Administration of medicines: Introduction
NB: See learning outcomes for this tutorial mapped to competencies, a PDF of the whole text, and a one-page summary.
☞ Why this subject matters...
This tutorial covers concepts that you may not have come across if you haven't worked in a hospital before. It describes common clinical problems and gives you troubleshooting tips for resolving administration issues, but it does not give an in-depth description of each method of giving medicines.
Routes available
Most clinical problems that you'll encounter will relate to administration of medicines into the gut ('enteral') or by injection but remember that there are other routes which you should not overlook. For example, the transdermal route can be a useful alternative if you are running out of suitable methods to give certain medicines (e.g. fentanyl patches for pain in a patient with dysphagia). Similarly, the inhaled route can be used to administer selected drugs other than bronchodilators and corticosteroids (e.g. antibiotics for cystic fibrosis, pentamidine for Pneumocystis jirovecii pneumonia).
Note that in many clinical situations in hospitals, the administration of medicines can involve unlicensed use. Although medicines cannot be promoted outside the limits of their marketing authorisation, the Human Medicines Regulations 2012 do not prohibit the use of unlicensed medicines. It is recognised that informed use of unlicensed medicines or of licensed medicines for unlicensed purposes (‘off-label’ use) is often necessary – particularly in paediatric patients.
For example, crushing tablets and opening capsules for administration through enteral feeding tubes is unlicensed but common practice. However, make sure you have investigated all the appropriate licensed options first (e.g. oral liquids). The MHRA has provided guidance on the use of unlicensed medicines.