The rights of medication administration

The classic five

• Right patient — two identifiers checked against the record, at the bedside, out loud.
• Right drug — the label read against the order, not against your memory of the order.
• Right dose — the amount checked against the order and against a plausible amount for this patient.
• Right route — confirmed on the order, because the same drug by a different route is a different drug.
• Right time — inside the ordered window, with the reason for any deviation documented.

The four additions

• Right reason — you can state why this patient is receiving this drug today.
• Right documentation — charted after administration, never before.
• Right response — you return and assess whether the drug did what it was ordered to do.
• Right to refuse — a competent patient may decline. Document the refusal, notify the prescriber, and never disguise a drug in food to get it swallowed.

The three checks

The label is read three times: when the drug leaves storage, when it is prepared, and at the bedside against the patient's identifiers. Three readings of the same label sound redundant. That redundancy is the point.

Order legibility

An order that cannot be read is not clarified by guessing, by asking the nurse who worked yesterday, or by picking the likelier of two drugs. It is clarified by the prescriber. Abbreviations on the Do-Not-Use list are written out in words: units, daily, every other day.

Margin notethe last check happens at the bed, not the cart.

Watch outnever chart a dose before it is given. A charted dose that was never administered is invisible to the next nurse.

Takeawaya right that was verified anywhere except at the bedside was not verified.

Class-level drug thinking → BOOK 05 · P3. Every calculation → BOOK 06 · P2.