The Nine (9) Rights of Medication Administration
Right Route and Form
NEVER ASSUME! Confirm the appropriateness of the prescribed route while also making sure the patient can take/receive the medication by the prescribed route.
Right to Refuse
Patient has the right to refuse medication. NEVER FORCE!! If refusal occurs, always respect the patient's right to refuse, determine the reason, offer patient education on why the medication is needed, and take appropriate action, including notifying the prescriber if patient still refuses. Document the refusal and a concise description of the reason for refusal. Document any further actions you take at this time, such as vital signs and/or system assessment.
Right Response
Refers to the drug and its desired response in the patient. Continually assess and evaluate the achievement of the desired response, as well as undesired response. Data gathering: monitoring vital signs, weight, edema, intake and output, nutritional intake, laboratory values, results of diagnostic testing, and auscultating heart and lung sounds.
Right Reason or Indication
Addresses the appropriateness in use of the medication to the patient. Confirm the rationale for use. Is it prescribed for pain or fever? Obtain a prescriber's order if needed for a different reason.
Right Documentation
Always assess the prescribed order in the patient's record for the presence of the following information: date and time of medication administration, dose, route, site of administration, and name of medication. Document any drug actions such as changes in symptoms the patient is experiencing, adverse effects, toxicity, and any other drug-related physical and/or psychological symptoms. Documentation must also reflect any improvement in the patient's condition, symptoms, or disease process, as well as no change or lack of improvement. Document any teaching, as well as an assessment of the degree of understanding exhibited by the patient. Other information: 1.) if a drug is not administered, with the reason why and any actions taken, 2.) actual time of drug administration, and 3.) data regarding clinical observations and treatment of the patient if a medication error has occurred (though do not include the incident report in the medical record).
Right Drug
Begins with RN's valid license to practice; must be signed by the prescriber involved in the patient's care. Specific medication order must be checked against the medication label or profile three (3) times minimum before giving the medication. Conduct the first check of the right drug/drug name during the initial preparation of the medication. Note the drugs indication and be aware that the drug may have multiple indications. Use of drug's generic name is recommended.
Right Patient
Confirm the name on the order and the patient, and be sure to use several identifier. Ask the patient to state his or her name, date of birth, check the patient's identification band to confirm the patient's name, identification umber, age, and allergies. Ask guardian or parents if the patient is pediatric. Acceptable identifiers: patient's name, date of birth, home address, social security number, or hospital/health care facility-assigned identification number.
Right Dose
Dosage is identified from the prescriber's order. Always confirm that the dosage amount is appropriate for the patient's age and size. Check the prescribed dose against the available drug stocks and against normal dosage range. Recheck all mathematical calculations and pay careful attention to decimal points.
Right Time
Each health care setting or institution has a policy regarding routine medication administration times. Include your three (3) checks! For routine medication orders, the standard of care is to give medications no more than 1/2 hour before or after the actual time specified in the prescriber's order. Stat orders must be given within 1/2 hour of the time the order is written. Other things to consider: multiple-drug therapy, drug-drug or food-drug compatibility, scheduling of diagnostic tests, bioavailability of the drug, drug actions, and any biorhythm effects such as occur with steroids.