Which of the following statements is true about oral medication administration?

• Resources
• How to Improve
• Measures
• Changes
• Improvement Stories
• Tools
• Publications
• IHI White Papers
• Audio and Video
• Case Studies

​by Frank Federico, RPh, Executive Director, Institute for Healthcare Improvement

One of the recommendations to reduce medication errors and harm is to use the “five rights”: the right patient, the right drug, the right dose, the right route, and the right time. When a medication error does occur during the administration of a medication, we are quick to blame the nurse and accuse her/him of not completing the five rights. The five rights should be accepted as a goal of the medication process not the “be all and end all” of medication safety. 

Judy Smetzer, Vice President of the Institute for Safe Medication Practices (ISMP), writes, “They 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 (e.g., right reason, right drug formulation, right line attachment) is not the answer, either.” [The five rights: A destination without a map. ISMP Medication Safety Alert. January 25, 2007;12(2).]

The five rights focus on individual performance and not on human factors and system defects that may make completing the tasks difficult or impossible.

There are a number of factors that may interfere with a nurse’s ability to complete these functions.

Ms. Smetzer continues, “Thus, 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 administration

Medication administration is a process that carries great responsibility in requiring that you know which medication is supposed to be given, as well as to whom, and when.  Remembering the various information that you need to keep track of can be overwhelming, but it is vital that you are aware of them.  We highly recommend familiarizing yourself with the seven rights of medication administration in order to protect both your patients and yourself.

Right Individual

Making sure that you have the right individual is obviously a very important step in medication administration.  The standard is to check with at least two other sources that you have the correct person before administering medication.  The most experienced of nurses can make a  mistake if tired, overworked, or managing several patients at once.  Despite your level of experience, you should always verify that you are giving the right person the right medication.

Right Medication

It goes without saying that ensuring that you have the right medication is paramount for a variety of reasons. Different patients can have different medical allergies, adverse reactions, and unexpected symptoms that could lead to catastrophic results.  Read the label of the medication, triple-check the patient’s charts, and make sure you are administering the correct medication for that patient.

Right Dose

The right dose is incredibly important as well, as the wrong dose could lead to overdosing a patient and possibly harming them.  The patient’s correct dose should be noted in their chart, and you should also know the form in which they should be receiving medication.  Are they taking pills, receiving medications through IV, or swallowing liquids?  These methods all require various doses. 

Right Time

Many medications have a specific time that they need to be administered, either due to the patient’s other medications or around their meals.  Not all medications require a specific time, but it is your responsibility to know which ones do and don’t.  Every time that medication is given to a patient, it should be recorded so that anyone treating them is aware of when medication was last administered. 

Right Route

“Route” in this case refers to where and how the medication is given to a patient.  While most medications are taken orally, this is not always the case.  The notes surrounding the way that medications should be administered are important to keep communication clear as nurse shifts change or others administer medication.  Medication can be given in several ways including rectally, vaginally, through the skin, in the eyes, in the ears, into the lungs, etc.  This leaves a lot of room for error if not correctly communicated. 

Right Documentation

It is the sole responsibility of the person administering the medication to properly document that administration.  Without proper documentation, communication can get lost between medical professionals.  Always double-check your documentation and make sure that all details are present and correct.

Right Response

Last, but certainly not least, is the response that the patient has to the medication administered.  Anytime that a patient is given medication, their response should be recorded to make sure that it is known to all treating the patient.  Additionally, the level to which the medication helps the patient should be recorded to keep track of what medication is working and what isn’t.  

What is administration of oral medication?

Which of the following is a principle of oral drug administration?

What is the characteristics of oral route administration?

Which of the following is a benefit of oral administration?