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In addition to the traditional “five rights” of medication administration, the nurse has six rights concerning safe medication administration: AAAA; BBBB; CCCC; DDDD; the right to administer medication safely; and the right to stop, think, and be vigilant when administering medications.
- a. the right to a complete and clear order
- b. the right to have the right drug, route, and dose dispensed
- c. the right to access to information
- d. the right to policies to guide safe medication administration
The traditional five rights of medication administration are AAAA. Experience indicates that five additional rights are essential to professional nursing practice: BBBB.
- the right client
- the right drug
- the right dose
- the right time
- the right route
- the right assessment
- the right documentation
- the client’s right to education
- the right evaluation
- the client’s right to refuse
Ensuring that the nurse has the right client is essential. The Joint Commission requires AAAA forms of client identification before administration. Identification of the
client must take place BBBB the nurse administers a medication.
Only drugs with complete orders should be administered. A complete order contains the following information: AAAA, BBBB, CCCC, DDDD, EEEE, FFFF, and GGGG.
- a. date and time the order is written
- b. drug name
- c. drug dosage
- d. drug route of administration
- e. frequency of administration
- f. special instructions for withholding or adjusting dosage based on nursing assessment
- g. health care provider’s signature
The right dose includes the AAAA and BBBB. This includes the nurse’s responsibility regarding CCCC.
- a. right dose within guidelines for the drug
- b. client’s physical status such as weight and renal function
- c. correct drug dose calculations
The right time is AAAA. Nurses must have knowledge of the effects of BBBB and foods on the drug. Drug dosing CCCC altered to fit a client’s lifestyle if appropriate.
Nurses must also be aware of medications that DDDD to ensure that the drugs are given to maintain these blood levels.
- a. the time the dose should be administered
- b. certain diagnostic tests
- c. may be
- d. must maintain therapeutic blood levels
The right route is necessary for AAAA. This includes the nurse’s knowledge of patient BBBB regarding the route. Nurses must also ensure that oral medications CCCC.
- a. appropriate absorption
- b. limitations
- c. are swallowed by the client
The right assessment includes the nurse’s collecting AAAA; BBBB; CCCC; right evaluation requires that client DDDD; and the client’s right to refuse a medication. The
nurse’s responsibility is to EEEE.
- a. appropriate assessment information before administering a medication
- b. right documentation of the medication administration
- c. right to education or the client receiving accurate and thorough information about all medications
- d. response to medication be assessed and documented
- e. determine the cause for refusal and reeducating the client as necessary
A medication error is defined as
“any preventable event that may cause or lead to inappropriate medication use or harm to a patient.”
Medication errors may occur at any time during the cycle of AAAA. Changes have been made to prevent errors in each of these areas.
Computerized order entry systems are becoming widely used. Most use AAAA that allows client information to be part of a database scanned before medication administration.
a bar coding system
Other examples of safety risks in medication administration include:
- pill splitting
- buying medications on the Internet
- “look-alike, sound-alike drug names.”
The Joint Commission has put forth a list of AAAA that have greater risk of being misinterpreted or misread.
abbreviations, acronyms, and symbols
The Joint Commission has also devoted AAAA of its National Patient Safety Goals to increased medication safety.