Medication errors are one of the most common and dangerous medical errors that a nurse or midwife could commit. This is mostly because medication error can result in permanent disability or even death of the patient. It is very important that the nurse or midwife has adequate knowledge about the patient’s medication because they spend much time with the patient and they mostly administer these medications.
We have known about the traditional 5 R’s (Rights) of Drug administration which includes: Right Patient, Right Drug, Right Time, Right Route, and Right Dosage. But over the years, more have been suggested through research to combat medication error.
THE 5 TRADITIONAL RIGHTS (R’s) OF DRUG ADMINISTRATION
RIGHT PATIENT: It is the responsibility of the nurse or midwife to ensure that patient being treated is, in fact, the correct recipient for whom medication was prescribed. Ask the patient’s full name even if you know the name already, confirming with medical wristbands if available. Check if the name matches with prescription, folder, or chart. Always make sure that you address the patient by their full name and not first name or surname alone. It is advisable not first name or surname alone as there could be patients with similar names. Also never forget to use two or more identifiers (Name, Assigned identification number (e.g., medical record number, NHIS Number), Date of birth, Phone number, Address, or Photo) which will be helpful in situations where different patients may have the same name.
RIGHT DRUG: The nurse or midwife must make sure that the medication being served is the same as the one prescribed. Some medications have similar spelling and sound but perform different functions and therefore the nurse must do due diligence in serving medications. It is also important to check for the expiry date of the medication. The nurse or midwife must inquire if the patient has any known allergies or history of an allergic response to a drug they are about to administer.
RIGHT ROUTE: Some common routes of drug administration includes oral, intramuscular, subcutaneous, intradermal, intravenous, sublingual, and topical. The routes of administration chosen to determine the time it takes to absorb the drug, time it takes for the drug to act, and potential side-effects. It is very important for the nurse or midwife to be knowledgeable in the understanding of the physiology influencing drug absorption rates and time of drug onset, as these principles relate to medication administration. The nurse or midwife must also be up to date on new drugs as well as uncommonly used drugs. Find out if patients can tolerate the ordered route for the prescribed medication.
RIGHT TIME: As a nurse or midwife, always make sure the patient’s medication is administered the time it was intended by the prescriber. Double-check that you are giving the prescribed at the correct time and confirm when the last dose was given. To maintain the therapeutic effect, certain medications have specific intervals during which another dose should be given. A guiding principle of this ‘right’ is that medications should be prescribed as closely to the time as possible, and nurses should not deviate from this time by more than half an hour to avoid consequences such as altering bioavailability or other chemical mechanisms. It is very important especially, with intravenous medications that they are administered at the correct rate to avoid undesirable consequences or complications.
RIGHT DOSE: Always ensure the right dose is administered. Overdosage has dangerous consequences and underdosing may not provide the therapeutic effect intended. The nurse or midwife must pay attention to the units of medications for example milligrams (mg) and micrograms (mcg) as these can be easily interchanged. For certain drugs that require calculated dosages based on weight, make sure the correct weight is taken and calculation also verified by another nurse. Other drugs also require reconstitution and therefore the nurse must ensure the right and correct amount of diluent is used.
OTHER “RIGHTS” (R’s) OF DRUG ADMINISTRATION
RIGHT PATIENT EDUCATION: The nurse or midwife must ensure that the patient understands what the medication is for. Explain to them the action of the drugs and various side effects. Make them aware they should contact the nurse on duty if they experience side-effects or reactions.
RIGHT DOCUMENTATION: Make sure you sign after administering the medication indicating your remarks as well.
RIGHT TO REFUSE: Make sure you have the patient consent to administer medications. It is important to note that patients do have a right to refuse medication if they have the capacity to do so except in certain situation (certain mental illnesses)
RIGHT ASSESSMENT: Check the client’s history of drug interactions, allergies, and contraindications. Check your patient actually needs the medication. Check Baseline observations such as Vital signs where necessary.
RIGHT EVALUATION: Monitor to see medication is working the way it should and observe patient continuously when required. Ensure medications are reviewed regularly