mark tozer's blog: EMS Medication Administration

EMS Providers should have a thorough understanding of rectal medication administration to ensure safe and effective treatment.

Here are some key points they should know:

1. Indications and Contraindications

Indications:

Need for rapid absorption and onset of action when other routes are not feasible or practical.
Common medications administered rectally include anticonvulsants (e.g., diazepam for seizures), antiemetics, and certain sedatives or analgesics.
Patients who are unable to take medications orally or intravenously.

Contraindications:

Rectal bleeding, inflammation, or injury.
Recent rectal surgery.
Allergy to the medication.
Conditions where rectal administration may not be safe or effective, as determined by local protocols or medical direction.

2. Mechanism of Action

Absorption:

Medications administered rectally are absorbed through the rectal mucosa into the systemic circulation, bypassing the gastrointestinal tract and first-pass metabolism in the liver.

3. Preparation and Technique

Medication Preparation:

Verify the “Six Rights” of medication administration: right patient, right medication, right dose, right route, right time and right documentation.
Ensure the medication is appropriate for rectal administration and prepare it according to protocol (e.g., suppository form).

Patient Preparation:

Position the patient on their left side (Sims Position) or in a knee-chest position to facilitate administration and retention of the medication.
Wear gloves and ensure privacy and dignity of the patient during the procedure.

4. Administration Techniques

Insertion:

Lubricate the suppository or applicator tip with water-soluble lubricant.
Gently insert the suppository or applicator into the rectum past the internal sphincter (approximately 1-2 inches in adults, less in children).
Instruct the patient to remain in position for a specified time to ensure retention and absorption of the medication.

5. Patient Communication and Education

Explain the Procedure:

Inform the patient (if conscious) about the purpose of the medication administration, how it will help, and what to expect during and after the procedure.

Instructions:

Provide clear instructions on maintaining the position to allow the medication to be absorbed properly.

6. Monitoring and Follow-Up

Observation:

Monitor the patient for signs of medication absorption, such as reduced seizure activity or relief of nausea.

Reassessment:

Regularly reassess the patient’s condition to determine the effectiveness of the medication and any need for additional intervention.

7. Complications and Management

Retention:

Ensure the suppository or medication remains in place for adequate absorption.

Adverse Reactions:

Be prepared to manage potential adverse reactions, such as local irritation or allergic reactions.

Discomfort:

Address any discomfort or concerns the patient may have during or after the procedure.

8. Special Considerations

Pediatric and Geriatric Patients:

Adjust dosage and technique based on age and physical condition; consider using smaller suppository sizes for children.

Environmental Factors:

Ensure privacy and maintain patient dignity during the procedure.

Patient Condition:

Be aware of any conditions that might affect rectal medication administration, such as rectal prolapse or recent rectal trauma.

9. Training and Proficiency

Simulation Training:

Regular practice using simulation models to maintain proficiency in rectal medication administration techniques.

Continuing Education:

Stay updated on best practices, new medications, and techniques for rectal administration.

10. Legal and Ethical Considerations

Scope of Practice:

Adhere to the legal scope of practice for their certification level and local regulations.

Informed Consent:

Obtain informed consent from the patient or guardian whenever possible.

Documentation:

Accurate documentation of medication name, dose, route, time of administration, and any observed effects or adverse reactions.

Conclusion

Effective rectal medication administration requires EMS providers to combine theoretical knowledge with practical skills.

Continuous training, adherence to protocols, and understanding the indications, techniques, and potential complications are essential for safe and effective patient care.

mark tozer's blog

Wednesday, July 24, 2024

EMS Medication Administration - Rectal Route