PRINCIPLES OF DRUG ADMINISTRATION

I. The “Five Plus Five Rights” of Drug Administration

5 Traditional Rights

1. right client
2. right drug
3. right dose
4. right time
5. right route

5 Additional Rights
1. right assessment
2. right documentation
3. client’s right to education
4. right evaluation
5. client’s right to refuse

A. Right Client
Nurse must do:
 verify client  check ID bracelet & room number
 have client state his name
 distinguish bw 2 client’s with same last names

B. Right Drug
 medication order may be prescribed by:
a. Physician
b. Dentist
c. Podiatrist
d.Advanced practice registered nurse (APRN

Components of a drug order:

1.date & time the order is written
2.drug name (generic preferred)
3.drug dosage
4.frequency & duration of administration
5.any special instructions for withholding or adjusting dosage
6.physician or other health care provider’s signature or name if TO or VO
7.signature of licensed practitioner taking TO or VO
 Nurse must do:
• check med order is complete & legible.
• know general purpose or action, dosage & route of drug
• compare drug card with drug label three times.
1. at time of contact with drug bottle/ container
2. before pouring drug
3. after pouring drug

4 Categories of Drug Orders:

1.Standing Order / Routine Order
 ongoing order
 may have special instructions to base administration
 include PRN orders
ex. digoxin 0.2 mg PO q.d., maintain blood level at 0.5 – 2.0 ng/ml
2.One-time (single) order
 given only once, at a specific time
ex. Cefixime 2mg IM at 7 AM on 12-1-05
3. PRN order
 given at client’s request & nurse’s judgement for need & safety
ex Mefenamic Acid 500mg q 4h PRN for pain
4. STAT order
 given once, immediately
ex. Morphine 2mg IV STAT

C. Right Dose
 Nurse must do:
• Calculate and check drug dose accurately.
• Check PDR, drug package insert or drug handbook for recommended range of
specific drugs.
• Check heparin, insulin and IV digitalis doses with another nurse.
 Stock- method vs Unit-dose method

D. Right Time
 Nurse must do:
• Administer drugs at specified times.
• Administer drugs that are affected by foods, before meals.
• Administer drugs that can irritate stomach, with food.
• Drug administration may be adjusted to fit schedule of client’s lifestyle, &
activities. & diagnostic procedures.
• Check expiration date.
• Antibiotics shld be administered at even intervals
E. Right Route
 Nurse must do:
• assess ability to swallow before giving oral meds.
• Do not crush or mix meds in other substances before consultation with
physician or pharmacist
• Use aseptic technique when administering drugs.
• Administer drug at appropriate sites

Stay with client until oral drugs have been swallowed.

F. Right Assessment
 get baseline data before drug administration.

G. Right Documentation
 Immediately record appropriate info
• Name, dose, route,time & date, nurse’s initial or signature
 Client’s response:
• narcotics
• analgesics
• antiemetics
• sedatives
unexpected reactions to meds.
 Use correct abbreviations & symbols.

H. Right to Education
 Client teaching :
• therapeutic purpose
• side-effects
• diet restrictions or requirements
• skill of administration
• laboratory monitoring
 Principle of Informed Consent

I. Right Evaluation
 client’s response to meds.
o effectiveness
o extent of side-effects or any adverse reactions

J. Right to Refuse
 Nurse must do:
• determine, when possible, reason for refusal.
• facilitate px’s compliance.
• explain risk for refusing meds & reinforce the reason for medication.
• Refusal shld be documented immediately.
• Head nurse or health care provider shld be informed when omission pose
threat to px