Pre‐procedure

ActionRationale

1. 1.Show
   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. 2.Show
   Wash hands with bactericidal soap and water or an alcohol‐based handrub.
   To minimize the risk of cross‐infection (DH [64], C; Fraise and Bradley [98], E).
3. 3.Show
   Before administering any prescribed drug, look at the patient's prescription chart and check the following:

   1. the correct patient is being given the drug
   2. drug
   3. dose
   4. date and time of administration
   5. route and method of administration
   6. diluent as appropriate
   7. validity of prescription
   8. signature of prescriber
   9. 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

Procedure

1. 4.Show
   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).
2. 5.Show
   Ask the patient to lie on their side with the ear to be treated uppermost.
   To ensure the best position for insertion of the drops. E
3. 6.Show
   Warm the drops to near body temperature by holding the container in the palm of the hand for a few minutes.
   To prevent trauma to the patient (ASHP [15], C; Rotherham NHS Foundation Trust [308], E; Perry [281], E).
4. 7.Show
   Wash hands and apply gloves.
   To reduce the risk of cross‐infection (DH [64], C; Fraise and Bradley [98], E).
5. 8.Show
   Pull the cartilaginous part of the pinna backwards and upwards (Action figure 8).
   To prepare the auditory meatus for instillation of the drops (Rotherham NHS Foundation Trust [308], E).
6. 9.Show
   If cerumen (ear wax) or drainage occludes the outermost portion of the ear canal, wipe it out gently with a cotton‐tipped applicator.
   To enable the medication to enter the ear. E
7. 10.Show
   Allow the drop(s) to fall in the direction of the external canal. The dropper should not touch the ear.
   To ensure that the medication reaches the area requiring therapy. E
8. 11.Show
   Gently massage over the tragus to help work in the drops.
   To aid the passage of medication into the ear and prevent the escape of medication. E
9. 12.Show
   If necessary, temporarily place a gauze swab over the ear canal.
   To prevent escape of the medication (Chernecky et al. [39], E).
10. 13.Show
    Request the patient to remain in their current position for 2–3 minutes.
    To allow the medication to reach the eardrum and be absorbed. To prevent escape of the medication (Aldridge, [4], E; Perry [281], E).

Post‐procedure

1. 14.Show
   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).