Experts have called for the five rights to be expanded to the ten rights of medication administration.
When it comes to the safe administration of medications, you can never be too careful, especially as up to 10% of patients experience unwanted side effects or reactions, and research shows that administration errors make up 60% of all drug errors.
The rights of medication administration are there not only to reduce the harm caused by medication errors but also to protect the interests of the patient and the nurse administering.
The 10 Rights of Medications Administration
1. Right patient
- Check the name on the prescription and wristband.
- Ideally, use 2 or more identifiers and ask the patient to identify themselves.
2. Right medication
- Check the name of the medication, brand names should be avoided.
- Check the expiry date.
- Check the prescription.
- Make sure medications, especially antibiotics, are reviewed regularly.
3. Right dose
- Check the prescription.
- Confirm the appropriateness of the dose using the BNF or local guidelines.
- If necessary, calculate the dose and have another nurse calculate the dose as well.
4. Right route
- Again, check the order and appropriateness of the route prescribed.
- Confirm that the patient can take or receive the medication by the ordered route.
5. Right time
- Check the frequency of the prescribed medication.
- Double-check that you are giving the prescribed at the correct time.
- Confirm when the last dose was given.
6. Right patient education
- Check if the patient understands what the medication is for.
- Make them aware they should contact a healthcare professional if they experience side-effects or reactions.
7. Right documentation
- Ensure you have signed for the medication AFTER it has been administered.
- Ensure the medication is prescribed correctly with a start and end date if appropriate.
8. Right to refuse
- Ensure you have the patient consent to administer medications.
- Be aware that patients do have a right to refuse medication if they have the capacity to do so.
9. Right assessment
- Check your patient actually needs the medication.
- Check for contraindications.
- Baseline observations if required.
10. Right evaluation
- Ensure the medication is working the way it should.
- Ensure medications are reviewed regularly.
- Ongoing observations if required.
Points 1 to 5 are the ‘5 Rights of Medication Administration. Points 6-10 are unratified checks that have been suggested by multiple US nursing boards and research panels to enhance patient safety.
Nurses reach out to me regularly with questions concerning medication administration and preparation.
One reader asked about a nurse’s responsibilities when drawing up an injectible medication but not administering it, and specifically wanted to know about the documentation duties affiliated with the draw-up.
Proper preparation and medication administration
One of the first general principles in medication administration that a nurse must adhere to is to personally prepare any medications properly ordered for a patient and to personally administer those medications.
Although there may be instances in which more than one healthcare provider may be required to administer a single medication, such as in a code, it is not generally acceptable practice to prepare any type of medication for another person to administer. Nor is it acceptable practice to administer a medication that another has prepared.
The reasons for this strict rule are numerous. First and foremost, because preparation and administration are fraught with potential for error, relying on another nurse to prepare a medication that you administer is dangerous at best.
Did your nurse colleague correctly pull the right medication? Did your nurse colleague calculate the correct amount of an injectible drug for the patient? Did the nurse check the order and determine the medication was ordered for this patient?
If there is a patient injury or death because of an incorrect drug or an incorrect amount given, both you and your colleague will be named in a suit filed by that patient or the patient’s family. During the judicial process, the two of you most likely will be at odds with each other, as your colleague will steadfastly state he or she prepared the drug as ordered while you try to convince the jury otherwise.
Explore Your Higher Education Options
In addition, since you administered a medication you did not personally prepare, you will need to overcome the testimony of a nurse expert that a general, cardinal rule in administering medications is that one never administers a drug not personally prepared.
Responsible and truthful documentation
A second reason this rule is important is the fact that along with personally preparing and administering a medication, the nurse doing so is also responsible for the proper, accurate and truthful documentation of the medication administered. This responsibility speaks to a nurse’s accountability when preparing, administering and documenting medications given.
Moreover, if you prepare a medication for someone else to administer, but you document the medication as given, you have just falsified that entry in the patient’s medical record. In contrast, if the nurse who administered the medication that you prepared documents the medication as given, your nurse colleague also has falsified the entry, since he or she did not prepare the medication.
Falsification of any record is a serious allegation that can result in an employee being fired or reported to the state board of nursing. And if a patient injury or death occurs because of the medication administered and its surrounding false documentation, a verdict against those involved in the professional negligence or wrongful death suit is very likely.
Following the basic rule coupled with the “8 rights of medication administration” — right patient, right dose, right medication, right route, right time, right reason, right response and right documentation — can help you avoid medication administration errors.
Discover how Nurse.com can help you find your next dream job. Nurse.com Job Seeker
Just sign up and wait to be paired with your perfect match.
Dealing with the guilt of leaving your job
NextUCSF telephone discharge program poster wins national honor
Our legal information columnist Nancy J. Brent, MS, JD, RN, concentrates her solo law practice in health law and legal representation, consultation, and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state.