Topical Skin Drug Application
Topical drugs are applied directly to the skin surface. They include lotions, pastes, ointments, creams, powders, shampoos, and aerosol sprays. Topical medications are absorbed through the epidermal layer into the dermis. The extent of absorption depends on the vascularity of the region.
Nitroglycerin, fentanyl, nicotine, and certain supplemental hormone replacements are used for systemic effects. Most other topical medications are used for local effects. Ointments have a fatty base, which is an ideal vehicle for such drugs as antimicrobials and antiseptics. Typically, topical medications should be applied two or three times a day to achieve their therapeutic effect.
Equipment
Patient’s medication record and chart ▪ prescribed medication ▪ gloves ▪ sterile 4″ × 4″ gauze pads ▪ transparent semipermeable dressing ▪ adhesive tape ▪ solvent (such as cottonseed oil) ▪ Optional: sterile gloves.
Implementation
Verify the doctor’s order.1
Avoid distractions and interruptions when preparing and administering the medication to prevent medication errors.1
Compare the medication label to the order and verify that the medication is correct.1
Check the expiration date on the medication; don’t give the medication if it has expired.
Check the patient’s medical record for an allergy to the prescribed medication. If the patient has an allergy, don’t administer the medication; notify the doctor.1
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.5
If your facility uses a bar code scanning system, scan your identification badge, the patient’s identification bracelet, and the medication’s bar code.
Provide privacy.
Explain the procedure thoroughly to the patient because he may have to apply the medication by himself after discharge.
Help the patient assume a comfortable position that provides access to the area to be treated.
Expose the area to be treated. Make sure the skin or mucous membrane is intact (unless the medication has been ordered to treat a skin lesion, such as an ulcer). Applying medication to broken or abraded skin may cause unwanted systemic absorption and result in further irritation.
If necessary, clean the skin of debris, including crusts, epidermal scales, and old medication. You may have to change your gloves if they become soiled.
Applying Paste, Cream, or Ointment
Open the container. Place the lid or cap upside down to prevent contamination of the inside surface.
Using your gloved hands, apply the medication to the affected area with long, smooth strokes that follow the direction of hair growth (as shown below). This technique avoids forcing medication into hair follicles, which can cause irritation and lead to folliculitis. Avoid excessive pressure when applying the medication because it could abrade the skin.
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