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Giving oral medications (and through a feeding tube)

  • Procedure

How to give medications by mouth or through a feeding tube safely: what may be crushed, how to position the patient and how to flush the tube.

Updated

What it is

The oral route is the most used: it is comfortable, cheap and non-invasive, but the patient must be able to swallow safely. Before giving tablets or liquids, check swallowing and alertness, and that the patient is not on gastric suction. When the patient has a nasogastric, gastrostomy or jejunostomy tube, many medications can go through it, but not all: extended-release and enteric-coated forms are not crushed. The order must name the tube route, not «by mouth».

Indications

  • An alert patient who swallows safely.
  • Tablets, capsules, powders or liquids ordered by mouth.
  • A patient with a nasogastric, gastrostomy or jejunostomy tube when the order names that route.

Contraindications and precautions

  • Coughing, choking or a wet voice when swallowing, or reduced alertness: hold oral medications and report.
  • Do not crush extended-release (sustained or long-acting) or enteric-coated forms; check a drug reference, the pharmacist or the «do not crush» list (ISMP publishes one).
  • Some medications are incompatible with the enteral feed: the feed is paused before and after them per protocol; ask the pharmacist.
  • Tube on suction: keep it clamped for a while after the medication, per protocol, so it can be absorbed.

Equipment

  • Medical order and medication record.
  • Medicine cups and a calibrated measuring device for liquids, such as an oral syringe.
  • Pill crusher.
  • Water for drinking or flushing the tube.
  • For a tube: enteral-tip syringe and gloves.

Step by step (and why)

  1. Apply the rights and identify the patient with two identifiers — prevents wrong-patient and wrong-drug errors.
  2. Assess swallowing and alertness, and check that there is no gastric suction — prevents aspiration and lost doses.
  3. Sit the patient up or raise the head of the bed — makes swallowing easier and protects the airway.
  4. Shake liquids and measure with an oral syringe or measuring device — the measure is exact.
  5. Offer an allowed drink and stay until everything is swallowed — confirms the dose was taken.
  6. Tube: check placement per protocol and pause the feed if the drug requires it — prevents aspiration and interactions.
  7. Crush each tablet separately and dilute it in water — mixing them can block the tube or cause incompatibilities.
  8. Flush with water before, between each drug and at the end, per protocol — keeps the tube open and delivers the full dose.
  9. Keep the head of the bed raised and restart the feed when due — lowers the risk of aspiration.
  10. Document the medications and the flush water on the fluid chart — flush water counts as intake.

Complications

  • Aspiration of the medication or fluid into the airway.
  • Tube blockage from poorly diluted or mixed medications.
  • Excess or toxic effect from crushing an extended-release form.
  • Loss of effect when the drug is incompatible with the enteral feed.

Next step: when to call for help

  • If the patient coughs, chokes or has a wet voice when swallowing: stop, reposition and tell the nurse in charge.
  • If the tube will not flush or seems out of place: do not force it or give anything; report.
  • If a tablet cannot be crushed and the patient cannot swallow: ask the prescriber or pharmacist for a liquid form or an alternative.
  • If an unexpected effect or a change in the patient appears after the dose: assess, document and tell the prescriber.

Test yourself

Think of the answer, then tap the question to see it.

Which oral forms must not be crushed?

Extended-release (sustained or long-acting) and enteric-coated forms, among others on the institution's list.

Why is each medication given separately through a feeding tube?

Because mixing them can block the tube or cause incompatibilities; the tube is flushed with water between them.

What does the nurse do if the patient coughs while swallowing a tablet?

Stops, repositions the patient and reports so swallowing is reassessed before going on.

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Connections

← All of nursing

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Nursing Skills (Open RN), 15.2 Basic Concepts of Administering Medications (Open RN, Chippewa Valley Technical College (LibreTexts), 2022); Nursing Skills (Open RN), 15.4 Checklist for Oral Medication Administration (Open RN, Chippewa Valley Technical College (LibreTexts), 2022); Nursing Skills (Open RN), 5.6 Checklist for Enteral Tube Medication Administration (Open RN, Chippewa Valley Technical College (LibreTexts), 2023).

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Representative model, for educational purposes only.