Ten Rights of Medication Administration with Nursing Implications
Right Medication. The medication given was the medication ordered. Nursing Responsibility: Check three times for safe administration. Read the medication administration record (MAR) and compare the label of the medication against it. Check the expiration date of the medication. If the dosage does not match the MAR, determine if you need to do a math calculation. While preparing the medication, look at the medication label and check against the MAR. Recheck the label on the container before returning to its storage place.
2. Right Amount / Dose. The dose ordered is appropriate for the client. Nursing Responsibility: Give special attention if the calculation indicates multiple pills/tablets or a large quantity of a liquid medication. This can be a cue that the math calculation may be incorrect. Double check calculations that appear questionable. Know the usual dosage range of the medication. Question a dose outside of the usual dosage range.
3. Right Patient/Client. Medication is given to the intended client. Nursing Responsibility: The Joint Commission s National Patient Safety Goal requires a nurse to use at least two client identifiers whenever administering medications. Neither identifier can be the client s room number. Acceptable identifiers may be the person s name, assigned identification number, photograph, or other person-specific identifier. Check the clients identification band with each administration of medication. Know the agency s name alert procedure when clients with the same or similar last names are on the nursing unit. 4. Right Route. Give the medication by the ordered route. Nursing Responsibility: Make certain that the route is safe and appropriate for the client. Clients may require physical assistance in assuming positions for intramuscular injections. 5. Right Time and Manner. Give the medication at the right frequency and at the time ordered according to agency policy. Nursing Responsibility: Medication given within 30 minutes before or after the scheduled time are considered to meet the right time standard. The nurse should also check institutional policy concerning administration of medications. Hospitals often have standardized interpretations for abbreviations. The nurse must memorize and utilize standard abbreviations in interpreting, transcribing, and BAUTISTA, Jesther Rowen, SN IV/CORPUZ, Rhodora, SN III
administering medications accurately. The schedule for the administration of a drug should be planned to maintain consistent blood levels of the drug in order to maximize the therapeutic effectiveness. The schedule for oral administration of drugs must be planned to prevent incompatibilities and maximize absorption. Certain drugs require administration on an empty stomach. Thus, they are given 1hour before or 2 hours after meals. Other medications should be given with foods to enhance absorption or reduce irritations. Still other drugs are not given with diary products or antacids. It is important to maintain the recommended schedule of administration for maximum therapeutic effectiveness. Before the administration of any p.r.n. medication, the patient s chart should be checked to ensure that the drug has not been administered by someone else, or that the specified time interval has passed since the medication was last administered. 6. Right Client Education. Explain information about the medication to the client.(e.g., why receiving, what to expect, any precautions). Nursing Responsibility: Clients may need guidance about measures to enhance drug effectiveness and prevent complications, such as drinking fluids. Some clients convey fear about their medications. The nurse can allay fears by listening carefully to clients concerns and giving correct information. 7. Right Documentation. Record the drug administered. Nursing Responsibility: The facts recorded in the chart are name of the drug, dosage, method of administration, specific relevant data such as pulse rate, and any other pertinent information. The record should also include the exact time of administration and the signature of the nurse providing the medication. Document medication administration after giving it, not before. If time of administration differs from prescribed time, note the time on the MAR and explain reason and follow-through activities. (e.g., pharmacy states medication will be available in 2 hrs.) in nursing notes. If medication is not given, follow the agency s policy for documenting the reason why. 8. Right to Refuse to Medication. Adults clients have the right to refuse any medication. Nursing Responsibility: Assess the reason for refusing the medication. If knowledge deficit underlies client s reason for refusal, provide appropriate explanation why the medication was ordered. Document if client refuses and medication and his reason. The nurse s role is to ensure that the client is fully informed of the potential consequences of refusal to the health care provider. 9. Right Assessment. Some medication require specific assessments prior to administration (e.g., apical pulse, blood pressure, lab results). Nursing Responsibility: Medication orders may include specific parameters for administration (e.g., do not give if pulse less than 60 or systolic blood pressure less than 100). Obtain baseline data before administration. Assess the client s vital signs. 10. Right Evaluation. Conduct appropriate follow-up (e.g., was the desired effect achieved or not? Did the client experience any side effects or adverse reaction?)
BAUTISTA, Jesther Rowen, SN IV/CORPUZ, Rhodora, SN III
Nursing Responsibility: in all activities, nurses need to be aware of the medications that a client is taking and record their effectiveness as assessed by the client and the nurse on the client s chart. The nurse may also report the client s response directly to the nurse manager and primary care provider.
Reference: KOZIER & ERB S Fundamentals of Nursing, Eight Edition ,VOL. 2, pp. 848-850 By: CORPUZ, Rhodora SNIII/ BAUTISTA, Jesther SNIV
BAUTISTA, Jesther Rowen, SN IV/CORPUZ, Rhodora, SN III