The “Five Rights” of Drug Administration - Pharmacology

What are the five rights of drug Administration ?

There are five traditional right actions that should be followed when giving medication. These are to determine the right patient, right drug, right dose, right time, and right route. Five additional rights include the right assessment, documentation, education, evaluation, and the right to refuse.

RIGHT PATIENT

The right patient means that the healthcare provider gives the drug to the right patient. Each time a drug is administered, the healthcare provider must verify who the patient is by the patient’s identification bracelet. This is the preferred method as opposed to identifying a patient by asking his or her name. Some patients will answer “yes” to any name and two patients can have similar sounding names or the same name. Some patients are not mentally alert and do not remember their name. Again, check the patient’s identification every time medication is administered.

RIGHT DRUG

Healthcare providers must be sure that the drug is the correct medication for the patient. This too leads to errors. Healthcare providers ask: Was this the drug prescribed on the medication order? Is the medication order legible and complete? Why is the patient receiving this medication? Is the medication consistent with the patient’s condition? Does the patient have any food or drug allergies?

Providers check the expiration date and return the medication to the pharmacy if it has expired. If the medication is used past the expiration date, the effect on the patient can be unpredictable.

Healthcare providers check the medication label three times before administering the drug. First, when they take the medication from the shelf or drawer. Next, the label should be checked before pouring the drug, and third it is checked after pouring the drug before throwing away the drug packaging.

RIGHT DOSE

The dose on the medication order must be within recommended guidelines. The healthcare provider should have a general idea of the dose before performing any drug calculations. If the calculated dose varies too much from this estimated dose, check with a pharmacist or another appropriate healthcare provider. Some drug calculations should always be checked by two individuals if the calculation is complicated or the drug has the potential to be harmful if the dose is too large or too small. Medications that are wrapped and labeled or pre-filled for the exact dose are preferred and can reduce errors.

Healthcare providers should also make sure they use the proper system of measurement when calculating a dose (see Chapter (Substance Abuse) Principles of Medication Administration).

RIGHT TIME

Is it the correct time to administer the drug? The time is specified in the drug order and may be given a half hour before or after the stated time depending on the policy of the hospital or healthcare facility. How often a drug is given is dependent on the half-life of the drug. Adrug’half-life is the amount of time for 1/2 of the drug to be eliminated from the body. A drug with a short half-life must be administered more frequently than a drug with a long half-life in order to maintain a therapeutic level of the drug in plasma.

The use of military time can avoid A.M. and P.M. errors.

Check if the patient is scheduled for diagnostic or other procedures that might interfere with administration of medications. Check if the patient should receive the medication even if they are scheduled to be NPO (nothing by mouth).

Healthcare providers should also make sure that medication is given in coordination with meals.Some drugs must be given with meals while other drugs are given a specific period before or after a meal.

Where possible, the medication schedule is adjusted to conform to the patient’s lifestyle, which may differ from the normal schedule. For example, Digoxin might be scheduled for 10 A.M. to conform to hospital policy, but the patient can take Digoxin any time in the morning. This becomes important once the patient is discharged and takes medication at home.

RIGHT ROUTE

The healthcare provider determines the proper routine to administer the drug so the patient’s body properly absorbs it. Here are the common routes:

  • Oral (by mouth): liquid, elixir, suspension, pill, tablet, and capsule
  • Sublingual (under tongue): pill, tablet, and capsule
  • Buccal (between gum and cheek): pill, tablet, and capsule
  • Topical (applied to skin): cream, ointment, and patch
  • Inhalation (aerosol sprays): liquid
  • Instillation (nose, eye, ear): liquid, cream, and ointment
  • Insertion (rectal, vaginal): suppository
  • Intradermal (beneath skin): injection
  • Subcutaneous (beneath skin): injection
  • Intramuscular (in muscle): injection
  • Intravenous (in vein): injection
  • Nasogastric and gastronomy tubes: liquid
  • Transdermal: patches

Make sure that the patient can swallow if the route of the medication is by mouth and stay with the patient until the medication is swallowed. Enteric coated or time-release drugs should not crushed or mixed. Caution should be used when administering intravenous medications because the body quickly absorbs these drugs. Therefore, healthcare providers need to know expected side effects, effects that occur when the drug is first given, effects the drug has during its therapeutic peak, and duration of the drug’s action. Caution should be used when administering any medication via this route.

Self-administration of medication (SAM) is the normal practice for patients in the home and workplace. This method is also used in some acute and long term care institutional settings. In these settings the nurse gives the patient a packet of medications with instructions that are kept at the bedside. The patient takes the medication according to the instructions and advises the nurse when he or she has done so. This practice help patients learn how to manage the medications and prepares them for discharge and use of these medications in the home. This method is often used with oncology (cancer) patients and maternity patients.

Patient controlled analgesia (PCA) is a common method of administering intravenous pain medication for many patients. This will be discussed further in a subsequent chapter.

RIGHT TO REFUSE MEDICATION

A mentally competent patient has the right to refuse medication. Refusal is Documented on the patient record. Patients should be advised of the consequences of the refusal to take the medication such as a worsening of the condition. As a general rule, every effort is made to encourage the patient to take the medication. However, no one should physically force a patient to take medication.

RIGHT TO EDUCATION

The patient has the right to be told about the medication that is about to be administered. The patient is told:

  • The name of the medication
  • Why the medication is given
  • What the medication looks like
  • How much of the medication to take
  • When to take the medication
  • When not to take the medication
  • What are the side effects, adverse effects, and toxic effects

This information is discussed in the best way the patient can understand. Healthcare providers should avoid speaking in medical terminology and, instead, use common words and expressions that are familiar to the patient and always in the language that the patient speaks.

The patient provides feedback that he or she understands everything about the medication. It is common for the healthcare provider to ask the patient to tell in his or her own words what was told to them about the medication.

The patient is also shown how to keep track of multiple medications .Typically, the patient is encouraged to keep a list of medications. The list should have the name of the medication, dose, time the medication is to be taken and the name and phone number of the pre scriber who ordered the medication.


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