Administering medications is one of the most common tasks completed by most nurses. Medication administration can be a monotonous and time-consuming task. One medication administration pass may take hours to complete. The actual act of giving the medications is often not the onerous part of medication administration. Gathering supplies and/or equipment and locating the patients account for large chunks of time. In my personal experience as a direct care nurse, often I would complete a medication pass only to turn around and have to start all over again with another round. Although medication administration is a common practice, it is also a matter of life and death. At times, some nurses become complacent when administering medications, but each medication error can have extreme consequences.
Medication errors can cause injury and even death. The amount of medications errors self-reported to the Food and Drug Administration (FDA) is staggering. Many people suspect the number of actual medication errors is much higher than the self-reported number. Each time a nurse is administering medications they need to be cognizant of the dangers. The best way to prevent medication errors at the point of administration is to follow the six rights of medication administration for each and every medication. Exceptions to following the six rights of medication administration could cost a nurse his/her license.
Six Rights of Medication Administration
Right Client – Medication errors often occur because one patient gets a drug intended for a different person. It is nearly impossible to remember each patient’s name and face. To identify a patient correctly, the nurse must check the medication administration record and the type of identification utilized in the facility. Identification types can vary greatly from one facility to another, but they usually include some combination of pictures and/or identification bands. It is imperative to always follow the facility’s policy for identification prior to administering medication.
Right Medication – Read the medication label carefully! This step alone is often overlooked as the nurse attempts to complete a medication administration pass. Read the medication order carefully! Ensure the label and order match exactly. If label and the order do not match call the physician or pharmacist before administering the medication. Always check the expiration date of the medication. If the drug is unfamiliar, consult a drug book or pharmacist prior to administering the medication.
Right Dose – Compare the dose in the order to the dose on hand. If it is the same then proceed, if not perform any conversions or calculations as required. If the correct dose is not available and calculations are required it is always best to have another nurse double check the calculation. A drug book will list therapeutic dose ranges for each medication to ensure the dose is not too high or too low. If the medication needs to be crushed, check a drug book or a “Do Not Crush” guide.
Right Time – The nurse must understand why a medication is ordered for certain times of day and whether that time schedule can be altered. Medications that must be given in a specific time range at should be given priority, for examples insulin before a meal or sleep aids when the patient is actually ready for bed.
Right Route – If the order does not specify a route of administration such as orally/ by mouth, injection or intravenously (IV) the nurse must consult the prescriber. If the prescribed route is not the recommended route the nurse should speak with the prescriber before administering the drug.
Right Documentation – This is a newer addition to the traditional “Five Rights”. Many medication errors result from faulty documentation. 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 Medication Administration Record (MAR) must be completed per facility policy.
Compliance with the “Six Rights” will help prevent any “wrongs” associated with medication errors – and just may save lives.