Topical Route: Ointment

Cream & Ointments are medicinal preparations for external use, intended for application to the skin.

CSS Considerations:

  • As per the CNO, medications administered via the topical route are not a Controlled Act; therefore, nurses do not need to delegate topical medication administration to PSWs.
  • CSS should assess the client’s current skin condition.
  • PSWs can apply topical medications on intact skin only and cannot provide treatment to broken skin or a wound.
  • The CSS must advise the PSW of an appropriate amount of cream/ointment to be used if not indicated on the prescription.

PSW Considerations:

Report to the office at 416-635-2860 if:

  • The client has signs of:
    • Broken skin
    • Pain
    • Tender to touch
    • Itchiness
  • The client’s skin condition is getting worse (affected area is getting larger) and the treatment is not effective
  • The cream is not in a container with the appropriate pharmacy labels, or the cream is not in the original container
  • The prescribed cream/ointment is running low or not available for use

Required Supplies:

  • Topical ointment
  • Gloves
  • Soap and water (to clean the affected area)

Procedure for Applying Ointments (Topical Route):

  1. Before beginning, assist the client with a sponge bath or shower as per the care plan, or cleanse the area where the topical medication is to be applied.
  2. Review the delegation notes in the client’s care plan via your mobile device.
  3. Explain the procedure to the client.
  4. Perform hand hygiene.
  5. Gather the ointment and materials that are needed.
  6. Check the label of the ointment for the expiration date.
    • Note: Do not use the medication if it is past the expiration date.
  7. Open the ointment tube or container.
  8. Place the cap of the ointment tube or container upside down on a table top to prevent contamination of the inner aspect of the cap.
  9. Put on gloves.
  10. Apply the topical medication onto the ordered area(s) using gloved hands, a tongue depressor, a cotton tipped applicator, or sterile gauze.
  11. Apply the topical medication in long and even strokes, following the direction of hair growth.
  12. Remove gloves and wash hands thoroughly.
  13. Put away all the supplies used.

Video Resource

Please click on the video link below for a visual demonstration of the procedure:
http://mosby.lambtoncollege.ca/advanced/skill/T001.html

References:

Burke, A. (2023, February 15). Medication administration: NCLEX-RN.
https://www.registerednursing.org/nclex/medication-administration/

College of Nurses of Ontario. (2022, October 21). Delegation.
https://www.cno.org/en/learn-about-standards-guidelines/educational-tools/ask-practice/delegation/

Doylee, G.R., & McCutcheon J.A. (2015). Administering topical medications.
https://pressbooks.bccampus.ca/clinicalproceduresforsaferpatientcaretrubscn/chapter/6-7-administering-topical-medications/

Mosby Nursing Video Skills. (2014). Applying topical medications.
http://mosby.lambtoncollege.ca/advanced/skill/T001.html