Safety Checks and Ten Rights of Medication Administration
According to the landmark 1999 Institute of Medicine report To Err is Human: Building a Safer Health System, medication errors are a leading cause of…
Before Medication Retrieval – First Checkpoint
Prior to accessing medications from a medication dispensing system (MDS), the nurse should conduct a clinical assessment to determine the appropriateness of the medication. This involves evaluating the patient’s diagnosis, allergies, current clinical condition, and the timing and effects of any previous doses. This step corresponds to the Right Assessment.
Note that some medications may require preparation before administration. Although hospitals may use various types of electronic Medication Administration Records (MARs) and MDS hardware, the core safety principles remain consistent across systems.
Step 1: General Preparation
Begin by performing hand hygiene. Wash hands with soap and water for at least 20 seconds, applying friction to all surfaces. If hands are not visibly soiled, an alcohol-based hand sanitizer may be used instead.
Step 2: First Safety Check – Medication Preparation Area
Access the patient’s electronic health record and open the MAR. Identify the medications due for administration, such as acetaminophen 800 mg every six hours as needed.
Next, log into the MDS and select the correct patient. Confirm the patient's identity by comparing the name displayed in the MDS with the MAR. This confirms the Right Patient.
Navigate to the medication list by selecting “remove meds.” Choose the intended medication and confirm the selection. Press “remove now” and follow on-screen instructions or flashing lights to locate the correct drawer. Retrieve the medication from the designated bin.
Compare the following details:
- Right Medication: Match the medication name on the label with the MAR.
- Right Dose: Confirm the labeled dose matches the dose in the MAR.
- Right Route: Verify the administration route on the label or, if unspecified, ensure the formulation is appropriate for the intended route.
- Right Time: Compare the scheduled time in the MAR with the current time.
Once verified, close the drawer and log out of the MDS.
Step 3: Medication Preparation
Prepare the medication according to institutional protocols and best practices specific to the route of administration. Refer to the companion videos in this series for detailed techniques on preparing medications for different routes.
Step 4: Second Safety Check – Pre-Administration
With the labeled medication in hand, verify the following against the MAR on the screen:
- Right Patient: Confirm that the name on the label matches the patient in the MAR.
- Right Medication: Verify the medication name.
- Right Dose: Confirm the dose.
- Right Route: Ensure the prepared route matches the MAR.
- Right Time: Check the administration time.
- Right Documentation: Immediately record the preparation details—such as the time and your initials—in the appropriate field.
Step 5: Final Safety Check – At the Bedside
Upon entering the patient’s room, verify the patient’s identity using two identifiers—full name and date of birth—and match these with the ID band. Log into the electronic health record and review the MAR.
With the medication ready, confirm the following:
- Right Patient: Match the ID band and MAR information.
- Right Medication: Reconfirm the medication name.
- Right Dose: Verify the labeled dose with the MAR.
- Right Route: Ensure consistency with the MAR.
- Right Time: Compare the MAR with the room clock.
Then provide a brief explanation of the medication’s purpose, expected effects, and potential side effects—fulfilling the Right Education. Ask the patient for permission to proceed, respecting their Right to Refuse.
After administration, observe the patient for therapeutic effects or adverse reactions to ensure the Right Evaluation. Promptly document the administration details, including time, dose, route, and any observations, satisfying the Right Documentation.
Note: Actual medication administration and patient monitoring will be covered in a separate video. This segment focuses solely on the acquisition and preparation phase within the Ten Rights framework, in line with current best practices.
Before Medication Retrieval – First Checkpoint
Prior to accessing medications from a medication dispensing system (MDS), the nurse should conduct a clinical assessment to determine the appropriateness of the medication. This involves evaluating the patient’s diagnosis, allergies, current clinical condition, and the timing and effects of any previous doses. This step corresponds to the Right Assessment.
Note that some medications may require preparation before administration. Although hospitals may use various types of electronic Medication Administration Records (MARs) and MDS hardware, the core safety principles remain consistent across systems.
Step 1: General Preparation
Begin by performing hand hygiene. Wash hands with soap and water for at least 20 seconds, applying friction to all surfaces. If hands are not visibly soiled, an alcohol-based hand sanitizer may be used instead.
Step 2: First Safety Check – Medication Preparation Area
Access the patient’s electronic health record and open the MAR. Identify the medications due for administration, such as acetaminophen 800 mg every six hours as needed.
Next, log into the MDS and select the correct patient. Confirm the patient's identity by comparing the name displayed in the MDS with the MAR. This confirms the Right Patient.
