Medication Administration

Medication Safety


For this section, please read pages 830-852, 859-866 in your Kozier and Erb text.   


According to a 1999 Institute of Medicine report medication errors kill about 7,000 hospital patients every year.

The five medication rights are as follows: 

·      Right drug. Read all labels. The nurse should get additional information for any unfamiliar drugs such as correct dosage and interactions. The nurse should question any unclear order or any order that seems inappropriate (Lilley & Guanci, 1994).  

·      Right patient. The nurse should ask the patient his or her name and check the patient's identification band. The nurse must ensure the name on the medication administration record (MAR) matches both the identification band and the medication label (Elliott & Yisi, 2010).  


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·      Right dose. The nurse should understand all measurements and abbreviations used at their facility. The nurse is responsible for ensuring that the prescribed dose is within the known dose range (Elliott & Yisi, 2010).   For any dose the nurse does not feel is correct, the nurse should double check the order or consult authoritative sources such as the pharmacy department. Do all calculations and, if uncertain of the results, have a coworker recheck the calculations (Lilley & Guanci, 1994).

·      Right route. Follow all policies and procedures (including your facility's protocols) for each route of administration. The nurse must use only recommended landmarks for intramuscular or subcutaneous injections and document the site (Lilley & Guanci, 1994).  The nurse is only permitted to administer medications by the route prescribed. If the route is questionable, the nurse should clarify it with the physician (Elliott & Yisi, 2010).  

·      Right time. To ensure therapeutic serum level, medications have to be administered at the correct time. Therefore, the nurse should question any order that seems inappropriate in its timing. Omit or delay a dose only when indicated by a specific condition or situation. Document the action, and notify the physician of the condition or situation (Elliott & Yisi, 2010).    
    While the five rights are standard in the nursing profession, documentation should be included in these rights. Nurses should always document their actions – remember “if it was not documented, it did not happen.”  Accurate nursing documentation keeps nurses out of court. In the event of a malpractice lawsuit, it will be crucial in the nurses’ defense (Medi-Smart Nursing Education Resources, 2010).

·      Right documentation. The nurse must document when the medication is administered. Failing to document when a medication has been administered creates the risk of another nurse repeated the dose because they assumed it had not been administered. The nurse document any “PRN” medications administered. Documentation should include the dose, time, reason for administration and the outcome. A patient’s refusal must be documented as well (Elliott & Yisi, 2010).   

References
Medi-Smart Nursing Education Resources. (2010).
Do's and Don'ts of Nursing Documentation. Retrieved from http://www.medi-smart.com/nursing-resources/documentation
Elliott, M., & Yisi, L. (2010). The nine right of medication administration: An overview. British Journal of Nursing, 19(5), 300-305.
Lilley, L. L., & Guanci, R. (1994). Med errors: Getting back to basics. 
The American Journal of Nursing, 94(9), 15-16. 
Photo image. Retrieved from http://www.motorola.com/staticfiles/Business/Solutions/Medical%20Administration/_Image/Static%20files/NE_EM_MC_ENC_MD.jpg