nurse allocates patient medications into tiny cups

Safe Medication Administration: How Many Rights Are There?

In nursing school we all learned the five basic rights of medication administration. Over time, and with increasing number of lawsuits and medical errors, it seems as though many facilities have added additional unofficial "rights" to the safe administration of medications. Is this helping or hindering compliance?

More than 1.5 million preventable adverse drug events occur annually in the United States, according to Joint Commission statistics. Of the 1.5 million adverse events, 400,000 events occur annually in U.S hospitals, representing $3.5 billion additional healthcare costs. In an effort to reduce adverse medication events, nursing organizations have promoted the 5 Rights of Medication Administration. The classic 5 Rights of Medication Administration are: right client , right dose, right drug, right route and the right time.

The Five Rights in Medication Administration

Over the years, new technology has flooded the healthcare market, touting electronic solutions to virtually eliminate medication errors. These electronic solutions include electronic orders and charting, bar coding to match patients with medical records and orders and computerized medication distribution. Yet the medication error rate remains high. This reinforces the need for a “human factor” to monitor the plethora of automation in the healthcare work environment.  Nurses provide an invaluable safety check for patients and in that effort, the 5 Rights of Medication Administration has continued to expand.

Most recently “right documentation” and “right reason” have been added to ensure that the right medication was ordered and documented for other care providers. This brought us to seven rights of medication administration, and still the number continues to rise. Right to refuse medication, right indication and right equipment are additional rights that have been added on over the years.

The importance of making time to purposefully go through these rights of medication administration every time for every patient is extremely challenging with regard to time management. However, taking shortcuts in the administration of medication is costly for everyone involved.

According to Judy Smetzer, Vice President of the Institute for Safe Medication Practices (ISMP), medication rights are merely broadly stated goals, or desired outcomes, of safe medication practices that offer no procedural guidance on how to achieve these goals. Thus, simply holding healthcare practitioners accountable for giving the right drug to the right patient in the right dose by the right route at the right time fails miserably to ensure medication safety. Adding a sixth, seventh, or eighth right is not the answer, either.” [The five rights: A destination without a map. ISMP Medication Safety Alert. January 25, 2007;12(2).]

Ms. Smetzer continues, “The healthcare practitioners’ duty is not so much to achieve the five rights, but to follow the procedural rules designed by the organization to produce these outcomes. And if the procedural rules cannot be followed because of system issues, healthcare practitioners also have a duty to report the problem so it can be remedied.”

Medication rights focus on individual performance and ignore system defects that may make completing the tasks difficult or impossible.  Thus medication rights should be accepted as a goal of the medication process, and not seen as the “be all and end all” of medication safety.

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