Nursing Procedure Checklist
EAR INSTILLATION
Instruction: Check under Correctly Done if identified skill is Correctly Incorrectly Not
correctly performed; Incorrectly Done if skill is not performed Done Done Done
correctly; and Not Done if the student failed to perform the 2 1 0
skill.
PROCEDURE
1. Gather equipment. Check medication order against the original
physician’s order according to agency policy. Clarify any
inconsistencies. Check the patient’s chart for allergies.
2. Know the actions, special nursing considerations, safe dose ranges,
purpose of administration, and adverse effects of the medication to
be administered. Consider the appropriateness of the medication for
this patient.
3. Perform hand hygiene.
4. Move the medication cart to the outside of the patient’s room or
prepare for administration in the medication area.
5. Unlock the medication cart or drawer. Enter pass code and scan
employee identification, if required.
6. Prepare medications for one patient at a time.
7. Read the MAR and select the proper medication from the patient’s
medication drawer or unit stock.
8. Compare the label with the MAR. Check expiration dates and
perform calculations, if necessary. Scan the bar code on the package, if
required.
9. When all medications for one patient have been prepared, recheck
the label with the MAR before taking them to the patient. Lock the
medication cart before leaving it.
10. Transport medications to the patient’s bedside carefully, and
always keep the medications in sight.
11. Ensure that the patient receives the medications at the correct
time.
12. Identify the patient. Usually, the patient should be identified using
two methods. Compare information with the MAR or CMAR.
a. Check the name and identification number on the patient’s
identification band.
b. Ask the patient to state his or her name.
c. If the patient cannot identify him or herself, verify the patient’s
identification with a staff member who knows the patient for the
second source.
13. Complete necessary assessments before administering
medications. Check allergy bracelet or ask patient about allergies.
Explain the purpose and action of each medication to the patient.
14. Scan the patient’s bar code on the identification band, if required.
15. Perform hand hygiene and put on gloves.
16. Cleanse external ear of any drainage with cotton ball or washcloth
moistened with normal saline.
17. Place patient on his or her unaffected side in bed, or if
ambulatory, have patient sit with head well tilted to the side so that
affected ear is uppermost.
18. Draw up the amount of solution needed in dropper. Do not return
excess medication to stock bottle. A prepackaged monodrip plastic
container may also be used.
19. Straighten auditory canal by pulling cartilaginous portion of pinna
up and back for an adult
20. Hold dropper in ear with its tip above auditory canal. Do not touch
dropper to ear. For an infant or an irrational or confused patient,
Nursing Procedure Checklist
protect dropper with a piece of soft tubing to help prevent injury to
ear.
21. Allow drops to fall on side of canal.
22. Release pinna after instilling drops, and have patient maintain the
position for 5 mins.
23. Gently press on tragus a few times.
24. If ordered, loosely insert a cotton ball into ear canal.
25. Remove gloves and perform hand hygiene.
26. Assist the patient to a comfortable position.
27. Evaluate patient’s response to medication within appropriate time
frame. Document accordingly.
TOTAL SCORE
Comment:
__________________________________________________________________
____________________________________________________________
__________________________
Score: ____ _____
Name of Student: Date
Performed:
(Signature Over Printed Name)
Evaluated by: Date of Evaluation:
(Signature Over Printed Name)
