Steps

Rationale/Points of Emphasis

1 Verify the order with the child’s medical record, including calculation of appropriate dose, and check for allergy to drug; if present, do not administer drug and notify prescriber.

Verifies correct drug, dose, route, time, and patient. Allergic reactions to medications may be life threatening.

2 Perform hand hygiene.

Reduces transmission of microorganisms.

3 Obtain medication and read the label to verify with the order; verify if the medication is to be administered into both eyes or only one and into which eye if only one. Check for expiration date; if expired, do not administer.

To decrease the chance of medication error, the patient, route, dose, frequency, and time to be administered must be verified each time a medication is administered.

caREminder

Bring medication to room temperature before administration. If it is not at room temperature, warm eye drops by holding the vial between the hands until warm because cold medication increases discomfort during ophthalmic administration.

4 Verify medication with the electronic record or take medication record and medication to the child to administer. Verify the child’s identity by comparing name on medication (if verified electronically) or on medication record with the child’s identification band and any other patient identifier required by the institution.

Ensures proper identification of the child.

5 Don gloves.

Standard precaution to reduce transmission of microorganisms.

6 Cleanse the eye with cotton ball or gauze soaked with normal saline if necessary. Move from the inner canthus of the eyelid to the outer canthus. Use a new cotton ball each time you sweep the eye.

Old medication or discharge from the eye may mat around the eye. Using a new cotton ball or gauze for each sweep of the eye prevents contamination.

7 Position the child supine in bed, or other flat surface, looking up. Restrain the uncooperative child for administration; obtain another person to assist the child to lie still if needed.

Facilitates safe rapid administration.

8 Rest your dominant hand against the child’s forehead. With the other hand, pull down the lower eyelid to expose the conjunctival sac.

Stabilizes hand, prevents poking the child in the eye with the dropper or medication tube, and allows for correct placement of the medication.

KidKare Instillation of ophthalmic medication may be frightening and intrusive to the child. Have the child keep his or her eyes closed until you are ready to administer. When the medication is ready to be administered, have the child open the eyes and look up. Immediately instill the correct drops of solution or ointment into the eyes when the child opens them.

9 Administer the medication.

9a Eye drops: If using a dropper, instill the correct amount of drops into the conjunctival sac, being careful not to touch the dropper to the eye (Figure 67-1). An alternate method of administration is to have the child close his or her eyes and tip the head backward. Place the medication drop(s) on the inner canthus and instruct the child to open eyes. Apply gentle pressure to the nasolacrimal duct (the inner canthus) with your index finger for about 30 seconds, or have the child or family member apply pressure.

Noncontact prevents contamination of the dropper or bottle. Promotes a more comfortable administration and allows for correct placement of the medication in a more controlled manner. Pressure slows drainage of medication into the lacrimal duct and being absorbed systemically, this can reduce adverse systemic effects.

9b Ointment: If using ointment, press the ointment tube at the end to dislodge the ointment from the tube and place a thin ribbon of ointment along the entire conjunctival sac from the inner canthus to the outer canthus or as prescribed (e.g., ¼-in ribbon). Have the child keep his or her eyes closed for up to 1 minute after administration (Figure 67-2).

Allows correct placement of the medication and allows time for the medication to disperse over the eye.

Figure 67-1 Instill the correct amount of eye drops into the conjunctival sac, being careful not to touch the dropper to the eye.

Figure 67-2 If using ointment, place a thin ribbon along the entire conjunctival sac from the inner canthus to the outer canthus.

10 Wipe excess medication off with a cotton ball or tissue.

Prevents irritation of medication to the skin surrounding eyes.

11 Remove gloves and perform hand hygiene.

Reduces transmission of microorganisms.

12 Return medication to appropriate storage area.

Provides safe storage of medication.