The six rights of medication administration are the right medication, the right dose, the right patient, the right route, the right time and the right documentation. I plan to implement all of these patient medication administration rights when I progress to working in the field. There are several parts of the medication administration process where errors can occur. Most commonly errors occur in prescribing, transcribing, dispensing, administering and monitoring medications. The nurse is the last line of defense for the patient and therefore it is the nurses responsibility to check and re-check all elements to the medication administration process and to question or correct and mistakes that have been made down the line. I will incorporate the right medication, by checking and double checking labels and orders and making sure that the right medication is given to the right patient. I will also compare the prescriber’s orders with the medication administration record when it is first ordered.
Then when preparing the medication I will compare the label of the medication with the medication administration record three different times; first before removing the container, second as the medication is being removed from the container and lastly at the bedside of the patient before administering the medication. There are many drugs that are spelled almost the same, but this does not mean that they are the same drug or that they are interchangeable. (Patricia A. Potter, 2013) I would also be sure to have the right dose to prevent over or under dosing. I would use measuring devices and conversions to calculate the correct dose and be sure to know which drugs can and cannot be crushed such as extended release tablets or specially coated tabs. An error in dosing can cost a nurse their license and potentially a patient’s life. I will make sure I am able to calculate the medication doses and know how to calculate drug doses by weight. I will also research the drug before administering it to know the recommended drug dosage range for the drug.
If the route or dosage of a drug is ever incorrect, I would contact the pharmacist or prescriber and document all communications. I would be sure to incorporate the right patient, by using two patient identifiers, one being a patient’s first and last name and the second being their date of birth or patient identification number. I would also utilize the electronic barcode scanner when giving medications if one is available. (Linda Lane Lilley, 2013) I would also be sure to know the right route and know which drugs can be given in which route. If a patient were given the wrong medication via an incorrect route, it can cause great damage. I would see what the prescriber has ordered as a route for a patient’s medication and if it is not listed, I would call the prescriber. The right route is necessary for the appropriate absorption of the medication and to ensure the patient is not harmed by administering the drug via the wrong route.
I would also use the right time in making sure that I know when a patient has received their medications and when their next ones are due. The right time is very important to be able to maintain an effective concentration of the medicine in the patient’s blood stream and maintain a therapeutic drug serum level. A dose given too soon can cause toxicity and missed doses can nullify the drug action and its effect. Medications may be given on half hour before or after the time prescribed. There may be circumstances which cause a delay or omission of a medication such as laboratory or diagnostic tests, and you must be sure to document this. Documentation is very important when a drug is administered; it must immediately be documented on the medication administration record with the time the drug was given and with the nurse’s initials, which will help to reduce the likelihood of mistakes or confusion.
I would make sure to keep the right documentation by before giving a medication, making sure that the medication administration record clearly stated the name and order for the patient fully written out. I would also record and chart each medication that was given, what it was given for, what drug was given, how much was given and what time; all immediately after giving the medication. If a drug is refused by the patient, there is a designated area to note the refusal in the medication administration record. (Patricia A. Potter, 2013) Distractions can be avoided when giving medications by not documenting until after a medication is given and after it is given it should be documented immediately after. Another way to avoid distraction is to not talk to anyone while preparing or administering your medication. This can totally distract you and maybe make it harder for you to concentrate or pay attention to what you are doing.
I would also make sure to prepare my medications for my patients in a quiet place to avoid all distraction. If the facility has a medication room then this would be the ideal place to prepare a medication. It is also okay to take your time and let others know that they need to be patient until you are finished with what you are doing. Never leave medications unattended or during the middle of a medication count. (Linda Lane Lilley, 2011) PINCH drugs are those drugs which have been labeled by the hospital or facility as high-alert medications. Medications on the PINCH list include Potassium, insulin, narcotics, chemotherapy and cardiac drugs, and heparin or other anti-clotting drugs. This system is in place to remind nurses of these drugs and which ones they are, so that they can be on a high-alert when administering them as well as using a double check system. When administering any of the PINCH drugs an RN must first have the order and medication verified by a second Registered Nurse before administering the medication. (M. Linda Workman, 2011)
Abbreviations you would not want to use when documenting anything including medications is (1) u/U for unit. This can be mistaken for the number four, number zero, or cc instead write out unit. Another abbreviation we do not use (2) is qd or qod; both could be mistaken for each other and instead we would write out daily or every other day. Another do not use abbreviation is (3) IU which can be mistaken for IV or the number ten, and instead we write out international unit. (4) We also will never use a trailing zero (9.0) or leave out the leading zero (0.9) or else the decimal point can easily be missed. Lastly, (4) we do not want to use the abbreviation MS which can mean morphine sulfate or magnesium sulfate, and so instead we write out the entire name. (Patricia A. Potter, 2013)
The nurse’s role and responsibilities in administering medications are to assess that the medication that is ordered is the correct medication. Assess the patient’s ability to administer their own medications, and decide when (time) a patient should receive a certain medication, administer medications appropriately and monitor the patient’s as well as the effects of the medications. The nurse is the last line of defense to save a patient from harm. It is the nurse’s responsibility to constantly follow through with these six rights of medication administration and make sure the patient is safe. The nurse must also take on the role of teaching patients and their family about the medications that the patient may be taking and assess the patient to ensure that the patient and/or the family is clear on instructions of medications and being able to administer them properly. (Patricia A. Potter, 2013)