Which of the following actions should the nurse take when instilling the eye drops?

According to the National Institutes of Health, proper technique during eye drop administration is crucial for the medication's efficacy and for preventing infection. This guide provides an authoritative, step-by-step breakdown of the best practices that address the critical question: Which of the following actions should the nurse take when instilling the eye drops?

Quick Summary

A nurse instilling eye drops should perform hand hygiene, use clean gloves, create a conjunctival sac by pulling down the lower eyelid, and instill the medication without touching the dropper to the eye, followed by nasolacrimal duct occlusion to prevent systemic absorption.

Key Points

• Hand Hygiene: Always wash hands and wear clean gloves to prevent infection.

• Conjunctival Sac: Instill the drops into the conjunctival sac, not directly onto the cornea.

• Avoid Contamination: Do not allow the dropper tip to touch the eye, eyelids, or lashes.

• Nasolacrimal Occlusion: Apply gentle pressure to the inner canthus to prevent systemic absorption.

• Educate and Position: Explain the procedure to the patient and ensure they are in a comfortable position, looking up.

Standardized Procedure: Ensuring Safety and Efficacy

Correctly administering eye drops is a fundamental nursing skill that requires precision and adherence to established protocols. A systematic approach minimizes the risk of infection, maximizes medication absorption, and ensures patient comfort. The following sections detail the evidence-based steps a nurse must take, covering everything from preparation to post-procedure care.

Step 1: Pre-Administration Preparation

Before beginning, the nurse must complete several preparatory actions to ensure the safety and effectiveness of the procedure.

• Verify the Order: Confirm the right patient, medication, dose, route, and time (the “five rights” of medication administration). Also, ensure the medication is for ophthalmic use and has not expired.
• Gather Supplies: Prepare all necessary equipment, including the prescribed eye drops, sterile gloves, tissues or cotton balls, and a normal saline solution if cleaning is required.
• Perform Hand Hygiene: Wash hands thoroughly with soap and water before and after the procedure. This is the single most important step in preventing cross-contamination.
• Don Gloves: Apply clean, non-sterile gloves to protect both the patient and the nurse.
• Educate the Patient: Briefly explain the procedure to the patient, ensuring they understand what to expect. This can reduce anxiety and increase cooperation.

Step 2: Positioning and Cleansing

The patient's position and the cleanliness of the eye are vital for successful instillation.

• Position the Patient: Have the patient sit or lie down with their head tilted slightly back. Instruct them to look up at the ceiling or at a fixed point to prevent blinking.
• Cleanse the Eye: If there is any discharge or crusting, use a sterile gauze pad or cotton ball moistened with normal saline to gently wipe the area. Always wipe from the inner canthus (corner of the eye near the nose) to the outer canthus, using a fresh wipe for each stroke to prevent spreading contaminants.

Step 3: Precise Instillation Technique

This stage is where the medication is delivered, and technique is paramount to avoid contamination and improper absorption.

• Expose the Conjunctival Sac: Using the thumb or index finger of your non-dominant hand, gently pull down on the lower eyelid. This creates a small pouch, or conjunctival sac, into which the drops will be instilled.
• Steady the Hand: Rest your dominant hand, holding the dropper bottle, on the patient’s forehead or cheek to steady it. This prevents sudden movements from causing injury or contaminating the bottle.
• Administer the Drops: Hold the dropper approximately 1 to 2 cm (1/2 to 3/4 inch) above the conjunctival sac. Squeeze the bottle to release the prescribed number of drops, ensuring the dropper tip does not touch the eye, eyelid, or eyelashes. Instilling drops directly onto the sensitive cornea can be painful and is incorrect.
• Multiple Drops: If more than one eye drop is prescribed for the same eye, wait approximately 3 to 5 minutes between each instillation to allow the first drop to be absorbed properly.

Step 4: Post-Instillation Care

Once the drops are in, proper care is needed to maximize effectiveness and minimize side effects.

