Safe Administration of Oral Medications

General Guidelines

The American Academy of Pediatrics recommends strict adherence to the "rights" of medication administration to ensure patient safety and therapeutic efficacy, including dispensing medication directly from the patient's prescription bottle, verifying patient identity, and checking medication expiration date 1
The safe administration of oral medications requires verification of the pharmacy prescription label and prescriber medication order, cross-referencing prescribed medication with patient allergies, and ensuring medication and dosage are appropriate for the health condition 1
Patients should be weighed in kilograms before first administration and periodically throughout therapy, and the weight-based correct dose should be verified, with questions directed to the pharmacist or prescriber 1
Medication dosage should be recorded using "leading 0s before a decimal amount and avoiding trailing zeros after a decimal" 1
The route of administration should be confirmed on the prescription, and proper administration technique should be ensured based on formulation (tablets, capsules, liquid) 1

Medications should be administered as ordered, with a flexibility of 30 minutes before or after the scheduled time unless otherwise specified, and patients who do not present for scheduled medication should be located 1
The American Academy of Pediatrics recommends considering the patient's ability to swallow when selecting between tablets, capsules, or liquid formulations, and determining if crushing tablets or opening capsules is appropriate and safe for patients with swallowing difficulties 2
Certain medications, such as oseltamivir (Tamiflu), can be administered without regard to meals, though administration with meals may improve gastrointestinal tolerability, according to the American Academy of Pediatrics 2
Oral bisphosphonates must be taken on an empty stomach, and the patient must remain upright, as recommended by the American Society of Clinical Oncology 3

Storage of schedule II controlled substances must be limited to authorized personnel, and documentation of administration should be reviewed regularly, as recommended by the American Academy of Pediatrics 1
Rapid access to emergency rescue medications should be provided in accordance with state law, according to the American Academy of Pediatrics 1
When converting between intravenous and oral routes, bioavailability differences should be considered, and dosing should be adjusted appropriately, as recommended by the American Academy of Pediatrics 4

Medication errors due to look-alike/sound-alike medications can be prevented by verifying medication name and dose twice, and using tall-man lettering for similar medication names, as recommended by the American Academy of Pediatrics 1
Improper crushing of extended-release formulations can be prevented by verifying whether a medication can be crushed before administration, and considering alternative formulations when crushing is not appropriate, according to the American Academy of Pediatrics 1
Poor adherence with complex regimens can be improved by simplifying medication regimens when possible, providing clear written instructions, and considering medication timing relative to the patient's daily routine, as recommended by the American Academy of Pediatrics 1