In addition to the traditional “five rights” of medication administration, the nurse has six rights concerning safe medication administration they are:
the right to a complete and clear order; the right to have the right drug, route, and dose dispensed; the right to access to information; the right to policies to guide safe medication administration; the right to administer medication safely; and the right to stop, think, and be vigilant when administering medications.
The traditional five rights of medication administration are:
the right client, the right drug, the right dose, the right time, and the right route. Experience indicates that five additional rights are essential to professional nursing practice: the right assessment, the right documentation, the client’s right to education, the right evaluation, and the client’s right to refuse.
Ensuring that the nurse has the right client is
essential. The Joint Commission requires two forms of client identification before administration.
Identification of the client must take place
each time the nurse administers a medication.
Ensuring that the right drug is administered is
a process that has been simplified for institutionalized patients by computerized order systems.
Only drugs with complete orders should
A complete order contains the following information:
date and time the order is written, drug name, drug dosage, drug route of administration, frequency of administration, special instructions for withholding or adjusting dosage based on nursing assessment, and health care provider’s signature.
The right dose includes
the right dose within guidelines for the drug and client’s physical status such as weight and renal function. This includes the nurse’s responsibility regarding correct drug dose calculations.
The right time is
the time the dose should be administered. Nurses must have knowledge of the effects of certain diagnostic tests and foods on the drug. Drug dosing may be altered to fit a client’s lifestyle if appropriate. Nurses must also be aware of medications that must maintain therapeutic blood levels to ensure that the drugs are given to maintain these blood levels.
The right route is necessary for
appropriate absorption. This includes the nurse’s knowledge of patient limitations regarding the route. Nurses must also ensure that oral medications are swallowed by the client.
The right assessment includes
the nurse’s collecting appropriate assessment information before administering a medication; right documentation of the medication administration; right to education or the client receiving accurate and thorough information about all medications; right evaluation requires that client response to medication be assessed and documented; and the client’s right to refuse a medication. The nurse’s responsibility is to determine the cause for refusal and reeducating the client as necessary.
The culture of safety
concerns health care system changes that have focused on medication error prevention.
A medication error is defined as
“any preventable event that may cause or lead to inappropriate medication use or harm to a patient.”
Medication errors may occur
at any time during the cycle of administration; ordering, transcribing, preparing, and administering. Changes have been made to prevent errors in each of these areas.
Computerized order entry systems are becoming widely used. Most use
a bar coding system that allows client information to be part of a database scanned before medication administration.
Other examples of safety risks in medication administration include
pill splitting, buying medications on the Internet, and “look-alike, sound-alike drug names.”
The Joint Commission has put forth a list of
abbreviations, acronyms, and symbols that have greater risk of being misinterpreted or misread.
The Joint Commission has also devoted six of its
National Patient Safety Goals to increased medication safety.