The administration of medication is a critical responsibility nurses must perform, no matter the setting. In nursing school, nurses are taught the five rights of medication administration. It’s essential to understand why these rights are used.
Even with implementing the five rights, medication errors continue to occur. According to the National Library of Medicine, they can result in patient harm or death.
The original five rights of medication administration are:
As nursing and patient care has advanced, some hospitals and other healthcare facilities have added more medication rights to avoid medication errors. These medication rights include:
- To Refuse
1. The right patient
When administering medication, the nurse must ensure the medication is for the right patient. This can be done in several ways. One way would be to ask the patient for their first and last name. The patient must give their full name.
You would then check the patient’s hospital wristband. The hospital wristband has a medical record (MR) number that can also be matched with the MR number in the chart.
In other settings, such as nursing homes, the nurse can identify a patient by asking for their name and date of birth. You can also compare the patient to the picture on the medication admission record (MAR). If a patient is confused or disoriented, consider asking a nurse familiar with the facility and the patient to help you identify the right patient.
2. The right drug
When providing medication to the patient, it’s imperative that it’s the correct medication. You need to know that the drug prescribed is the right drug to be administered. Some medicines have very similar spelling or sound alike.
Some facilities still have paper charts that require physicians to write their orders on paper, and then the nurse transcribes the order. In this case, you must ensure the physician’s writing is legible, so the correct drug and dosage are copied as it was written.
After ensuring the right medication is obtained, it’s also good practice to check the expiration date. Additionally, before administering the medication to the patient, make it a habit to ask if they have any allergies.
3. The right route
Medication is administered to patients in various manners. The way a drug is given can affect its absorption time, affecting how long it will take to affect the patient. Some routes of administration include:
- Eye or ear drops
It’s crucial to know which route of administration to take for each patient and their specific medication and dosage.
4. The right time
The medications the physician prescribes should be given as ordered and as the time of the dosages are spaced so a therapeutic effect can be reached, then maintained. The right time can be critical for regularly scheduled medications, preoperative medication, and pain medication to keep the patient comfortable.
5. The right dose
A nurse can verify if the dose is correct by looking it up since the dose range will be listed. Sometimes a dose must be calculated for a patient’s weight, especially for children. You can also consult with the pharmacy. If you notice the dose is incorrect for your patient, you should clarify with the physician.
An example of the wrong dose given to a patient was when a physician used the unacceptable abbreviation of “U” for units, referring to regular sliding scale insulin.
- The nurse transcribed the order onto the handwritten medication record, using the unapproved abbreviation of “U.”
- The nurse who gave the insulin coverage for a 200 blood sugar thought the 4U on the medication record was 40 units of regular insulin.
- The U looked like a 0. The nurse demonstrated “just following orders” instead of questioning such a high insulin dose to cover a blood sugar of 200.
- The nurse realized the error and reported it to her supervisor quickly.
The patient was monitored, and thankfully, the error did not cause the patient harm.
6. The right documentation
It is imperative to document correctly. Document date, time, medication, dose, route—including where it was given, for example, if it was injected, then where. Include a follow-up note to document the patient’s response, such as did the pain medication work for the patient?
7. The right reason
Do you know why the medication you’re giving was prescribed? Some drugs can have off-label uses and different reasons for being ordered for a patient. An example would be the use of Metformin for Polycystic Ovary Syndrome and Type II Diabetes Mellitus and prediabetes. As the administering nurse, you should know why it is prescribed for the patient.
8. The right response
It is necessary to assess the patient for side effects and the positive results from the medication given.
If the medication has an adverse effect, such as nausea, but the medicine must be used for the treatment, perhaps a different drug can be considered, or an anti-nausea medication be given. If a pain medication is not relieving pain, contact the physician for an order to ensure the patient gets something that will help alleviate their pain.
9. The right to receive education
Nurses educate patients on their diagnosis and care, including the medication they are receiving. By providing the proper education and giving the patient a chance to ask questions, you can actively participate in their care.
Education should include why the medication was prescribed, the desired effects, how often they receive it, the dosage, route, and possible side effects.
10. The right to refuse
We all have the right to refuse all or some of our prescribed care. A patient may refuse a bath, a procedure, physical therapy, or even medication. By providing adequate education, the patient will be able to make an informed decision. If they refuse, you should educate the patient and possibly their caregiver about the possible consequences of not taking the prescribed medicine. You should also notify the physician. Detailed documentation regarding a patient’s refusal must be entered into the chart.
Other issues that can contribute to medication errors
Sometimes, the patient load and acuity may lead a nurse to not be as diligent as they should be when administering medications. With interruptions and work overload, the nurse may feel added pressure to rush and make an error. If you feel overwhelmed by these issues, make sure to let your supervisor know.
Results of using the ten rights of medication administration
What can we learn by always using the five rights of medication administration? We understand that, at a minimum, we need to follow these five basic rights to provide safe patient care.
We became nurses to help people and provide the best care we can for them. Let’s keep doing just that.