Mindanao State University – Iligan Ins tute of Technology College of Nursing

Name: Jan Louis P. Lapay Date: 04/28/2022

Evaluator: Neil M. Martin, MAN, MBE, RN Score: ___________________________

ADMINISTERING MEDICATION VIA A METERED-DOSE INHALER (MDI)

Definition:
A Metered-Dose Inhaler is a pressurized canister of medicine in a plastic holder with a mouthpiece. Metered-dose inhalers (MDI) are used for medications administered by means of the inhaled route
and are usually intended to produce local effects.

Purpose:
Inhaled medications such as the MDIs are absorbed rapidly through pulmonary circulation, producing systemic effects. . Drugs administered by inhalation provide control of airway hyperactivity or
constriction.

Indication:
 For patients with known COPD or asthma with acute exacerbations.
 For patients with known respiratory disease with evidence of airflow obstruction who require endotracheal intubation in order to control the degree of respiratory failure.
 For patients without known respiratory disease whoexhibit expiratory wheezing.

PROCEDURE RATIONALE 5 4 3 2 1
1. Gather equipment. Check each medication order against This comparison helps to identify errors that may haveoccurred when orders
the original order in the medical record, according to were transcribed. The primary careprovider’s order is the legal record of
facility policy. Clarify any inconsistencies. Check the medication ordersfor each facility.
patient’s chart for allergies.

2. Know the actions, special nursing considerations, safe This knowledge aids the nurse in evaluating thetherapeutic effect of
dose ranges, purpose of administration, and adverse the medication in relation to thepatient’s disorder and can also be used to
effects of the medications to be administered. Consider educate thepatient about the medication.
the appropriateness of the medication for this patient.

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Mindanao State University – Iligan Ins tute of Technology College of Nursing
3. Perform hand hygiene. Hand hygiene prevents the spread of microorganisms.

4. Move the medication cart to the outside of the patient’s Organization facilitates error-free administration andsaves time
room or prepare for administration in the medication
area.

5. Unlock the medication cart or drawer. Enter pass code Locking the cart or drawer safeguards each patient’smedication supply.
and scan employee identification, if required. Hospital accrediting organizationsrequire medication carts to be locked
when not in use.Entering pass code and scanning ID allows only
authorized users into the system and identifies user fordocumentation by the
computer.

6. Prepare medications for one patient at a time This prevents errors in medication administration.

7. Read the CMAR/MAR and select the proper medication This is the first check of the label.
from the patient’s medication drawer or unit stock.

8. Compare the label with the CMAR/MAR. Check This is the second check of the label. Verify calculationswith another nurse
expiration dates and perform calculations, if necessary. to ensure safety, if necessary.
Scan the bar code on the package, if required.

9. When all medications for one patient have been This is a third check to ensure accuracy and to preventerrors. Some facilities
prepared, recheck the label with the MAR before taking require the third check to occur atthe bedside, after identifying the patient
them to the patient. and beforeadministration.

10. Lock the medication cart before leaving it. Locking the cart or drawer safeguards the patient’smedication supply.
Hospital accrediting organizationsrequire medication carts to be locked
when not in use.

11. Transport medications to the patient’s bedside carefully, Careful handling and close observation prevent accidentalor deliberate
and keep the medications in sight at all times. disarrangement of medications.

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Mindanao State University – Iligan Ins tute of Technology College of Nursing
12. Ensure that the patient receives the medications at the Check agency policy, which may allow for administrationwithin a period of 30
correct time. minutes before or 30 minutes afterdesignated time.

13. Perform hand hygiene and put on PPE, if indicated. Hand hygiene and PPE prevent the spread ofmicroorganisms. PPE is
required based on transmissionprecautions.

14. Identify the patient. Usually, the patient should be Identifying the patient ensures the right patient receivesthe medications and
identified using two methods. Compare information with helps prevent errors.
the CMAR/MAR.
a. Check the name and identification number on the
patient’s identification band. This requires a response from the patient, but illness andstrange surroundings
b. Ask the patient to state his or her name and birth date, often cause patients to beconfused.
based on facility policy. This is another way to double-check identity. Do not usethe name on the door
c. If the patient cannot identify him- or herself, verify the or over the bed, because thesesigns may be inaccurate.
patient’s identification with a staff member who knows
the patient for the second source.

15. Complete necessary assessments before administering Assessment is a prerequisite to administration ofmedications.
medications. Check the patient’s allergy bracelet or ask Explanation relieves anxiety and facilitatescooperation.
the patient about allergies. Explain what you are going
to do and the reason to the patient.

16. Scan the patient’s bar code on the identification band, if Provides an additional check to ensure that the
required. medication is given to the right patient.

17. Remove the mouthpiece cover from the MDI and the The use of a spacer is preferred because it traps themedication and
spacer. Attach the MDI to the spacer. aids in delivery of the correct dose.

18. Shake the inhaler and spacer well. The medication and propellant may separate when thecanister is not in
use. Shaking well ensures that thepatient is receiving the correct dosage of
medication.

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Mindanao State University – Iligan Ins tute of Technology College of Nursing
19. Have patient place the spacer’s mouthpiece into mouth, Medication should not leak out around the mouthpiece.
grasping securely with teeth and lips. Have patient
breathe normally through the spacer.

20. Patient should depress the canister, releasing one puff The spacer will hold the medication in suspension for ashort period so that
into the spacer, then inhale slowly and deeply through the patient can receive more of theprescribed medication than if it had been
the mouth. projected intothe air. Breathing slowly and deeply distributes the
medication deep into the airways.

21. Instruct patient to hold his or her breath for 5 to 10 This allows better distribution and longer absorption timefor the medication.
seconds, or as long as possible, and then to exhale
slowly through pursed lips.

22. Wait 1 to 5 minutes, as prescribed, before administering This ensures that both puffs are absorbed as much aspossible.
the next puff. Bronchodilation after the first puff allows fordeeper penetration by
subsequent puffs.

23. After the prescribed amount of puffs has been By replacing the cap, the patient is preventing any dustor dirt from
administered, have patient remove the MDI from the entering and being propelled into thebronchioles with later doses.
spacer and replace the caps on both.

24. Have the patient gargle and rinse with tap water after Rinsing removes medication residue from the mouth.Rinsing is necessary
using an MDI, as necessary. Clean the MDI according to when using inhaled steroids becauseoral fungal infections can occur. The
the manufacturer’s directions. buildup ofmedication in the device can attract bacteria and affecthow the
medication is delivered.

25. Remove gloves and additional PPE, if used. Perform Removing PPE properly reduces the risk for infectiontransmission and
hand hygiene. contamination of other items. Handhygiene prevents the spread of
microorganisms.

26. Document the administration of the medication Timely documentation helps to ensure patient safety.
immediately after administration.

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