Chapter 15: Medicines optimization: ensuring quality and safety
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15.8 Medication: eye administration
Essential equipment
- Personal protective equipment
- Non‐sterile powder‐free gloves
- Eye preparation to be administered
- Recording sheet or book as required by law or hospital policy
- Patient's prescription chart, to check dose, route, etc.
- Electronic identity check equipment, where relevant
- Low‐linting swabs
- Sterile 0.9% sodium chloride or warm water
- Eye drops at room temperature or eye ointment
Optional equipment
- Eye swab
Pre‐procedure
ActionRationale
- 1.
Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [257], C).
- 2.Ask the patient to explain how their eyes feel, if they are able to.To gain a baseline understanding of current problems or changes the patient is experiencing. E
- 3.Before administering any prescribed drug, look at the patient's prescription chart and check the following:
- the correct patient is being given the drug
- drug
- dose
- date and time of administration
- route and method of administration
- diluent as appropriate
- validity of prescription
- signature of prescriber
- the prescription is legible.
To ensure that the correct patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route (DH [61], C; RPS [317] C).To protect the patient from harm (DH [61], C).If any of these pieces of information are missing, unclear or illegible, do not proceed with the administration. Consult with the prescriber.To prevent any errors occurring. E - 4.Wash hands and apply gloves.
Procedure
- 5.Take the medication and the prescription chart to the patient. Check the patient's identity by asking them to state their full name and date of birth. If the patient is unable to confirm these details, then check the patient identity band against the prescription chart. If an electronic identity check system for the patient and/or medicine identification is in place, then use it in accordance with hospital policy and procedures. Check the patient's allergy status by asking them or by checking the name band.To ensure that the medication is administered to the correct patient and prevent any errors related to drug allergies (NPSA [262], C).
- 6.Ask the patient to sit back with their neck slightly hyperextended or lie down.
- 7.If there is any discharge, proceed as for eye swabbing (see Chapter c13: Diagnostic tests). If any crusting or drainage is present around the eye, gently wash it away with warm water or 0.9% sodium chloride and a swab. Always wipe from the inner to the outer canthus.To prevent the introduction of micro‐organisms into the lacrimal ducts (Potter and Perry [289], E).
- 8.Ask the patient to look at the ceiling and carefully pull the skin below the affected eye using a wet swab to expose the conjunctival sac.To move the sensitive cornea up and away from the conjunctival sac and reduce stimulation of the blink reflex (Potter and Perry [289], E).
- 9.If administering both drops and ointment, administer drops first.Ointment will leave a film in the eye, which may hamper the absorption of medication in drop form (Jevon et al. [146], E).
- 10.Either:Administer the prescribed number of drops, holding the eye dropper 1–2 cm above the eye. If the patient blinks or closes their eye, repeat the procedure.To provide even distribution of medication across the eye. The therapeutic effect of drugs is obtained only when drops enter the conjunctival sac (Potter and Perry [289], E).Or:Apply a thin stream of ointment evenly along the inner edge of the lower eyelid on the conjunctiva from the nasal corner outwards. If there is excess medication on the eyelid, gently wipe it from the inner to the outer canthus.To provide even distribution of medication across the eye and lid margin and reduce the risk of cross‐infection, contamination of the tube and trauma to the eye (Fraise and Bradley [98], E; Perry [281], E; Stollery et al. [342], E).To avoid excess ointment irritating the surrounding skin (Stollery et al. [342], E).
- 11.Ask the patient to close their eyes and keep them closed for 1–2 minutes.
- 12.Explain to the patient that they may have blurred vision for a few minutes after application. Explain that they should refrain from driving or operating machinery until their vision returns to normal.To ensure the patient understands why they have blurred vision (Aldridge [4], E).
Post‐procedure
- 13.Clean any equipment used and discard all disposable equipment in appropriate containers.
- 14.Record the administration on the appropriate charts.To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (RPS [317], C).