Therapeutics

What staff need to know when Administering Eye Medications

Ensure patients’ safety when instilling eye drops and ointments with these steps.

Mary Jo Bettwy, Brookville, Pa.

Eye medications such as drops and ointments are used for diagnostic and therapeutic reasons. Ointments may be used for both lubrication and medicinal purposes. In the clinical setting, nurses and technicians are called upon to place eye drops and ointments into patients’ eyes so frequently that it becomes second nature. Some may even assert that even with the most squeamish or difficult patients, they can administer eye medications with their eyes closed and one hand tied behind their backs. All too often for the sake of speed or convenience, proper drop and ointment administration procedures are abandoned, jeopardizing industry standards for basic infection prevention and patient safety protocols. What follows is a checklist of proper eye drop and ointment installation.

1. Check the physician’s order to verify correct medication, correct eye and patient. Always confirm your patient’s identity prior to giving any eye medication by verifying name and date of birth.

2. Obtain the correct medication and double check that the correct drop is in your hand by reading the label. Pay strict attention to the expiration date. Refer to your facility’s policy on expiration dates to determine if a medication can still be used. Also, obtain other necessary items such as facial tissues or gauze pads.

3. Perform good hand hygiene with soap and water or an alcohol-based hand sanitizer.

4. Inspect the medication for cloudiness, discoloration, and precipitation. The drop may not have expired, but there may be oxidization near the dropper. If the medication appears too abnormal, discard it and open a new bottle. The exception to this would be suspension medications, which normally may have a cloudy or milky appearance. Always shake ophthalmic suspension medication to remix the solution. Use a sterile gauze pad to remove any crust or residue from the tips of tubes of ointment.

5. Explain the procedure to the patient, being sure to explain possible side effects of the medication. For example, anesthetic drops may cause a brief burning sensation, dilating drops such as mydriatics and cycloplegics may cause slight stinging, blurred vision, and sensitivity to light, while ointment will cause vision to be blurry following administration.

6. Have the patient assume a sitting position or lay in a supine position.

7. Instruct the patient to tilt his or her head back and look up with eyes open. This position of gaze provides maximum exposure to the lower fornix and moves the cornea away from the lower lid, minimizing the risk of contacting the eye, lid or lashes with the tip of the bottle or tube. If necessary, recline the exam chair.

8. Using your non-dominant hand, pull down gently on the skin over the cheekbone to expose the cul-de-sac of the lower lid, creating a cup in which to catch the medication. For infants and children, use your thumb and index finger to separate the lids by resting them on the bony prominences above and below the eye, being careful not to apply pressure on the eye. If the infant or child is uncooperative with this technique and you are unable to separate the lids, you may place the drop of medication on the inner canthus while the patient remains supine. This may also be an appropriate method for adults who have difficulty not squeezing their eyes closed.

9. Using your opposite hand, gently squeeze the bottle between your thumb and forefinger until the desired amount of medication is delivered to the lower cul-de-sac. To steady your hand, you may also rest it against the patient’s forehead if necessary. Avoid placing drops directly on the eye to prevent patient discomfort.

10. When administering ointment, hold the tip of the tube close to the eye and with light, even pressure, squeeze out a thin ribbon from the inner canthus to the outer canthus. Usually a ½ inch ribbon of ointment is enough. Instruct the patient to roll the eye behind closed lids to distribute the medication. If the tube has been opened prior to this use, express one inch of ointment onto a gauze pad or tissue prior to use.

11. To prevent contamination of the medication, be careful not touch the lid, lashes, or eye surface with the dropper or tip of the ointment.

12. Ask the patient to blink a few times to distribute the medication and then gently close the eyes to allow for absorption.

13. Gently wipe away excess medication or tears with a tissue. Remember to use a clean tissue for each eye to prevent cross contamination.

14. Replace the cap of the bottle or tube to prevent contamination and return it to the storage area as recommended by the manufacturer. For example, proparacaine in clear bottles, should be kept refrigerated to prevent discoloration.

15. If administering more than one medication, it is optimal to wait 3-5 minutes between each to allow for adequate absorption. If both drops and ointment have been ordered, the drops should be instilled first.

16. Date newly opened bottles or tubes of ointment.

17. Perform post procedure hand hygiene.

18. Document medication administration in the patient’s medical record to include the eye or eyes treated, and date, time and dose. Be sure to note any adverse reaction and the patient’s response. OP

Resources:

APIC position paper: Safe injection, infusion, and medication vial practices in health care, 2010.

ASORN. (2011). Instillation of Eye Drops and Ointments. Ophthalmic Procedures in the Office and Clinic.

McCann, J. A. (2003). Nursing Procedures and Protocols. Springhouse, Pa: Lippincott Williams & Wilkins.

Mary Jo Bettwy, RN, BSN, MS is a clinical manager with Laurel Eye Clinic, Brookville, Pa., a multi-location practice that includes two laser and surgery centers and 11 eye clinics.