The Rights of Medication

Administration
March 13th, 2012

By Jennifer Olin, 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, its time to give
some more.
Its 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 taskbut 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.
Lets 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 patients name and face. To identify a client correctly, the nurse must
check the medication administration form against the clients 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 prescribers 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 prescribers 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 patients 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.

10 Rights of Medication Administration

Whether you are a nurse giving medication or a patient receiving medication, it is
important to understand the 10 rights of medication administration. You may be giving
medications to a family member or taking them yourself. Safety should be the first thing
on your mind with medications. There is always a risk of giving the wrong pill, the wrong
dose, or the wrong persons medication. If this happens, harm to the person can occur
and some reactions can be deadly. While there has always been protocol for giving
drugs in the hospital, it is important for everyone to know the safety rules for medications.
In the past, you may have heard of the 5 Rights of Medication Administration: right
patient, right drug, right route, right time, and right dose. Medical practices have
changed to include a few more rights.

10 Rights of Medication Administration

1. Right Patient
Make sure you are giving the right medication to the right person.If you are at home and
giving medication to a family member, make sure you check the bottle and giving the
right prescription to the right person.
If you work in the medical field, always ask the patients name, check an ID band, and
check the medication bottles to compare before giving a medication.

2. Right Medication
When your doctor prescribes a medication, there will be a prescription label on the bottle.
It isnt safe to just grab any bottle and take any pill. Even pharmacies can make
mistakes. Check your pills and your prescription label carefully to make sure you have
the right medication. Check the label every time you grab your bottle to take a dose. Most
pill bottles are easily mixed up because they look so much alike. Also, never store a
different medication in an empty pill bottle that was used for something else.
In a healthcare setting, check the medication supply and compare it to the doctors
orders to make sure it is the right one. Some medications have sound alike names.
These include the drugs Inderal (Heart Medication)/Adderall (ADHD Stimulant), Celexa
(Anti-depressant)/Celebrex (Anti-Inflammatory), Paxil (Anti-depressant)/Plavix (Blood
Thinner), and many others that could be dangerous medication errors if mixed up.

3. Right Dosage
This is one of the most important in the 10 rights of medication administration. Before you
leave the doctors office, ask how much of the medication you should take. Then if you
are unsure after you leave, talk to the pharmacist. When you get home do not play with
dosages. Do not break pills in half or take more or less than the doctor wants you to.
Check to see if it takes more than one pill to make your right dosage. For example; you
may need two 25mg tabs to make a 50mg dosage.
In the healthcare setting, check the doctors orders to your supply of the medication on
hand. Calculate the dosage yourself to make sure it is right. Be aware of the difference
of a pediatric dose and an adult dose.

4. Right Route
If your doctor gives you pill form and you cant swallow, you may need to ask for liquid
form of the medication. This is especially important for children that cannot swallow pills
yet. Check to see if the medication is given by suppositories (rectal or vaginal) and only
use topical creams and lotions on the skin.
Nurses should always make sure their patients can swallow pills okay and make sure the
medication is given the right route. Some injections can either be IM (In the Muscle) or
Sub-Q (In the fatty tissue).

5. Right Time
If your doctor orders a medication at HS, this means take it at bedtime. Some bedtime
medications can make you sleepy. If you see the letters, QAM that means take the
medication in the morning.

6. Right Documentation
Athome you should keep a journal of the meds you take, what time you took them and
how much you took. If you give yourself injections, write down the injection site since
most injection sites should be rotated.
Nurses need to write down a medication that is given after they give the actual dose.
Nurses should also document injection sites. Any medication documentation needs to be
initialed yourself, never let anyone document for you.
7. Right Client Education
Know the side-effects of the medications you and your loved ones are taking. Let them
know what they are and have them tell you if they feel an unwanted reaction to the
medication.
The same thing goes for nurses in the hospital, let your patients know what to expect
from the medication: side-effects, benefits, and reactions that might happen.

8. Right to Refuse
At home or in the hospital, people taking medications have the right to refuse
medications. If someone tells you they dont want to take something, simply dispose of
the medication and call the doctor to let them know. Nurses must legally document a
refusal of medication.

9. Right Assessment
Have a copy of the patients medical history. Medications like blood pressure medications
always warrant a quick blood pressure check before giving a blood pressure medication.
Ask the doctor what number is too low to give the medication.

10. Right Evaluation

Make sure you check for drug allergies and interactions between different medications.
Doctors and pharmacists dont always catch them and we need to be a third set of eyes.
At home, it is important to keep a drug guide so you can check prescriptions against
each other.

Medication Administration Guidelines

After learning about the 10 rights of medication administration, here are the guidelines for
medication administration. Whenever a medication is given, follow these guidelines for
medication safety:
1. Let them know what they are taking and answer questions.
2. Give them responsibilities. Hand them their meds and let them take them.
3. Give them privacy.
4. Dont get distracted while giving medications.
5. Use a quiet place for medication administration.
6. Dont leave bottles open or leave them out on a counter. Keep small children in mind.
7. Wash your hands with soap and water before giving someone medicine.
8. Wash your hands after you give someone medicine, especially if there are multiple
sick people in your home.