Journal of Advanced Practice Nursing

Exactly How Many Meds? A Nurse's Rights & Wrongs


By Laura Fitzgerald, ASRN Staff Writer

How many rights does it really take to keep from making a wrong? Sometimes your medication administration procedures can feel a bit like running a maze. You think the object of the game is to get through as quickly as possible and feel certain you can see the way out just ahead. The problem is, mazes are tricky. One wrong turn can change a normal shift into a nightmare of consequences.

In truth, the only safe and effective way to get through a maze is to put your hand on the wall and keep it there while you follow the turns, no matter what. Passing medications is much the same, if you stick to your guns, refuse to take short cuts and follow all the rights you can, the turns will lead you and your patients to a safe ending.

What are these rights and how do they affect the quality of nursing care you're giving your patient? There are many versions available. For this discussion we'll walk through eight rights as they would occur during the administration process.

1. Right reason: If the old man in 24B is yelling and it's two o'clock in the morning, what are your options?

Do you:

A. Close his door and pretend you can't hear him.

B. Walk around with your stethoscope in your ears so you really can't hear him.

C. Give him demerol and phenergan to put him to sleep.

D. Spend some time with him trying to calm his anxiety.

There are all kinds of reasons for medicating someone. Some of them are appropriate, some are not. Before you ever reach the medication cart make sure you know why you are giving a medication and that the drug has been approved for that use.

2. Right time: Do you know your institution's policy on how early or late scheduled medications can be given? What about prn medications? Are you within these parameters with the medication you are about to give? Have you exceeded the frequency or maximum dosage restrictions?

3. Right drug: Confirm your orders, confirm your transcribed MRAs, confirm the medication in your hand with the written documentation. Is the package intact and before its expiration date? Does it look the way it's supposed to look? Is this drug appropriate for your patient allergies and physical well-being? Does the blood typing match and have you confirmed this with another nurse?

4. Right dose: Again- Confirm your orders, confirm your MRAs, confirm that the medication in your hand matches the dosage on your documentation. If it doesn't, is there a more appropriate option? Calculations can cause errors and should be minimized whenever possible. Check yourself twice and allow others to check you again. Is the amount of medication you're about to give with in reasonable parameters for that drug's dosaging?

5. Right patient: Check the name on your MAR. Check the name on your medication. Check these against each other. Carry the MAR into the room, check the name band and verbally ask the patient their name. Confirm this information with your MAR. If your patient is unable to identify themselves, verify their identification with a family member or second nurse.

6. Right route: How is this particular medication supposed to enter the body? Is the form you have in your hand able to follow that route? If in doubt, confirm swallowing mechanisms before administering medications that should be swallowed. What kind of reaction time can you expect from this administration route? Always confirm IV access and appropriateness of the ports and lines being used for IV administration.

7. Right method: What special precautions are called for? Does the patient need to remain upright? Should this medication be crushed? How fast should this IV medication be pushed? Do other administrations need to be held during this medication? Does your patient understand what medication he is receiving and why? Does he agree to the treatment?

8. Right documentation: The most appropriate time to chart a medication is when it is given. Have you stated exactly what you gave, when, how and where if appropriate? Did you note any circumstances that led you to provide medication such as high blood sugar reading or complaints of pain? Did you follow up with your patient after it was administrated and document the outcomes? Did you sign your name?

It may seem like a very cumbersome set of responsibilities, but if you're willing to make as many right-hand turns as it takes the course will never lead you wrong. Your patients and your peace of mind will thank you for it when you find yourself safely at the other end of the medication maze.


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Editor-in Chief:
Kirsten Nicole

Editorial Staff:
Kirsten Nicole
Stan Kenyon
Robyn Bowman
Kimberly McNabb
Lisa Gordon
Stephanie Robinson

Kirsten Nicole
Stan Kenyon
Liz Di Bernardo
Cris Lobato
Elisa Howard
Susan Cramer