Skills
Medication Administration: Ear Drops - CE
Quick Sheet
ALERT
If medication is ordered for both ears, ask the patient to stay in the side-lying position for a few minutes after the first dose before turning to the other
side.
Administer only sterile solutions into the ear in case the eardrum is ruptured.
Do not occlude the ear canal with a medicine dropper because it may injure the eardrum.
Do not force any solution into the ear.
Take steps to eliminate interruptions and distractions during medication preparation.
1. Perform hand hygiene before patient contact.
2. Introduce yourself to the patient
3. Verify the correct patient using two identifiers.
4. Assess the patient's baseline vital signs, medication history, and drug allergies.
5. Assess the patient for contraindications to receiving the ear medication and advise the practitioner accordingly.
6. Assess the condition of the external ear structures and canal.
7. Determine whether the patient has symptoms of discomfort or hearing impairment.
8. Assess the patient's level of consciousness and ability to follow instructions.
9. Assess the patient's knowledge regarding drug therapy and motivation to self-administer medication.
10. Assess the patient's ability to grasp and manipulate a dropper.
11. Prepare the medication for instillation.
12. Obtain the medication and verify the expiration date.
13. Inspect the medication for particulates, discoloration, or other loss of integrity. Do not use any medication that is cloudy or precipitated unless
such is indicated by its manufacturer as being safe; otherwise, this may lead to harmful reactions.
14. Understand drug reference information pertinent to the medication's action, purpose, onset of action and peak action, normal dose, common
side effects, and nursing implications, if needed.
15. Perform hand hygiene and don gloves.
16. Explain the procedure to the patient and ensure that he or she agrees to treatment.
17. Check accuracy and completeness of the medication administration record (MAR) with the practitioner's original order.
18. Ensure the six rights of medication safety: right medication, right dose, right time, right route, right patient, and right documentation. Use a
bar code system or compare the MAR to the patient's armband.
19. Label all medications, medication containers, and other solutions, including those on a sterile field. The only exceptions are medications that
are still in their original container or medications that are administered immediately by the person who prepared them.
20. Warm the medication to room temperature per the organization's practice.
21. Instruct the patient to assume a side-lying position (if not contraindicated by the patient's condition) with the ear to be treated facing up or
have the patient sit in a chair or at the bedside with his or her head tilted. Stabilize the patient's head.
22. For adults and children more than 3 years old, gently pull the pinna up and outward (Figure 1); for children 3 years old or younger, pull the
pinna down and back (Figure 2).
23. Gently wipe out any cerumen or drainage that occludes the outermost portion of the ear canal with a cotton-tipped applicator (Figure 3). Do
not use the cotton-tipped applicator to clean the ear canal because it may force wax inward, occluding the canal.
24. While holding the dropper above the ear canal, gently squeeze the dropper and instill the prescribed drops (Figure 1) (Figure 2). To avoid
pressure and potential injury to the eardrum, do not occlude the ear canal with the dropper while instilling the medication.
25. Ask the patient to remain in the side-lying position for a few minutes. Gently massage or apply light pressure to the tragus of the ear with a
finger (Figure 4).
26. If ordered by the practitioner, insert a portion of a cotton ball into the outermost part of the canal. Remove the cotton ball after the medication
is absorbed. Do not allow the cotton to block the canal; blocking the canal impairs hearing.
27. Assist the patient to a comfortable position after the drops are absorbed.
28. Ask the patient if he or she feels any discomfort during and after instillation.
29. Evaluate the condition of the patient's external ear between medication instillations.
30. Evaluate the patient's hearing acuity.
31. Monitor the patient for adverse or allergic reactions to the medication. Recognize and immediately treat dyspnea, wheezing, and circulatory
collapse, which are signs of a severe anaphylactic reaction. Follow the organization's practice for emergency response.
32. Assess, treat, and reassess pain.
33. Discard supplies, remove gloves, and perform hand hygiene.
34. Document the procedure in the patient's record.
Adapted from Perry, A.G. and others (Eds.). (2022). Clinical nursing skills & techniques (10th ed.). St. Louis: Elsevier.
Clinical Review: Suzanne M. Casey, MSN-Ed, RN
Published: July 2021