There are “Five Rights” to accurate medication administration. If all are observed, the potential for mistakes is drastically reduced. Nurses learn these rules in school. The tendency to skimp on them is a problem that often stems from factors such as overconfidence and staffing shortages. There is no excuse to skimp on rules; follow the rules and keep your patients safe.
These 5 Rights are:
The Right Medication
Check the label on the bottle, bubble pack or other packaging, the M.D. order, and the medication administration record (MAR). If there are any discrepancies, ask. Check the chart and M.D. notes and ask the pharmacy. If doubt remains, call the M.D. for clarification.
The Right Dose
Check the M.D. order, the MAR, and the packaging label. If you are unfamiliar with this medication, check your drug book. Be sure you are using the most up-to-date source. If you are unsure of a dose, ask. Consult with the pharmacist or call the M.D.
The Right Time
Again, check the order, the MAR, and the medication label. Give the medication at the precise time. If you question the frequency, look it up and if necessary, consult the pharmacist or M.D.
The Right Route
Again, always check the order, the MAR, and the medication label. Can this medication be given as ordered? Can the patient swallow it? Or can it be crushed? Is it available in a liquid form? If it’s an IV med, is it compatible with the solutions and site? If it’s injectable, what other parameters need to be considered?
The Right Patient
Most important of all, do you have the right patient? How do you know? Verify all the above steps and then verify the patient information. Check the wrist band. Ask the patient to tell you his name and date of birth. If he can’t tell you, does he know his physician’s name? Is there a family member present to verify identification?
Double-Check and Document
When all these steps have been followed, check for any protocols from your facility especially in regards to IV or injectable medications. Make sure the patient swallows any oral medications. Observe the patient for a response and any possible reaction. Follow protocols for medications that require frequent monitoring and for any specific procedures or protocols required if this is the patient’s first dose of a medication.
Document on the MAR and anywhere else appropriate whether additional information is needed or appropriate to the situation. Notify the M.D. immediately in the event of any reaction or error.