Topical Medications

Overview

1. Purpose
   1. Topical medications are absorbed through the skin
   2. They may have local benefits like decreasing itching or inflammation
   3. OR they may have systemic effects (like medicated patches)

Nursing Points

General

1. Supplies needed
   1. The topical medication
      1. Cream
      2. Ointment
      3. Lotion
      4. Paste
      5. Patch
   2. Washcloth or bath wipe
   3. Permanent marker/pen
2. ALWAYS
   1. Remove old patch or cream before applying new
      1. Exception – barrier cream shouldn’t be removed – can cause skin breakdown – just apply over it
   2. Rotate sites, especially with patches
   3. Wear gloves when administering!
      1. Otherwise YOU could get a dose!

Assessment

1. Skin
   1. Only apply over broken skin if that is the purpose of the medication (i.e. bacitracin for a skin tear)
   2. Medicated patches should be applied over clean, dry, hairless, intact skin
      1. May need to use a razor to remove hair before applying

Nursing Concepts

1. Steps and Nursing Considerations
   1. Verify provider order
   2. ALWAYS follow 5 rights BEFORE preparing medication
      1. Right Patient
      2. Right Drug
      3. Right Dose
      4. Right Route
      5. Right Time
   3. ALWAYS prepare medications at the patient’s bedside
   4. Gather supplies
   5. Perform hand hygiene
   6. Don clean gloves
   7. Let the patient know what meds they will be receiving
   8. Creams, ointments, and lotions
      1. Place prescribed amount in palm of gloved hand
      2. Rub hands together to warm/soften if needed
      3. Spread evenly over skin in intended location
         1. Use even strokes
         2. Follow the direction of hair growth
      4. Apply to desired thickness based on manufacturer instructions or provider orders
   9. Medicated patches
      1. Remove old patch
      2. Dispose of old patch by folding medicated sides together and disposing in an appropriate waste container (per facility policy)
      3. Choose new site
      4. Clean the skin at the new site
      5. Time/date/initial the outside of the patch
      6. Remove backing/covering
      7. Hold only by the very edge of the patch
      8. Apply patch to desired area, press firmly for 10 seconds
   10. Nitro Paste/Ointment
       1. Remove previous dosing paper
       2. Dispose of appropriately
       3. Choose new site
          1. Typically chest,  upper arm or upper back
       4. Clean the skin at the new site
       5. Apply the desired inches of paste/ointment to the back of the dosing paper using the measuring guide
          1. Open the packet on the dotted line
          2. Squeeze the tube or packet gently
          3. Don’t glob
       6. Place the paper with ointment directly on the skin
          1. Don’t rub it in
       7. Time/Date/Initial the paper
       8. Secure the dosing paper with tape on at least 2 sides or with a Tegaderm
   11. AFTER administration
       1. Document administration and patient’s response
       2. If using barcode medication administration
          1. Scan all meds before preparing
          2. Confirm administration AFTER giving to patient
   12. Discard all used supplies
   13. Remove gloves
   14. Perform hand hygiene
   15. For PRN meds, return in 15-30 minutes to evaluate response

Patient Education

1. Indication and possible side effect(s) of medication(s)
2. Signs to report to nurse or provider