Navigate to the medication list by selecting “remove meds.” Choose the intended medication and confirm the selection. Press “remove now” and follow on-screen instructions or flashing lights to locate the correct drawer. Retrieve the medication from the designated bin.
Compare the following details:
- Right Medication: Match the medication name on the label with the MAR.
- Right Dose: Confirm the labeled dose matches the dose in the MAR.
- Right Route: Verify the administration route on the label or, if unspecified, ensure the formulation is appropriate for the intended route.
- Right Time: Compare the scheduled time in the MAR with the current time.
Once verified, close the drawer and log out of the MDS.
Step 3: Medication Preparation
Prepare the medication according to institutional protocols and best practices specific to the route of administration. Refer to the companion videos in this series for detailed techniques on preparing medications for different routes.
Step 4: Second Safety Check – Pre-Administration
With the labeled medication in hand, verify the following against the MAR on the screen:
- Right Patient: Confirm that the name on the label matches the patient in the MAR.
- Right Medication: Verify the medication name.
- Right Dose: Confirm the dose.
- Right Route: Ensure the prepared route matches the MAR.
- Right Time: Check the administration time.
- Right Documentation: Immediately record the preparation details—such as the time and your initials—in the appropriate field.
Step 5: Final Safety Check – At the Bedside
Upon entering the patient’s room, verify the patient’s identity using two identifiers—full name and date of birth—and match these with the ID band. Log into the electronic health record and review the MAR.
With the medication ready, confirm the following:
- Right Patient: Match the ID band and MAR information.
- Right Medication: Reconfirm the medication name.
- Right Dose: Verify the labeled dose with the MAR.
- Right Route: Ensure consistency with the MAR.
- Right Time: Compare the MAR with the room clock.
Then provide a brief explanation of the medication’s purpose, expected effects, and potential side effects—fulfilling the Right Education. Ask the patient for permission to proceed, respecting their Right to Refuse.
After administration, observe the patient for therapeutic effects or adverse reactions to ensure the Right Evaluation. Promptly document the administration details, including time, dose, route, and any observations, satisfying the Right Documentation.
Note: Actual medication administration and patient monitoring will be covered in a separate video. This segment focuses solely on the acquisition and preparation phase within the Ten Rights framework, in line with current best practices.
View the full transcript and gain access to JoVE Science Education videos
Q1: What are the Ten Rights of medication administration?
The Ten Rights of medication administration are essential safety standards nurses must follow to prevent medication errors. They include the right patient, right medication, right dose, right time, right route, right documentation, right education, right to refuse, right assessment, and right evaluation. These rights form a comprehensive framework to ensure patient safety throughout the medication administration process.
Q2: Why are safety checkpoints important during medication acquisition?
Safety checkpoints before, during, and after retrieving medications are critical for applying the Ten Rights framework consistently. According to the Institute of Medicine report To Err is Human, medication errors are a leading cause of preventable harm and death in hospitals. These checkpoints help nurses verify each right systematically, reducing the risk of errors before medications reach patients.
Q3: What should nurses verify before retrieving a medication from the pharmacy?
Before retrieving medications, nurses must verify the right patient, right medication, right dose, right time, and right route by checking the medication order against the patient's chart. This first checkpoint ensures the order is complete, accurate, and appropriate for the patient. Confirming these details prevents errors from entering the medication administration process early.
Q4: How does the right documentation support medication safety?
Right documentation requires nurses to record medication administration accurately and promptly, creating a legal and clinical record of what was given. This documentation supports continuity of care, allows other healthcare providers to track the patient's medication history, and provides evidence of compliance with the Ten Rights. Accurate records are essential for identifying medication errors and preventing adverse events.
Q5: What does the right to refuse mean in medication administration?
The right to refuse acknowledges that patients have the authority to decline medications even when prescribed. Nurses must respect this decision, document the refusal, and notify the prescriber. Understanding and honoring patient autonomy is a fundamental aspect of ethical medication administration and supports informed consent in healthcare.
Q6: How do right assessment and right evaluation protect patients during medication administration?
Right assessment involves evaluating the patient's condition, allergies, and contraindications before administering medication. Right evaluation requires monitoring the patient after administration to determine if the medication achieved its intended effect and assess for adverse reactions. Together, these rights ensure medications are appropriate for the patient's current status and that outcomes are monitored.
Q7: How does the Ten Rights framework apply when preparing and administering oral tablet and liquid medications?
The Ten Rights framework applies to all medication routes, including oral tablets and liquids. Nurses must verify the right patient, medication, dose, time, and route before preparing and administering oral tablet and liquid medications. Each checkpoint ensures accuracy and safety, regardless of the administration method used.