Nurses play a crucial role in medication administration, a complex process with multiple potential points of error. They are the last line of defense in ensuring correct prescription and dispensing before administering medication. All medication errors could have significant financial and patient safety implications. To minimize errors, nursing education emphasizes the importance of following the “Five R's” or “Five Rights” of medication administration to maintain patient safety.
Following the Five Rights of Medication Administration
Nursing students are taught to follow the five rights to administer medication safely to every patient every time.
1. RIGHT PATIENT: Confirm that the intended recipient of medication matches the prescribed medication.
- Ask patients to state their full name aloud and check for matching information on medical wristbands or charts.
- Avoid addressing patients by first name or surname alone to prevent confusion in cases where multiple patients have similar names.
- For patients without wristbands or with altered mentation, use alternative means to confirm their identity with due diligence.
2. RIGHT DRUG: Ensure that the prescribed medication matches the medication to be administered, despite similar names or spellings.
- When checking medication packaging, verify the correct medication name and expiration date.
- Explicitly ask patients about known allergies or history of allergic reactions before administering medication.
- Educate patients around how to distinguish between hypersensitivity reactions and expected side effects.
3. RIGHT ROUTE: Understanding that different medications can be administered through various routes, each with varying absorption time, drug action time, and potential side effects. Common routes include oral, intramuscular, intravenous, topical, and subcutaneous injection.
- Stay educated and updated on newer or less commonly administered medications to ensure safe delivery to patients.
- Maintain a basic understanding of drug absorption rates and onset time, considering factors such as bioavailability and the influence of different routes of administration.
4. RIGHT TIME: Administer medications at the intended time prescribed by the healthcare provider because medications often have specific intervals or window periods for optimal therapeutic effect.
- Strive to administer medications as close to the prescribed time as possible, avoiding deviations of more than half an hour.
- Administer infused medications, like intravenous drugs, at the correct rate to prevent complications.
5. RIGHT DOSE: Ensure the correct dosage of medication is administered. Errors in dosage, unit conversion, and substance concentration are common in medication administration. Errors can occur due to misplaced decimals, arithmetic mistakes, or confusion between different units of measurement. Nurses may give an incorrect dose even if the correct medication and patient identity are verified, without checking the strength of the medication.
- Use positive behaviors to reduce medication errors including consulting with pharmacists, using calculators for accurate calculations, and seeking input from patients or their families regarding their usual home doses.
The Limitations of the Five Rights in Nursing Education
Unfortunately, the traditional Five Rights framework has not significantly reduced medication administration error rates. There are a number of reasons why this may be the case. For example:
- Workplace strains such as workload and interruptions make it challenging to adhere to the Five Rights consistently.
- Nurses with less experience may struggle to find key information on pharmaceutical packaging, while experienced nurses may become accustomed to outdated packaging.
- Inconsistencies in teaching and practicing the 'five rights' hinder their suitability for modern practice.
Patient involvement, nursing experience, and critical thinking are crucial considerations beyond the Five Rights. The Five Rights don’t exist in a vacuum; each right is much more complex than can be communicated in a few sentences.
The Five Rights were also established during a time when medical errors were solely attributed to healthcare providers, with less patient involvement in their own care. They don’t take into account that actions that lead to medication administration errors occur at various points in the process, not just during administration, and don’t put enough emphasis on the importance of critical thinking throughout the administration process.
What can we do about it?
Improving medication administration safety requires interprofessional collaboration beyond the nursing staff and addressing system-level factors that increase errors. Additional rights are needed along with patient education and involvement.
Modern technologies like barcode medication administration and computerized provider order entry can assist with medication administration. It’s critical to make sure that nursing education programs incorporate practical aspects of medication administration work, including mathematical skills, and close supervision, support, and feedback from nursing lab educators. By developing clinical reasoning skills through practice, our future nurses will be better prepared to safely administer medication in a complex medical setting.