Rights of Medication Administration review for nursing students!
The purpose of the Rights of Medication Administration is to prevent medication errors. The nurse is the last safety net in medication administration, and we must always double or even triple check everything. As a nurse, I’ve caught many medication errors by using the Rights of Medication Administration.
For example, I’ve discovered errors where pharmacy put in the wrong dose and frequency or the physician accidently ordered a medication that was meant for another patient. In addition, I’ve encountered medication dispensing errors where the Pyxis system dispensed the wrong medication. Therefore, even with all the technology available today, errors can still happen and by following the Rights of Medication Administration we may be able to prevent some of them.
How Many Rights of Medication Administration are there?
The medication administration rights have really evolved over time. We started out the 5 rights, which really lay the foundation for the nurse’s safety checks during medication administration. However, the number of rights has grown and you have probably heard of the 5 Rights, 7 Rights, 9 Rights, and 10 Rights etc. So, in this review I’m going to cover the 5 Rights, and then I’m going to cover some of the extra ones that have been added on over the years.
As a nurse, you want to perform these rights every time you give medications. If something doesn’t seem right or make sense ALWAYS take the time to investigate it.
5 Rights of Medication Administration
Confirm you have the right patient for the medication by using at least TWO patient identifiers.
Example: Have patient state their full name and date of birth and compare this information to the patient’s identification band and to the MAR (medication administration record).
Check the medication order and make sure the medication name on the order matches the name of the medication you’re administering. Be sure to look at it fully because some medications have similar names and if you do a quick glance you may not catch it.
Here is an example: Acetazolamide (diuretic) vs. Acetohexamide (treats diabetes and helps lower blood glucose)
Also, during this step confirm that the medication is not expired or damaged along with the patient’s allergies.
Check that the dosage ordered matches the dosage you plan to administer. Many times you’re not going to be dispensed with the exact dose because the pill needs to be split or the vial contains more medication than what was ordered. But whatever the reason is, you want to always double check your math if calculating and if needed, have another nurse double check it with you.
Check the prescribed route on the order with how you plan to administer it. Medications can be given various ways. Most common routes are oral, IV, subq, IM, topically etc.
Make sure you have the right supplies for the prescribed route. For example if giving IV: confirm the IV access works by flushing it and once the med has been given flush the access again, IM: select the best muscle to use with the right sized needle, orally: check how well your patient swallows, do they need them crushed or mixed in apple sauce or pudding, and if so, can that particular medication be crushed, topically: remove and clean previous dose off the skin before applying the fresh dose.
Check how often the medication was prescribed and that it matches how often you will be administering the dose. Make sure you’re familiar with the common frequencies.
In addition, make sure you are administering the medication at the right time…not too late or too soon (especially with PRN medications). The facility you work at should have a specific policy that outlines the time frames for administering medications, and this is very important for time critical meds like antibiotics, anticoagulants, insulin etc.
Chart after giving the medication. This is very important because remember the phrase if you didn’t chart it, it didn’t happen.
Documentation helps tell other caregivers when the patient’s last dose was, which is very important for the next shift, when the patient is being transferred to another unit, or being discharged.
In the documentation be sure to include: the medication name, dose, time, route, site you used (example: fentanyl patch….where did u place it), any numerical data that is needed like: vital signs (hr, bp, temp, pain rating), lab values, descriptive words and location of pain if giving pain medication, follow-up to how it helped the pt (pain meds) etc.
Inform the patient or their caregiver about what medications you’re administering, why it’s prescribed, how often it’s taken, dosage, technique for administering like with an injection, and expected vs. abnormal side effects…the patient needs to be included in their care so when they go home they understand how to take the medication and what to monitor for.
Collect important assessment data that is needed for certain meds before administering them. This can be vital sign data (ex: heart rate with beta blockers), lab values (ex: warfarin…know INR level), health history information (their last dose, other meds they’re taking that could interact, allergies, underlying health conditions)
When you see the order as yourself “why was this medication ordered?” “What condition is the med treating?” For example, let’s say your patient has right-sided heart failure and is in fluid volume overload. The doctor orders Furosemide. Ask yourself…how will this medication help my patient? It will help pull fluid from the blood into the urinary system to be voided. Therefore, the nurse should prepare the patient with easy access to the bathroom, monitor for dehydration, and for a low potassium level. Furosemide is a loop diuretic that wastes potassium.
*Right to refuse
The patient can refuse medications. If after educating the patient about why it’s ordered and assessing the patient’s concern for why they don’t want to take it, they still decline to take it, be sure to document thoroughly. In addition, let the prescribing physician know.
Follow-up and assess if the medication provides the right effect and document. Example: Your patient is experiencing uncontrollable a-fib. You receive an order to start a Diltiazem drip. You need to evaluate if this medication is providing the proper effect. It should control the rate which may help convert the rhythm back to normal sinus rhythm. Therefore, the nurse will be evaluating the patient regularly by monitoring the patient’s rhythm, heart rate and blood pressure.
Now test your knowledge with this “Rights of Medication Administration Nursing Quiz”.