Safety and Ethics
2.6 Safe Medication Administration
Amanda Egert; Kimberly Lee; and Manu Gill
Safe Medication Administration
Since nurses play a pivotal and hands-on role in all aspects of client care, the responsibility of ensuring client safety during medication administration often lies with them. The following sections summarize safety considerations for medication orders, medication administration, assessment/monitoring after medication administration, and documentation.
Safety Considerations – Medication Orders
Medications must be administered in response to an order from a practitioner or on the basis of a standing order that is subsequently appropriately authenticated by a practitioner. All practitioner orders for the administration of drugs and biologicals must include at least the following:
- Name of the client
- Age and weight of the client to facilitate dose calculation when applicable. Policies and procedures must address weight-based dosing for pediatric clients as well as in other circumstances identified in the hospital’s policies. (Note that dose calculations are based on metric weight (kg, or g for newborns)).
- Date and time of the order
- Drug name
- Dose, frequency, and route
- Dose calculation requirements, when applicable
- Exact strength or concentration, when applicable
- Quantity and/or duration, when applicable
- Specific instructions for use, when applicable
- Name of the prescriber
Safety Considerations – Medication Preparation
The following safety considerations were taken from Clinical Procedures for Safer Patient Care by Glynda Rees Doyle and Jodie Anita McCutcheon.[1]
- Plan medication administration to avoid disruption:
- Dispense medication in a quiet area
- Avoid conversations with others
- Follow agency’s no-interruption zone policy
- Prepare medications for ONE client at a time.
- Follow the SEVEN RIGHTS of medication preparation (see below).
- Check that the medication has not expired.
- Perform hand hygiene.
- Check room for additional precautions (contact precautions, droplet precautions, and airborne precautions).
- Introduce yourself to client.
- Confirm client ID using two client identifiers (e.g., name and date of birth) AND check against MAR.
- Check allergy band for any allergies, and ask client about type and severity of reaction.
- Complete necessary focused assessments, lab values, and/or vital signs, and document on MAR.
- Provide client education as necessary.
- If a client questions or expresses concern regarding a medication, stop and do not administer.
Safety Considerations – Medication Administration
The Seven Rights
For the purposes of this textbook, we will discuss the 7 RIGHTS and 3 CHECKS of medication administration. It is important that nurses always follow their hospital and regulatory College policies and guidelines.[2]
7 Rights and 3 Checks of Medication Administration
The 7 RIGHTS are:
- The right patient/client
- The right medication (drug)
- The right dose
- The right route
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