Routes of Medication Administration

Oral and Enteral Administration Protocols

Administering oral medications requires strict adherence to drug formulations to ensure safe absorption. Enteric-coated tablets must never be crushed or chewed, and they should not be split unless the manufacturer specifically permits it. Damaging this protective barrier alters where the drug is released in the gastrointestinal tract. Similarly, extended-release, sustained-release, and controlled-release medications are engineered to release their active ingredients gradually over time. Patients must swallow these formulations whole unless the specific product instructions permit splitting or opening. Crushing an extended-release dosage form disrupts its release profile, resulting in an unsafe bolus of medication entering circulation.

Medications absorbed through the oral mucosa bypass standard gastrointestinal digestion. Sublingual medications must be placed directly under the tongue and allowed to dissolve completely. Patients must not chew the tablet or swallow it whole. Buccal medications are positioned between the cheek and the upper or lower gums, allowing active ingredients to be absorbed directly through the oral mucosa. For both sublingual and buccal therapies, patients must avoid eating, drinking, or smoking until the medication is fully dissolved, as fluid or food intake can wash the medication away or interfere with mucosal absorption.

Liquid oral medications demand exact volumetric measurement to avoid dosing errors. When using a medicine cup, place the cup on a flat surface and read the measurement at eye level at the bottom of the meniscus. For small liquid doses, particularly those under 5 mL, nurses must use a calibrated oral syringe rather than an administration cup. Household spoons or cups must never be used to measure medications because of their extreme measurement variability. Before giving oral medications to a patient with dysphagia, assess whether swallowing is safe and follow the prescribed swallowing plan; if oral administration is permitted, position the patient upright as tolerated and maintain the recommended position afterward.

Medication delivery via enteral feeding tubes introduces specific mechanical and physical considerations. Tube placement must always be verified before any medication or fluid is introduced. To maintain patency, flush an enteral feeding tube with water before and after medication administration, commonly using 15 to 30 mL of water per flush for adults unless a different volume is ordered or fluid restrictions apply. Each medication must be prepared separately, crushing only tablets that may safely be crushed, and the tube must be flushed with water between medications according to facility policy and the patient's fluid allowance. Never mix medications directly into continuous enteral nutritional feeding bags. Furthermore, continuous enteral feedings must be held for a prescribed duration before and after medications that bind to formula, such as phenytoin.

To reduce clogging in small-bore feeding tubes, crush only medications suitable for crushing, disperse them thoroughly in an appropriate water source, and flush the tube as directed. Although sterile water is required for some patients, it is not used solely to prevent occlusion. Finally, when administering medications through an enteral tube connected to suction, the suction must be clamped for 20 to 30 minutes following administration so that the medication is not immediately evacuated.