Sublingual (under the tongue) and buccal (between the cheek and gum) medications are administered by a registered nurse (RN), licensed practical nurse (LPN), physician, child, or family member who is knowledgeable about the techniques of administering transmucosal medication to a child as well as the particular medication being used and its possible effects on the child.
Principles of pharmacologic management (see Chapter 6) are followed.
Sublingual and buccal medications are absorbed by the oral mucosa, which has a rich vascular supply and lacks a stratum corneum epidermidis; therefore, absorption by this route is rapid. Medications given this way can be detected in the blood within 1 minute, and peak levels are generally achieved within 10 to 15 minutes.
Medications are administered within 1 hour of prescribed time.
EQUIPMENT
Prescribed medication
Nonsterile gloves
CHILD AND FAMILY ASSESSMENT AND PREPARATION
Assess sublingual/buccal mucosa for redness and/or disrupted integrity, and notify prescriber if disruption in mucosal integrity is present.
Assess child’s previous experiences with receiving sublingual or buccal medications.
Assess child’s and family’s understanding of need for sublingual or buccal medication that will be administered.
Prepare the child, as appropriate to cognitive level, and the family for medication administration. Use therapeutic play to allow the child to work through his or her fears and master control of the situation.
Assess for drug allergies; if present, notify healthcare prescriber. Label child’s record and apply identification band indicating allergies.
Teach the child and the family about the medication’s actions and side effects, how the medication is to be given, and the reason for its use.
PROCEDURE Administering Sublingual and Buccal Medication
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 the prescriber.
Verifies correct drug, dose, route, time, and patient. Allergic reactions to medications may be life threatening.
2 Perform hand hygiene and don gloves.
Reduces transmission of microorganisms.
3 Obtain medication and read the label to verify that it is the same medication as prescribed in the order. Check for expiration date; if expired, do not administer.
Ensures that correct medication is being given.
caREminder
Use caution not to get the medication wet or to place it against the skin, because sublingual and buccal medications degrade and are absorbed very rapidly.
4 Verify the medication with the child’s electronic medication record or take the 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 child’s identification band and any other patient identifier required by the institution.
Ensures proper identification of the child.
5 Place the medication either under the child’s tongue (sublingual) or between the cheek and the gum (buccal). If repeated doses are to be administered, alternate sides of the mouth for subsequent doses. The child should not eat, drink, or smoke while the medication is in his or her mouth.
These locations aid in quick absorption of medication. Eating, drinking, and smoking interfere with absorption of the medication.
KidKare If the child has trouble raising his or her tongue, place one end of a straw in the sublingual pocket and drop the tablet in via the other end. Tell the child not to swallow the medication but to let it be absorbed in the mouth.
6 Remove gloves and perform hand hygiene.
Reduces transmission of microorganisms.
7 Return medication to appropriate storage area.
Maintains organization and provides safe storage of medication.
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PROCEDURE
KidKare If the child has trouble raising his or her tongue, place one end of a straw in the sublingual pocket and drop the tablet in via the other end. Tell the child not to swallow the medication but to let it be absorbed in the mouth.
