Safe medication administration is one of the top priorities in nursing. It’s how we heal our patients! So let’s talk about the ten rights of medication administration and how to use them in practice.
1. Right Patient
The first of the 10 medication administration rights is having the right patient. You need to start by knowing what medication is for what patient. Ask the patient to verify their name and date of birth and match it with their medical record. Then go ahead and scan the patients arm band into the system to verify it. Doing so will give you two verifications to ensure you have the correct patient.
2. Right Medication
Next off you need to make sure you have the right medication. Read the order of the medication on the MAR (Medication Administration Record) as well as on the medication itself. You can do this first when getting the medication from the Pyxis or the patients’ cassette and then again at the bedside. Just like with the right patient, this will give you two more verifications to ensure you have the correct medication.
3. Right Dose
When checking for the right medication, also check to see if it’s the correct dose that has been ordered in the MAR. Again, you can do this when obtaining the medication as well as at the patients’ bedside.
4. Right Time
Next up is the right timing of the medication. Sometimes medications get delivered off schedule, it happens. So make sure the previous nurse gave it on schedule, and if not, then reschedule the next due time in the MAR to help avoid medication errors. Sometimes when the medication has been given off schedule, the MAR doesn’t pick this up and the previous nurse might have forgotten to modify the next due time. So if a medication is due every 8 hours, make sure it’s been 8 hours since it was last given. You can verify all the correct medication administration times at the beginning of your shift, when obtaining the medication, as well as at the bedside for three times the safety.
5. Right Route
The right route is super important. Maybe you have a capsule medication, and you just assume it’s ordered orally but in reality that patient is NPO (nothing by mouth) with an NG (nasogastric) tube. You double check the order to see that it’s actually ordered NG tube, good thing you looked! Or maybe the order is PO (oral), but you also see that there’s a new order for the patient to be NPO for a procedure tomorrow. Is this mediation supposed to be held or given with a small sip of water? Check the doctors note and call to clarify if it’s not noted anywhere.
Also visit Tips for New Nurses on Calling the Doctor, A Guide to Nasogastric (aka NG) Tubes, and A Guide to IV Therapy for more info.
6. Right to Refuse
Part of knowing your 10 medication administration rights is understanding the right to refuse. Patients who are fully alert and oriented always have the right to refuse treatment. The only patients who have waived their right to refuse are those on a psych hold. So educate your patients as much as possible as to why the medication was ordered and how it will benefit them. Try to understand why they are refusing their medication and chart accordingly.
If the patient is refusing the medication because it made them feel sick last time, try to explain the side effects and actions you can take to avoid them. You can communicate the patients’ refusal reason with the doctor when they’re doing rounds to maybe get a modification or a different medication ordered. But ultimately, the patient has the right to refuse.
7. Right Documentation
Regardless of if the medication was given or if it was refused, you must document on it. Using your MAR to scan the medications in is the best form of documentation. If the patient refused, there should be a drop down in your MAR that says ‘refused’ rather than ‘given’. So be sure to document accordingly.
8. Right Patient Education
Whenever you’re doing a med pass, it’s the perfect time for patient education. What meds are you giving? Does the patient take these at home? Do they already know what they’re for? Are they aware of the side effects? If not, you need to be educating them. Even if they are taking these medications at home, they may not be well versed in them. So let the patient know if there are any adverse reactions or side effects they should be aware of. If there’s family at the bedside, include them in on the conversation. The more educating you can do the better. And don’t forget to chart on your education!
9. Right Assessment
Along with education, you’re going to need to check back in on your patient to make sure they are tolerating the medication/medications well. Are there any adverse reactions? Side effects? Do they appear to be tolerating the medication well?
If this is a new medication, you can chart that the patient is ‘tolerating the medication well’ or if not, then list the side effects the patient is experiencing. If the patient is experiencing any adverse reactions or too strong of side effects, be sure to stop the medication and let your charge nurse and the patients’ doctor know so that something can be done.
10. Right Evaluation
And the last of the 10 medication administration rights, the right evaluation. If the patient received medication for pain, then you need to go back in and evaluated their level of pain to make sure it’s getting better. If there hasn’t been any change, or if the pain has gotten worse, then you’re going to need to either call the doctor and/or try some non-pharmaceutical remedies. Your evaluation should reflect on how well the medication did its job so you can adjust your care as you go, with the right doctors’ orders that is. And don’t forget to relay this information to the next nurse in your handoff report.
Be sure to visit Nursing Fundamentals: A Guide to Pain, Patient Education: How to Effectively Manage Acute and Chronic Pain, and Essentials of a Good Bedside Handoff Report for more information.
And that’s it! The 10 rights of medication administration!
Be sure to follow along with the entire Nursing Fundamentals Series:
- A Guide to Intravenous Fluids
- A Guide to Delegation and the Nursing Process
- An Intro to Pharmacology
- And more!