01.05 6 Rights of Medication Administration

Okay, before we begin to the specific medication classes and start diving in more and more to the drugs and how they work and everything and really kinda covering what, you know, the exciting part about pharmacy and pharmacology and what Tarang and I really enjoyed talking about. There are some ground rules that we need to cover. One of those things that we need to cover is the 6 Rights of medication administration. By following these 6 rules, you’re going to be able to keep your patient safe, which as we know, is really kinda the number one thing the NCLEX is looking for and that you’re going to be able to well, keep your job and just do a good job as a nurse. You keep them safe, accurate and everything. So, let’s talk about this 6 rights of medication administration and hopefully this is not the first time you’ve heard of these 6 rights. Hopefully, they’ve been covered on your pharmacology class and you’ve noticed them kinda popping up on medication questions and things as you’ve been taking your classes.

So, again, this will just be kinda be a very brief lecture as we just kinda go through these points. So, the first right is the Right Drug. What we wanna know here is this, the drug, the medication, that the physician ordered, okay. Now, in most hospitals, and in most place as your work, a lot of all these is gonna be done in electronic medical record. Okay, usually you will scan the patient, and then you’ll scan the drug and you wanna make sure that that drug matches what the physician has ordered. Because I can tell you, when you go in and you grab all your drugs from omnicell, or your pixes or whatever medication storage system that your hospital uses, it’s very easy for those drugs to kinda intermix. It’s definitely happened to me before that I am in a rush, I go in, I grab all my drugs, I come back to my patient’s bed, and low and behold, you know, a hydralazine has mixed its way into the crestor bin. Okay. So, that can be very detrimental to the patient. So, just be very careful if you don’t have a, like an electrolyte medical thing, or before you give, even with that, it’s important as you’re looking at your electrolyte medical record and the patient’s medication administration record, you’re comparing what you see on your medication label to what the order is. Okay. So, it is the right drug? What’s the expiration date? Especially with things like insulin, this is gonna matter. You’ll have expiration dates on all your insulins, that should be clearly marked. And, one thing that I always do with every single nurse that I preceptor nursing student, is before I even allow them into the medication room, I make them sit down and write out every drug. And even if they write out the drug, I’m gonna ask them what’s that drug given for, what’s that given for, what are we looking for. So, if you’re unfamiliar with it, you’re really need to consult the drug guy and don’t be afraid to call the pharmacist if you don’t have a resource available on your unit. Call the pharmacy and that’s their job, you know, is to know the drugs and understand them. So, call the pharmacy, and I always have the pharmacy number really kind of speed dial on my phone, and just ask them really quickly, “How should I give this? What’s the best way to do it? I’m not sure about this drug.” Okay. So that is, Right Drug.

Now, let’s talk Right Dose. Are you giving the dose that the physician ordered? You need to perform any calculations that you might need, we talked about drug calculations already. And with like a lot of blood pressure medications, you might be half-ing a dose or like with the carvedilol or something like that. You might be giving half a pill. So, make sure that you’re giving the appropriate dose with that, okay. Be sure that’s a medication that can be crashed or can be split. And then, make sure that you’re giving the appropriate dose with that, okay. Now, this also comes into play quite a bit with insulin. You’ll find throughout your nursing career that some nurses like to kind of determine their own administration for insulin. If the patient’s blood sugar is a little high, they might go ahead and tossed a couple of extra units on there. I don’t want you to do that. Insulin is a medication that you really shouldn’t play around with, especially, I know I mentioned this in the podcast, and some of the videos and things before. But, insulin is a low blood sugars, are one of the main reasons that we have rapid responses in the hospital. I’m in the rapid response team and low blood sugars are one of the most common reasons. So, a patient’s blood sugars will come back at 200 or whatever and that will call for maybe 4 units of insulin and you’ll see a nurse maybe give 6 or 8 or 10 units. Don’t go, don’t do that. Just don’t do that. I guess I’ll leave it as simple as that. Give the right dose that is called for.

