Otic medications are administered by a registered nurse (RN), licensed practical nurse (LPN), physician, or family member who is knowledgeable about the medication and techniques of administering otic medication to a child.
Principles of pharmacologic management (see Chapter 6) are followed.
Medications are administered within 1 hour of prescribed time.
EQUIPMENT
Prescribed medication
Nonsterile gloves
Dropper (if needed)
CHILD AND FAMILY ASSESSMENT AND PREPARATION
Assess child’s previous experiences with receiving otic medications.
Assess child’s and family’s understanding of need for otic medication that will be administered.
Prepare the child, as appropriate to cognitive level, and family for medication administration. Use therapeutic play to allow the child to work through his or her fears and master control of the situation. Explain that the medication may make the ear tickle.
Assess for drug allergies; if present, notify healthcare provider. Label child’s record and apply identification band indicating allergies.
Clear the auditory canal of obstructing cerumen or inflammatory debris.
PROCEDURE Administering Otic Medication
Steps
Rationale/Points of Emphasis
1 Verify the order with the child’s medical record. 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 and don gloves.
Standard precaution to reduce transmission of microorganisms.
3 Obtain medication and read the label to verify with the order. Check for expiration date; if expired, do not administer. Verify in which ear medication is to be administered.
If the otic medication is kept in the refrigerator, allow the medication to come to room temperature before administration. Warm the solution by gently rotating the bottle in your hands before administration. Cold medication may cause discomfort and produce vomiting or vertigo in the child.
To decrease chance of medication error, patient, route, dose, frequency, and time to be administered must be verified each time a medication is administered.
4 Verify the medication with the electronic record or take medication record and bottle of medication to child to administer. Verify the child’s identity by comparing name on medication (if verified electronically) or on medication record with child’s identification band and any other patient identifier required by the institution.
Ensures proper identification of the child.
5 Have the child lie in a supine position with his or her head turned to the appropriate side; the child can also lie across a family member’s lap. Soothe child afterward to keep him or her quiet while the medication is instilling.
Allows entry of the eardrops into the ear canal.
caREminder
Talk to children, sing to them, or turn on videos to distract them, to facilitate instillation of medication.
6 Pull the earlobe down and back for children younger than 3 years (Figure 69-1A). For older children, pull the pinna up and back (Figure 69-1B).
Straightens the ear canal and facilitates entry of the eardrops into the ear canal.
Figure 69-1 (A) Pull the ear down and back for children younger than 3 years. (B) For older children, pull the ear up and back.
7 Administer the ordered amount of drops into the ear canal, holding the dropper ½ inch above the ear canal and being careful not to contaminate the ear dropper.
Reduces transmission of microorganisms onto the dropper.
8 Gently massage the tragus (area anterior to the ear canal) unless contraindicated due to pain.
Facilitates entry of the medication into the ear canal. Pushing on the tragus in the presence of a patent tympanostomy tube improves medication penetration to the middle ear.
9 Have the child remain in the supine position with the head turned for 3-5 minutes. Distract and soothe child to keep him or her quiet while the medication is instilling.
Gives time for the medication to enter the ear canal.
10 Repeat with other ear if prescribed.
11 Remove gloves and perform hand hygiene. Return medication to appropriate storage area.
Reduces transmission of microorganisms. Provides safe storage of medication.
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PROCEDURE
If the otic medication is kept in the refrigerator, allow the medication to come to room temperature before administration. Warm the solution by gently rotating the bottle in your hands before administration. Cold medication may cause discomfort and produce vomiting or vertigo in the child.
