|Administering medication. It's one of your
most important nursing activities and one of the riskiest.
Legally, a licensed nurse is held to certain expectations
for administering medications:
•knowing a drug's indications, safe dosages, toxicity,
possible adverse effects, and contraindications
•refusing to accept an unclear drug order unless the
prescriber clarifies it
•knowing how often to monitor the patients responses.
As an advocate for safe medication practices, I want to review
ways to reduce the chance of problems and alert you to sources
of error that can affect each drug dose you administer.
The first step to safeguard against trouble is to obtain a
thorough medication history. Find out all of the drugs your
patient takes: their names, doses, intended effects, and administration
times. Ask about prescription and over-the-counter (OTC) preparations,
herbal supplements, and vitamins. The more she takes, the
greater her risk.
Finding out about drug allergies is important too because
they can trigger reactions ranging from mild to life-threatening.
Check your patient's chart for a history of allergies before
you administer any drug, and carefully monitor her after giving
it. If she develops an allergy after receiving a drug, prominently
note the drug name in her chart and describe the details of
Five rights: Not foolproof
Although the "five rights" of drug administration
help prevent problems, don't assume they're foolproof. Here's
The right drug. A prescriber's sloppy handwriting,
a pharmacy error, or a nursing mistake can lead to administering
the wrong drub. For your part, check the medication administration
record for ordered drugs, be on guard for sound-like or look-alike
drug names, and ask the pharmacist, your instructor, or the
prescriber if you have any questions.
The right patient. Before giving a medication,
check your patient's I. IF she's alert, ask her to state her
name. Overlooking the ID, misreading the name and "hearing"
the name you expect are all potential sources of error.
The right dose. Miscalculation by the prescriber,
the pharmacist, or the nurse is a major concern: For unfamiliar
doses, check a reference. Question the prescriber about any
dose that's higher or lower than the recommended amount. And
always have another dose to check your figures.
The right route. Given by the wrong route,
some medications are fatal. If you're unsure of the route,
don't administer the medication.
The right time. Some drugs must be given at precise intervals
to maintain therapeutic levels. Always check with the prescriber
or the pharmacist if the schedule changes.
Involving the patient
Another source of medication errors is the patient. That's
why you need to teach her:
•why she's taking a specific medication
•how to take it properly, including not stopping until
the practitioner gives the okay
•possible adverse responses
what steps to take if she isn't getting the expected response
•how to protect herself if she's allergic to a medication:
Tell her never to take it and to inform every healthcare provider
she sees about her allergy. Also suggest that she wear an
Back up your teaching with written instructions, and remember
to tell your patient about potential problems with OTC drugs.
If a medication error occurs in spite of your best efforts,
don't hesitate to report it. Notify the prescribing physician
right away, then document exactly what happened, including
the patient's response and actions taken. Fill out an incident
report according to your facility's policy. Although being
involved in a medication error can be upsetting, detailed
documentation is likely to help if you ever need to discuss
an error in court.