Now, it’s going to right route. This is one of the NCLEX will question you on quite a bit. Now, remember, when a medication order is written, you need to have the medication, you need to have the dose and you need to have the route. So, on your medication order, it should say IV, should say PO, it should say PR. It should say the route of the medication is to be given. If you don’t have a route for a medication, don’t give it. There’s one medication in particular that we give a lot in my hospital called nimodipine and from that -pine, you know, we’ll talk about this more in the future. But, -pine, we know that this is a Calcium channel blocker. And one of the, there’s a black box morning on this because what it does, is it comes with a big pill. It’s like a horse pill, big huge vitamin-sized pill, capsule, I should say. And what will happen is, a lot of times, it will be given for stroke patients to help in vaso spasming, you know, with our hemorrhagic strokes. So, what will happen is, is it comes with this little capsule and we can’t give that capsule to a patient who isn’t awake, he can’t take it. So, what we’ll gonna do is we’ll take that, the liquid that’s inside there, out, and so, we’ll draw the liquid out, you know, in a little syringe or whatever. There’s the syringe, it’s not bad. So, we’ll draw the liquid out in our syringe and what has happened, is patients, or nurses they’re disconnecting their needle and they’re giving that in an IV. Now, nomodipine is to only only only be given PO. So, there have been deaths, there have been very significant side effects and issues when nurses have given nomodipine IV because they’ll about up there, they’ll draw up out of a capsule which is obviously a PO. And, they’ll have it in their syringe and they’ll think, well, I guess, I can give it IV. You do not, ever, change the route of a medication. If it is to be administered IV, PO, PR, IM, however, that’s the way you give it, okay. Another one that I’ll see, you know, that insulin is supposed to be given is Subq. One way that are nurses, I’ve seen nurses that kind of make mistakes that they’ll end up giving the subq insulin, they’ll end up giving it in IV, that’s has much faster onset and the body is much more susceptible to that. So, that can also cause severe issues.

Next one is right time. This one’s important to talk about because medications are scheduled and need to be given at specific times. Like, levothyroxine, that needs to be given in the morning before meal, your rapid acting insulins need to be given right before meal, and there’s just some specific times. Some medications needs to be given right before bed, your HMG CoA reductase inhibitors for example, need to be given before sleep. So, because medications are on specific time schedules and they work on specific time schedules, it is incredibly important that you’re giving them at the right time. This might just seem like a convenience issue, but it’s not. The way that some medications work, they are very sensitive to the time that they’re given. Another reason for this, like you might have your, a patient who needs albuterol and metoprolol. Okay, one is a beta blocker, one is a beta agonist. Giving these at the same time will kinda cancel each other out, not exactly but they’ll kind of a negative effect on each other. So, it’s very important to make sure that you give medications when they’re scheduled, as they’re scheduled, okay.

The next one here is right patient. I don’t have to talk too much about this, obviously, is this the right medication for the right patient? And, the one thing that you’ll be tested on with the right patient is gonna be 2 identifiers. Okay, make sure you do 2 patient identifiers, name and birthdate, hospital record number, whatever it is, if your patient isn’t able to speak, you need to verify their name and birthdate with what you see on their wrist band versus what you see in the chart. Because, mistakes can happen and you really just don’t want a patient’s safety, your career, and everything to come down to giving the wrong medication to the wrong patient. One way to avoid this is to do pull medications for specific patients, keep them separate and pull them in different times. So, go give your medications to the patient at the right time, make sure you’re not mixing anything in there, make sure not all jumbled up in a pocket, don’t pull every patient’s meds into one counter, just start reaping them open, ‘cause a lot of medications look the same especially when we’re talking IV medications, most IV medications are clear liquid. So, it can be very easy to really mess things up and really cause severe harm to your patient. So, whenever we talk harm to the patient, we’re talking patient’s safety, patient safety, is what the NCLEX loves to test about, okay? So, whenever you notice anything in your studies with a patient safety issue, that’s an area you really need to focus on especially with pharmacology with the NCLEX.

Lastly, let’s talk about documentation. You need to be documenting your medications after giving them. Don’t document that you give a medication prior to giving it, don’t scan it, save it before going in the room, before giving the medication or anything like that. Because anything could happen. The patient may develop nausea, you might get called away, they might not get that medication, and if you document that it was given, and it wasn’t actually given, then, that’s an issue. Okay? So, again, for example, let’s say, you document ahead of time that you have given blood pressure medication. You go to the patient’s room, their blood pressure in 90 / 50, and according to the medical record, they we’re given a blood pressure medication by you. So, don’t just do that. Don’t document ahead of time. Never never chart ahead. Okay. And if you don’t ever give a medication, make sure you document why you did not give it. So, let’s say, never ahead of time and document why not. It doesn’t have to be a huge documentation or anything like that. If it’s indicated for blood sugars were too low, you didn’t give insulin to that. If blood pressure is too low, you didn’t give insulin for that. They have explosive diarrhea, you did not give docusate for that. So, those are some kind of the reasons you might not give a medication. If you didn’t give a medication, leave a brief note, and if required, make sure you call your physician and let them know that a medication wasn’t given and why. Okay, that’s a change in a patient’s plan, okay.

So, these are really the basic rights of medication administration. Keep in mind that it’s essential to know patient safety, to keep your patient safe and these 6 things right here are going to be how you keep your patient safe. There’s a downloadable PDF below this video. Make sure you download that, it will print out as an 8 1/2 x 11. That will go very nicely into like your pharmacology notebook, or, whatever, binder, that will be a good way for you to remember this. Remember some of these stories and make sure that you’re always, before anything with an NCLEX medication question, think through the 6 rights, okay? If one of these 6 rights apply, the rest of the question doesn’t really matter, we just really need to come back to this 6 rights.