Ear Meds Administation PDF

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Meds admin and assessment used in HA and PNUR 125....

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9/10/2021

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Skills Administering Ear Medications Extended Text ALERT

OVERVIEW Ear (otic) medications are usually in a solution and instilled by drops. When administering ear medications, be aware of certain safety precautions. Internal ear structures are very sensitive to temperature extremes; administer eardrops at room temperature. Instilling cold drops can cause pain, vertigo (severe dizziness) or nausea and debilitate a patient for several minutes. Although structures of the outer ear are not sterile, use sterile drops and solutions in case the eardrum is ruptured. A final safety precaution is to avoid forcing any solution into the ear. Do not occlude the ear canal with a medicine dropper because this can cause pressure within the canal during instillation and subsequent injury to the eardrum. If you follow these precautions, instillation of eardrops is a safe and effective therapy. Medication may be needed in one or both ears. Cerumenolytic drops may help reduce or remove excess ear wax. Antibiotic ear drops may be indicated for treatment of ear infections.

SUPPLIES Click here for a list of supplies.

ASSESSMENT AND PREPARATION • Check the accuracy and completeness of each medication administration record (MAR) against the health care provider’s medication order. Confirm the patient’s name, the drug and dosage, number of drops to instill, ear to be treated (left, right, or both), and the time of administration. Clarify incomplete or unclear orders with the health care provider. • Note patient allergies. • Read manufacturer’s application/administration directions carefully. • Observe the Six Rights of Medication Administration: right medication, right dose, right patient, right route, right time, and right documentation. (For details, see the video skill "Ensuring the Six Rights of Medication Administration.") • Prepare medications for application. Check label of medication against MAR two times. Check expiration date on container. • If ear medication has been refrigerated, hold container in hands for a few minutes to bring to body temperature. • Understand drug reference information pertinent to the medication’s action, purpose, onset of action and peak action, normal dose, common side effects, and nursing implications, if needed.

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DELEGATION The skill of administering ear medication cannot be delegated to NAP. Be sure to inform NAP of the following: • Review the expected therapeutic effects as well as potential side effects of medications that should be reported to the nurse. • Discuss the potential for temporary hearing changes after administration of ear medications.

PROCEDURE 1. Verify the health care provider’s orders. 2. Gather the necessary equipment and supplies. 3. Provide for the patient’s privacy. 4. Perform hand hygiene and don gloves. 5. Introduce yourself to the patient and family, if present. 6. Identify the patient using two identifiers. Ask the patient about allergies. 7. Take the medication to the patient at the correct time (refer to agency policy). Give time-critical medications (e.g., stat and “now” doses) at the exact time ordered. As you proceed, apply the Six Rights of Medication Administration. 8. Label all medications, medication containers, and other solutions, including those on a sterile field. The only exceptions are medications that are still in their original container or medications that are administered immediately by the person who prepared them. 9. Explain the procedure to the patient and ensure that he or she agrees to treatment. Discuss the purpose of each medication, its action, and possible adverse effects. Allow the patient to ask questions about the drugs. Patients who wish to self-instill medications may be allowed to do so under a nurse’s supervision (check agency policy). Assess the patient’s ability to grasp and manipulate a dropper. 10. Instill ear medication: a. Warm the medication to room temperature per the organization’s practice. b. Position the patient on his or her side (if not contraindicated) with the ear to be treated facing up. Alternately, the patient may sit in a chair or at the bedside. Tilt the patient’s head toward the unaffected side, and stabilize it with the patient’s own hand. c. For an adult or child older than 3 years of age, straighten the ear canal by pulling the pinna up and back to the 10 o’clock position. For a child younger than 3 years of age, pull the pinna down and back to the 6 o’clock or 9 o’clock position. d. If cerumen or drainage occludes the outermost portion of the ear canal, wipe it out gently with a cotton-tipped applicator. Take care not to force cerumen into the canal. e. Instill the prescribed drops by holding the dropper 1 cm (½ inch) above the ear canal. f. Ask the patient to remain in a side-lying position, on the unaffected side, for a few minutes. Gently massage or put pressure on the tragus of the ear with your finger. g. If ordered, gently insert a portion of a cotton ball into the outermost part of the ear canal. Do not press cotton into the canal. Remove the cotton after 15 minutes. 11. Dispose of your used supplies in the appropriate trash receptacle, remove and dispose of your gloves (if used), and perform hand hygiene. 12. After the drops have been absorbed, help the patient into a comfortable position and place toiletries and personal items within reach. 13. Place the call light within easy reach, and make sure the patient knows how to use it to summon assistance. 14. To ensure the patient’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. 15. Leave the patient’s room tidy. 16. Document and report the patient’s response and expected or unexpected outcomes.

