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Administering Topical Medications (102.073)

Administering Topical Medications (102.073) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Medication Administration, Route of

102.073

1
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: ADMINISTERING TOPICAL MEDICATIONS

Effective Date: April, 2002 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed October, 2003 March, 2005 March, 2008 October 2011

PURPOSE: To provide guidelines for the administration of topical medications at UWMF Clinics.

DEFINITION: Topical medications are applied directly to the skin or mucous membranes. They include
lotions, pastes, ointments, creams, powders, shampoos, patches, gels, and sprays. Topical medications are
absorbed through the epidermal layer into the dermis. The extent of absorption depends on the vascularity of the
region.

POLICY: Clinical staff will utilize the following guidelines to administer topical medications to UWMF
patients. The preparation and administration of a medication should be completed by the same person.

SUPPLIES: Provider’s order, Patient record, Medication(s), Applicator, Gloves
Optional items may include cotton balls, soap, gauze, and tape

PROCEDURE:
1. Check each medication against provider’s order and clarify any inconsistencies.

2. Identify the patient: include date of birth and verify allergies.

3. Wash hands then gather equipment.

4. Know medication’s actions, special considerations, safe-dose ranges, purpose of administration, and
adverse effects. For example:
Never apply medication without first removing previous applications to prevent skin irritation from
an accumulation of medication
Be sure to wear gloves to prevent absorption by your own skin.

5. Prepare medication, adhering to the five rights of drug administration.
Right – drug, dose, time, route, patient
Check the expiration date of the medication

6. Provide good light and privacy by closing curtains or door.

7. Provide patient education:
Explain medication(s), reason(s) for the medication(s), and administration technique to patient
Explain possible sensations to expect during administration (cold or warm to skin, etc.).

8. Put on gloves.

9. Position the patient in a comfortable position.


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10. Inspect condition of patient's skin thoroughly.

11. If indicated, cleanse the area to be treated with warm water and mild soap.
NOTE: If the area is very irritated, use warm water only.

12. Pat the area dry, unless moisture retention is desired.

13. Re-inspect the condition of the patient’s skin. Note the color, temperature, circulation, texture, drainage,
and any changes from the previous observation. If skin is excessively dry and flaking, check with provider
or pharmacist to see if topical agent can be applied while skin is still damp.

14. Change gloves and wash hands (if necessary).

Administering an Aerosol Spray

Shake the container well.
Follow the manufacturer’s directions regarding the distance to hold the spray from the affected area.
Spray the medication evenly over the affected area.
Be sure to direct the spray away from the patient’s face.
Explain to patient that area will feel cool and dry.

Administering Creams, Gels, Pastes, Ointments, and Oil-based Lotions

Place 1 to 2 teaspoons of medication in the palm of gloved hand or use a tongue blade.
Apply medication smoothly and evenly over the surface of area to be
treated. Read manufacturer’s recommendations regarding whether medication should be rubbed in or
applied to skin surface only
Follow the direction of the person’s hair growth.
Explain to patient that skin may feel greasy after application.

Applying a Transdermal Patch

Remove the old patch (if one) and rotate sites
Follow the manufacturer’s directions regarding removal of the patch backing.
Apply the patch to a smooth skin area that is free of lesions or excess hair.
Do not rub or massage ointment into skin.
Instruct patient when to remove patch.

Administering Nitroglycerin Paste or Ointment

Apply gloves and remove the old medication patch
from the patient’s skin and cleanse the area.
Squeeze out the ordered number of inches of
medication onto a paper measuring guide (comes
with the medication)
Place the ointment and paper on the patient’s skin.
Do not touch the ointment, rotate sites.
Cover the ointment and tape the paper in place.
Avoid hairy surfaces or over scar tissue.
Do not rub or massage ointment into skin.


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Applying Suspension-based Lotions

Shake the medication well.
Moisten a gauze pad or cotton ball with lotion and gently pat it onto the area to be treated.

Applying Powders

Be sure the area to be treated is completely dry.
Fully spread apart any skin folds such as between toes or under arms.
Dust skin site lightly using dispenser so area is covered with thin layer.
Cover skin area with dressing if ordered.

15. Help the client to dress and return to a position of comfort.

16. Dispose of soiled supplies in a proper container. Remove gloves and wash hands.

17. Document (Progress Notes in HealthLink utilizing SmartPhrase: .medinclinic)
Manufacture, Lot #, Expiration date (as indicated)
NDC#
VIS# (if applicable)
Name, dosage, route of medication, site of injection, and time given
Assessment and laboratory results relevant to purpose of the medication
Effects of the medication on patient
Teaching about the drug or injection technique
How patient tolerated procedure, i.e., desired effect, adverse reactions

18. Check on patient to ensure that allergic reaction is not occurring.

19. Perform discharge teaching regarding new medications.

REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: LaVay Morrison, RN, BSN, Clinical Staff Educator
WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support

REFERENCE:
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.

Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO: Mosby
Elsevier.

AUTHORIZATION:



Medical Director Date