Safety Checks and Ten Rights of Medication Administration

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.