MONITORING AND CARE • Monitor the patient for adverse or allergic reactions to the medication. Recognize and immediately treat dyspnea, wheezing, and circulatory collapse, which are signs of a severe anaphylactic reaction. Follow the organization’s practice for emergency response. • Ask the patient or a family member to name the ear medication and state its action, purpose, dosage, schedule, and side effects. • Note the patient's response to the medication by assessing for hearing changes; ask if symptoms have been relieved, and note any side effects. • Watch the patient or family member instill the next dose of ear medication, providing appropriate reinforcement of technique. • Monitor the patient for adverse or allergic reactions to the medication. Recognize and immediately treat dyspnea, wheezing, and circulatory collapse, which are signs of a severe anaphylactic reaction. Follow the organization’s practice for emergency response. • Assess, treat, and reassess pain.

EXPECTED OUTCOMES • Correct medication is administered according to the six rights of medication safety. • Patient is comfortable during administration. https://connect.elsevierperformancemanager.com/#/content/skills/13701/extended-text

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• Ear canal becomes clear, without drainage, excess cerumen, or inflammation, as medication is repeatedly instilled. • If applicable, the patient is able to explain steps for instilling eardrops and demonstrates proper technique for self-administration. • Patient experiences no adverse reaction or side effects from medication.

UNEXPECTED OUTCOMES • • • • • • • •

Medication error occurs. Patient experiences discomfort during administration. Ear canal is inflamed, swollen, and tender to palpation. Drainage is present. Cerumen occludes the ear canal. Patient is unable to explain medication information and steps for medication instillation. Patient has difficulty in self-administering eardrops. Patient experiences adverse reaction or side effects from the medication.

DOCUMENTATION Documentation Guidelines: • Record the time of administration, type and strength of medication applied, number of drops instilled, and application site (right, left, or both ears) in the MAR immediately after administration, not before. Include your initials or signature. Record patient teaching and validation of the patient's understanding. • Document objective data related to the ear involved (e.g., redness, drainage, irritation, cerumen) as well as any subjective data (e.g., pain, itching, altered hearing) and the patient’s response to the medications, including any adverse reactions. • Record the reason any medication was withheld and follow facility policy for noting withheld doses. • Record unexpected outcomes and related nursing interventions.

Sample Documentation: 1300 Patient complains of pain in both ears, rated 6 on 0/10 scale. Redness noted on external ear structures and ear canals bilaterally. Removed scant, yellow drainage with cotton-tipped applicator from R ear. Aurodex ear medication, two drops instilled in each ear as ordered. —K. Morgan, RN, 6/22/20 1330 States relief from c/o bilateral ear pain. Rates pain 2 on 0/10 scale. —K. Morgan, RN, 6/22/20

PEDIATRIC CONSIDERATIONS • Insert cotton pledgets loosely into ear canal to prevent medication from flowing out. To prevent cotton from absorbing medication, premoisten it with a few drops of medication.

OLDER ADULT CONSIDERATIONS • Many older adults accumulate cerumen in the ear. This should be removed by irrigation before administering medication.

HOME CARE CONSIDERATIONS • All medications should be kept away from children, cognitively impaired adults, and pets.

REFERENCES 1. Aaron, K. and others. (2018). Ear drops for the removal of ear wax. Cochrane Database Of Systematic Reviews, 7 , Art. No.: CD012171. doi:10.1002/14651858.CD012171.pub2 (Level I) 2. Skidmore-Roth, L. (2019). Appendix B: Ophthalmic, nasal, topical, and otic products. Mosby’s nursing drug reference (32nd ed., pp. 13471359). St. Louis: Mosby. 3. Joint Commission, The (TJC). (2019). National patient safety goals: Hospital accreditation program. Retrieved July 5, 2019, from https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2019.pdf https://connect.elsevierperformancemanager.com/#/content/skills/13701/extended-text

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(https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2019.pdf ) (Level VII) 4. Brown, T.L. (2019). Chapter 22: Pediatric nursing interventions and skills. In M.J. Hockenberry, D. Wilson (Eds.), Wong’s nursing care of infants and children (11th ed., pp. 678-735). St. Louis: Mosby.

Elsevier Skills Levels of Evidence • • • • • • •

Systematic review of all relevant randomized controlled trials At least one well-designed randomized controlled trial Well-designed controlled trials without randomization Well-designed case-controlled or cohort studies Descriptive or qualitative studies Single descriptive or qualitative study Authority opinion or expert committee reports

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