• Nasolacrimal Duct Occlusion: Gently apply pressure to the inner canthus with a clean tissue for 30 to 60 seconds. This action closes the nasolacrimal duct, preventing the medication from draining into the systemic circulation, which is particularly important for certain medications like beta-blockers.
• Blot Excess Medication: Use a tissue to blot any excess medication that has spilled onto the patient’s cheek.
• Patient Instructions: Remind the patient to close their eyes gently and avoid squeezing or rubbing them. Explain that squeezing can push the medication out, and rubbing can cause irritation.

Key Comparisons: Best Practices vs. Common Errors

To reinforce the proper technique, it's helpful to compare recommended actions against common mistakes.

Action	Best Practice	Common Error
Hand Hygiene	Wash hands thoroughly and wear clean gloves.	Forgetting to wash hands or not wearing gloves.
Instillation Site	Drop into the conjunctival sac.	Drop directly onto the sensitive cornea.
Dropper Contact	Keep the dropper tip away from the eye and lashes.	Allowing the dropper to touch the eye, causing contamination.
Head Position	Head tilted back, looking up.	Head forward or looking down.
Post-Instillation	Apply pressure to the inner canthus for 30-60 seconds.	Squeezing eyes shut tightly or rubbing the eye.
Multiple Drops	Wait 3-5 minutes between drops in the same eye.	Instilling drops in rapid succession, which dilutes the medication.

Special Considerations for Different Patients

Age and physical condition can influence the administration technique.

• Pediatric Patients: Administering drops to an infant or young child often requires a different approach. The closed-eye technique can be useful, where the drop is placed at the inner corner of the child's closed eye while lying down. When the child opens their eye, the medication will flow in. Parental assistance may be necessary to gently restrain the child.
• Elderly Patients: For patients with unsteady hands or those who are uncooperative, assistance may be required. Ensuring a calm environment and providing clear, simple instructions can help. If tremor is an issue, a specialized eye drop guide or a supine position may be beneficial. Gently but firmly holding the patient’s head can help prevent movement.

Conclusion: Adherence is Paramount

Correct eye drop administration is more than just delivering a medication; it's about patient safety, infection control, and treatment effectiveness. By following the meticulous steps outlined, a nurse can ensure a safe and successful procedure every time. The proper actions—including strict hygiene, precise technique, and careful post-instillation care—are non-negotiable standards of care. Adherence to these guidelines not only protects the patient but also reflects the high professional standards of nursing practice.

For more detailed information on nursing skills, please refer to authoritative resources such as the National Center for Biotechnology Information.

Frequently Asked Questions

What is the very first action a nurse should take before instilling eye drops?

The very first action is to perform hand hygiene and don clean gloves to prevent contamination and infection.

Why is it important to pull down the lower eyelid to form a pocket?

Pulling down the lower eyelid creates the conjunctival sac, a safe and non-sensitive area for the medication to be instilled, which helps with absorption.

What should the nurse do if the patient blinks when the drop is administered?

If the patient blinks, assess if the drop was successfully delivered. If not, another drop can be administered, but the nurse should wait a few seconds and ensure the patient is ready.

How can a nurse prevent eye drop medication from being absorbed systemically?

To prevent systemic absorption, the nurse should apply gentle pressure to the inner canthus (nasolacrimal duct) for 30 to 60 seconds after instillation.

What is the recommended wait time between two different types of eye drops for the same eye?

If administering more than one eye drop, wait at least 3 to 5 minutes between each application to ensure proper absorption and prevent dilution of the medication.

Is it okay for the dropper tip to touch the patient's eye or eyelashes?

No, the dropper tip should never touch the patient's eye, eyelids, or eyelashes, as this can contaminate the bottle and lead to infection.

How should a nurse handle administering eye drops to a pediatric patient?

For children, a nurse might use the closed-eye technique by placing the drop in the inner corner of the eye while the child is supine. The drop will flow in when the child opens their eye.