Thursday, March 17, 2011

The Six Rights of Medication Administration

You thought there were only 5 Rights of Medication Administration, didn't you? Well, one of the important rights gets commonly left out of the mix. Medication administration is probably one of the scariest things to learn as a new nurse and it is also probably one of the most dangerous. We always need to remain alert and cognizant when we are preparing medications. You can reduce your risk for medication errors by preparing medications for only one patient at a time and by always following the 6 Rights of Medication Administration.

Let's take a look at all of the rights.

Right Patient - Make sure you are preparing medications for only one patient at a time. This helps to reduce errors and confusion. Label any drugs that you have to prepare in the med room. No meds should go into a patient's room without a label. Check each medication against the patient's arm band, don't just check the first one you give. This helps to reduce errors from accidentally having a medication for another patient in the room with you. If you check each medication against the patient's ID then you are not only checking the patient's ID but you are also checking to be sure each medication that you have in the room is prescribed for that patient.

Right Drug - Always be sure to check the label of your drug for the correct patient name and the correct drug name. Take extra care with drugs that look alike/sound alike such as Xanex and Zantac. Think about your patient and if the medication you are giving makes sense for the patients diagnoses. Ensure that you are getting another RN to sign off on any high alert medications. Each hospital should have a policy around what constitutes a high alert medication. The Institute for Healthcare Improvement has a web page dedicated to high-alert medications.

Right Dose - Ensure that the dose you are giving is the dose that has been ordered. If your drugs come ready to give from the pharmacy, the pharmacist will check this and then the RN is the double check. Don't not check dosages because you think the pharmacy has already done this. Errors can occur at any step during the process but YOU are the last line between a medication and a patient so it is imperative that you go through the 6 Rights. Check your dose against what is ordered on the Medication Administration Record and be sure that the dose is within the limits for the patient's weight. Also, if your drugs do come up ready to give from pharmacy, ensure that the dose ordered is actually what is in the syringe. If the label reads that 20 mg should be 0.5ml, be sure that 0.5ml is actually what is in the syringe and not just that it says 0.5ml on the label.

Right Time - Be sure you are giving a dose at the right time. Check your MAR for the times that the drug has been ordered and check to be sure you are the correct interval away from the last dose. For instance, if you have a medication ordered q12 hours and dose you are giving is at 0800, be sure that the last dose was given at 2000 the previous night and that it wasn't given late (say 0100) for some reason. Be sure that medications ordered q8 hours are actually timed for q8 hours.

Right Route - Always be sure that you are giving a drug via the route that is ordered. Be careful with drugs that can be given via multiple routes and check to see that you have the right medication for the right route. In other words, if you are giving Zantac IV, be sure you don't have an oral formulation for that drug. The drug label should specify the route and many hospitals use different types of syringes for oral and IV medications as a safety precaution. Never give a drug via another route other than what is ordered unless you check with the provider or the pharmacy.

Right Documentation - This is the 6th Right that is commonly left out! After you give a medication, you need to be sure to properly document it's administration. If you don't, you run the risk of you or someone else causing a medication error because they didn't know that the drug had been given (or you didn't remember that you gave the drug!). This can happen more easily than you think when you are caring for multiple patients to be sure to take the time after your medication administration to properly document what you have given. Always document your drugs given AFTER they have been given and not before. Any number of things can happen when you go in a room to give medications that might prevent you from giving the med. If your patient is on strict I&Os, be sure to record the volume of any meds that were given as well. Remember that the MAR is a very important communication tool between nurses and other health care team members. Have some sort of system on your nursing "brain" that tells you when you have given and documented a medication. For instance, on my own nursing brain, I put circles around and highlight all of my medication time. Once I have given the medication, I put one line through the time. Then, once I have documented the medication, I put another line through it making an X. That way, I can easily look at my nursing sheet and see what I need to give and what I need to document.

Here is a link to the Institute for Healthcare Improvement's medication safety guides.

Slow down when you are giving medications and take the time to go through all of these rights every time. No amount of needing to "hurry up" is worth causing a medication error for a patient.

On another note - most hospitals have a system for reporting and tracking any kind of error or near miss. Anytime you have a medication error or almost have a medication error, be sure to document it through this system and NOT in the patient's chart. Systems keep track of errors and near misses so that they can make system safety adjustments to try and prevent future errors. In order to do this, they must have current data. If you do have an actual medication error, contact the provider and your manager right away. You will probably also need to contact your hospital's Risk Department to ensure that you are following up with the patient and with documentation according to hospital policy.

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