch the video below which demonstrates two ways in which you can administer eye drops to residents.

Video credit to Dr Brad Elkins

Topical application of medicines is in the form of creams, ointments and patches. General guidance for patches include application of the patch to a clean, dry, non-hairy area of the skin. You should use the heat of your hand to ensure that the patch has fully adhered to the skin. When a patch is being used continuously, be sure to rotate the sites of application to prevent irritation when removing patch. When disposing of the used patch, fold the patch in half, adhesive sides together, press and seal then dispose in a sealed bin or take to the pharmacy for destruction.

We will cover administering creams and ointments in more detail in Week 3.

Medicines that are taken orally are ingested such as tablets, capsules and syrups. Tablets and capsules should be given to the patient to swallow with water or a drink as indicated on the dispensed label on the medicine. Liquids should be given orally according to the dispensing label which will indicate how much liquid should be administered.

These are the most common types of medicines you will come across in the care setting.

There are several routes of administration that require you to have additional qualifications in order to administer to residents:

• Administration of injectable medicines is by piercing the skin for example with administration of insulin. Additional training is required before you can administer injections.
• Administering via an enteral feeding tube such as PEG, NG tube or JEG. You will need additional training before you administer medicines via an enteral feeding tube.
• Vaginal administration of medicines is via pessaries or vaginal creams. You will need additional training before you administer medicines via the vaginal route.
• Rectal administration of medicines uses enemas and suppositories. You will need additional training before you administer medicines via the rectal route.

Oral Hygiene

As most of the medicines that residents will need to take is via the oral route, it is important to ensure that their oral hygiene is maintained. In particular residents with swallowing problems may have poor oral hygiene. This increases the likelihood of chest infection if they aspirate i.e. food, drink, or medicines go into the lungs inadvertently.

When cleaning a resident’s mouth, you should should ensure you:

• Wash your hands and use clinical gloves
• Use a small infant-size soft toothbrush first (then move on to medium size toothbrush)
• Use a smear of mild mint fluoride toothpaste
• Guide the resident with gentle hand on hand movements to enable them to do the movement themselves
• Touch and clean the outside of the mouth first
• Clean the outer edges of teeth and gums
• Clean the inside of the mouth, gums, teeth and the palate
• Never put your fingers between the residents teeth

There are other considerations to make when ensuring that optimal oral and dental care is provided to the residents:

• You should ensure that you clean residents teeth at least twice daily or after every meal if the resident has poor oral health.
• Residents should be provided with adequate hydration for oro-dispersible, sublingual and buccal formulations that dissolve in the mouth.
• Many liquid formulations contain sugar therefore residents should be offered a drink of water after administration
• Residents who use asthma inhalers should be encouraged to rinse and spit following administration