The “Rights” of Medication Administration

March 13th, 2012


By , BSN, RN

Nurses give meds. It is one of the most routine, daily duties for nurses working in a direct care setting. It is sometimes a tedious job, and can take hours from start to finish. And when you turn around, it’s time to give some more.

It’s not just the actual giving of the medications that eats up all the time. There is tracking down the MAR (medication administration record), double checking hand written prescriptions, collecting the various medications and the equipment for giving them, and making sure all the patients are on the floor to receive them.

Despite all of the above, it may seem that giving patients medicine is not a particularly difficult task—but it is one with life and death implications. According the U.S. Food and Drug Administration (FDA) medication errors cause at least one death every day and injure approximately 1.3 million people in the U.S. every year. And those are just the reported mistakes.

The FDA says these mishaps can occur an every stage of the medication delivery system including:

  • Prescribing
  • Repackaging
  • Dispensing
  • Administering
  • Monitoring

The FDA lists the most common causes for these errors as:

  • Poor communication.
  • Ambiguities in product names, directions for use, medical abbreviations or writing.
  • Poor procedures or techniques, or patient misuse because of poor understanding of the directions for use of the product.

Many of these problem areas can fall within the realm of nursing administration of medications. It is for just these reasons that standards for medication administration were developed. Standards are those actions that ensure safe nursing practice.

The standards, in this case, are called the “rights” of medication administration and over the years there have been five, then six and now in many places eight “rights.” All medication errors can be linked, in some way, to an inconsistency in adhering to these “rights” of medication administration. The “rights” are taught from early on in nursing education and training, they are reinforced in the workplace and the FDA, drug companies and healthcare organizations issue signs, posters and plaques that hang in every facility where medications are given, reminding the providers to check and recheck what they do.

Let’s take a look at these “rights.”

  1. Right Client – Med errors often occur because one patient gets a drug intended for another. It is difficult to remember every patient’s name and face. To identify a client correctly, the nurse must check the medication administration form against the client’s identification bracelet and ask the client to state his or her name to ensure the ID band is correct.
  2. Right Medication – This is a multi-step process. The medication should be checked against the medication order and the medication label. Nurses should only administer medications they prepare and verify. If an error occurs, the nurse who give the medication is the one responsible for the error.

    If a client questions the medication a nurse is about to give it is important not to administer it until it can be rechecked against the prescriber’s order. An alert client will know if a medication is different from those received before.

  3. Right Dose – The unit dose system is designed to minimize errors. If a medication must be prepared from a larger volume or strength than needed or when the prescriber orders an amount different than what the pharmacy supplies, the chance for a mistake multiplies. When performing medication calculations or conversions, have a colleague, another qualified RN check the calculated dose.
  4. Right Time – The nurse must understand why a medication is ordered for certain times of day and whether that time schedule can be altered. Every institution has recommended time schedules for medications ordered at frequent intervals. Medications that must act at certain times should be given priority, for example insulin at the precise time before a meal or sleep aids when the patient is actually ready to go to sleep.
  5. Right Route – If a prescriber’s order does not designate a route of administration such as orally or by injection or IV (intravenously) the nurse must consult the prescriber. If the prescribed route is not the recommended route the nurse should double check with the prescriber.
  6. Right Documentation – This is a fairly new addition to the traditional “Five Rights” but has been widely adopted by facilities and caregivers. Many medication errors result from inaccurate documentation. The documentation should clearly reflect the patient’s name, the name of the ordered medication, the time the drug was given and the medications dosage, route and frequency. If any of this information is missing the nurse must contact the prescriber to verify the order. After giving the medication the MAR must be completed per facility policy.

    The final two “Rights” listed are new and are still in the process of being adopted by many facilities although they are highly recommended.

  7. Right Reason – Confirming the rationale for the ordered medication, what is it treating?
  8. Right Response – Make sure the drug has the desired effect? Is the patient now able to sleep, has pain diminished, is the blood pressure lower? And be sure to document monitoring the patient.

So there you have it. As many standards as we have been able to implement for the safe administration of medications. And still, medication errors happen every day, everywhere. You cannot be cautious enough. Apply the nursing process: assess, plan, and evaluate both before and after giving a patient a medication and you both should come out safely.

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