Neonatal drug administration

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Neonatal drug administration

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Drug administration is a complex system involving a number of essential phases and steps that midwives must follow to prevent mistakes (NMC 2010). A simple way to avoid error is to follow the ‘seven rights’ of medicine administration (Pape 2003) (Figure 76.1).



  • Right patient: Check that the name, date of birth and hospital number of the baby match the prescription chart. Check for any known allergies.
  • Right drug: Does the drug fit with the medical management plan for the baby? Is the drug correctly prescribed? Never administer a drug without an understanding of its usage and dosage, therapeutic action and potential side effects.
  • Right reason: Question the reason for administration and assess if the drug is necessary. Midwives must perform an assessment of the baby’s current condition and question if the baby is fit to have the required dose.
  • Right dose: Does the dose take into account the baby’s current weight? Underdosing can result in the medicine proving ineffective and overdosing can lead to adverse or fatal responses.
  • Right time: Check the last dose (if relevant) and ensure that it is appropriate to administer the drug at the prescribed time.
  • Right route: Check that the prescribed route of administration is appropriate for the baby. Routes of administration include oral, intramuscular, subcuticular, intradermal or topical. Although medicines are sometimes administered intravenously (IV) or via an umbilical venous catheter (UVC) these routes of administration are generally reserved for sick neonates. Additional training is required for midwives to gain this skill.
  • Right documentation: Following drug administration the midwife needs to immediately document and sign on the appropriate drug administration chart.

Preparation for administration


The need to administer medications in neonates can generate significant anxiety for parents and carers. Time must be taken to explain the rationale and the potential adverse effects of treatment prior to administration. Effective communication skills are essential to not only prepare the parents but also to obtain consent for the drug to be given to the baby. Allow time for parents to ask questions. It is important to follow local infection control policies to minimise the risk of harm to the baby and others. This will require drugs to be checked and prepared in the designated drug preparation area where you are working. This should be a quiet and clean environment with no distractions; distractions can lead to significant errors.


Oral administration


Midwives will sometimes be required to administer oral medication to neonates and also, educate parents to give oral medication with safety and confidence.


Tips for oral liquid drug administration



Intramuscular administration


The intramuscular (IM) route should only be used where no acceptable alternative exists for administration, due to the procedure causing pain for the baby. A maximum volume of 1 mL should be administered via this route. Reduction of pain is possible by using the vastus lateralis site (outer thigh; Figure 76.3). It may be useful to adopt distraction strategies such as breastfeeding, non-nutritive sucking and oral sucrose administration (Shah et al. 2009).


Tips for IM administration


Jun 19, 2019 | Posted by in MIDWIFERY | Comments Off on Neonatal drug administration
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