12 RIGHTS OF DRUG ADMINISTRATION

1. 2. 3. 4. 5. 6. 7. RIGHT CLIENT RIGHT DRUG RIGHT DOSE RIGHT ROUTE RIGHT TIME RIGHT ASSESSMENT RIGHT MOTIVATION/ APPROACH 8. RIGHT OF THE CLIENT TO REFUSE 9. RIGHT OF THE CLIENT TO KNOW THE REASON FOR THE DRUG 10. RIGHT EVALUATION 11. RIGHT DOCUMENTATION 12. RIGHT DRUG PREPARATION

RIGHT CLIENT Check ID bracelet Have client state his or her name Address the person by name before giving the drug Always double check orders that the client questions RIGHT DRUG Means that the right client receives the drug that was prescribed For hospitalized clients, the drug orders are written on the doctor s order sheet and signed by the duly authorized person A telephone order (TO) for medications must be cosigned by the physician within 24 hours Check the drug label 3 times before administering the medication COMPONENTS OF DRUG ORDERS: Date and time the order is written Drug name Drug dosage Route of administration Frequency of administration Physician/ provider s signature Categories of Drug Orders Standing order- protocols derived from guidelines created by healthcare providers for use in specific settings, for treating certain diseases or sets of symptoms Standard order- may be an ongoing order, may be given for a specific number of doses or days. May include prn orders One time or single order- given once and usually at a specific time PRN orders- given at the client s request and nurse s judgment concerning need and safety Stat orders- given once immediately RIGHT DOSE Refers to the dose prescribed for a particular client NURSING IMPLICATION: Be familiar with the various measurement system and the conversion from one system to another Measuring devices: Medication cups Dropper Syringe Tuberculin Insulin General purpose For use in administering .50-50ml of medication Nursing Implication: Always use the appropriate measuring device and read it correctly Always measure the volume of a liquid medication at the lowest point of the meniscus Shake all suspensions and emulsions When measuring drops of medication with a dropper, always hold the dropper vertically and close to the medication cup Do not attempt to divide unscored tablets and do not administer tablets which have been broken unevenly along the scoring When preparing to administer an injectable medication: Determine the exact volume of drug to be administered Select the right type and size of syringe and needle When removing a drug from a multiple dose vial, wipe the stopper on the vial with an alcohol sponge Inject an amount of air into the vial equal to the volume of fluid to be removed and withdraw the required amount of liquid If there are air bubbles in the syringe, these must be removed by holding the syringe with the needle toward the ceiling and tapping the syringe with your finger to move the air bubbles toward the hub. They should be expelled by gently pushing on the plunger.

When medication is in a glass ampule, flick the top of the ampule to be sure all medication is in the larger bottom portion. Wrap the neck of the ampule with dry gauze pad and snap off the top RIGHT ROUTE Is necessary for adequate or appropriate absorption Includes the correct route of administration, and administration in such a way that the client is able to take the entire dose of the drug and receive maximal benefit from it Nursing implications Be sure to know the prescribed route by which a medication is to be administered If no route is specified in the order, the prescribing physician should be questioned about the intended route Always gain the client s cooperation, before attempting to administer a dose of medication Consider the client s developmental level during administration of medication Assess the client s ability to swallow prior to administering oral medications Use aseptic technique when administering drugs especially parenteral ones RIGHT TIME The time at which the prescribed dose should be administered Nursing Implication To achieve maximum effectiveness, medications are scheduled to be administered at a specific time Administer drugs that are affected by foods, such as tetracycline and penicillin before meals Administer drugs such as potassium and aspirin after meals or with food It is the nurse s responsibility to check whether the client is scheduled for diagnostic purposes such as endoscopy, fasting blood sugar etc. Check the expiration date. Discard the medication or return to pharmacy if the date is passed Antibiotics should be administered at even intervals throughout a 24-hour period to maintain therapeutic blood level RIGHT DOCUMENTATION Requires that the nurse immediately record the appropriate information about the drug administered right documentation includes the drug, dosage, route, time, and the client s response Nursing implication: Be sure to document the medication and the time it was administered Document site location after administering intradermal, subcutaneous, or intramuscular injection Document the effectiveness of medication administered within: 30 minutes to 1 hour for oral meds 20 min for intramuscular meds 10-15 min for intravenous bolus meds Delay in charting could result in forgetting to chart the medication Documentation is also the primary evidence for insurance companies Right documentation as not only a legal requirement but also a safety responsibility of the nurse CLIENT S RIGHT TO EDUCATION This right is a principle of informed consent which is based on the individual s having the knowledge to make a decision Patient teaching topics: Name of medication Purpose of medication How and when to take medication How to monitor drug s effectiveness Drugs/foods that may cause interactions Possible adverse effects Signs and symptoms to bring to the doctor s attention Storing and handling RIGHT OF THE CLIENT TO REFUSE MEDICATION Clients can and do refuse medications NURSING IMPLICATIONS: Be sure to assess client s reason for refusing medication If knowledge deficit underlies client s reason for refusal. Provide appropriate explanation for why medication is ordered Document if client refuses medication and client reason Secure consent and report or inform the physician