We are excited to bring you content from Dennis Taylor, RN, DNP, PhD, ACNP-BS, FCCM of Lexington and current President of the North Carolina Nurses Association. Thanks to Dennis for contributing, please enjoy his thorough discussion of patient prescriptions and medications.
Often a nurse may be responsible for discharging a patient from the hospital or transporting them within a facility from one area to another. Will this also include the movement of medications with the patient? If so, the nurse must be very diligent in confirming the medications being transported and there must be a mechanism in place for appropriate transfer of medications to another provider. We often think in terms of the 5 Rights of medication administration (1)
What Is The Right Patient?
‘Right patient’ – ascertaining that a patient being treated is, in fact, the correct recipient for whom medication was prescribed.
What Is The Right Drug?
‘Right drug’ – ensuring that the medication to be administered is identical to the drug name that was prescribed. Some brand names or generic names may have very similar spelling or sound very similar due to prefix, suffix, or starting with the same first letter. After affirming the name and expiratory date of the intended drug, nursing providers should also develop a routine habit of explicitly asking patients about known allergies or history of an allergic response to a drug they are about to administer.
What Is The Right Route?
‘Right Route’ – Medications can be given to patients in many different ways, all of which vary in the time it takes to absorb the chemical, time it takes for the drug to act, and potential side-effects based on the mode of administration. It is crucial that nurses remain educated and up to date on newer medications or less commonly administered medications to learn how they are safely delivered to patients before being asked to do so in clinical practice.
What Is The Right Time?
‘Right time’ – administering medications at a time that was intended by the prescriber. Often, certain drugs have specific intervals or window-periods during which another dose should be given to maintain a therapeutic effect or level. A guiding principle of this ‘right’ is that medications should be prescribed as closely to the time as possible, and nurses should not deviate from this time by more than half an hour to avoid consequences such as altering bioavailability or other chemical mechanisms. Similarly, it is crucial that medications that are given by an infusion, such as intravenous medications, are administered at the correct rate. Failure to deliver a drug at the correct rate may lead to devastating consequences for a patient.
What Is The Right Dose?
‘Right dose’ – Incorrect dosage, conversion of units, and incorrect substance concentration are a prevalent modality of medication administration error. This error type stems from nurses giving a patient an incorrect dose of medications, even if it is the correct medication and the patient’s identity is verified, without first checking to ensure it is the correct strength for the patient. This may be due to misplaced decimals, errors in arithmetic, or incorrect conversion between two units. Studies that have emphasized observing positive behaviors nurses have adapted to help reduce medical errors include consulting with pharmacy personnel, using calculators to assist in arithmetic, or in some cases, cross-consulting with patients or their families about usual doses they administer at home.
It is important to understand which medications may require another nurse to verify that the correct dose is given (ie. Insulin) or that part of the medication was given and some was wasted (narcotics). Institutional policy will generally address these medications. Obviously, any controlled substances must be transported under strict security and must be accounted for when transferring to another provider or unit. In many facilities there may be Pharmacy technicians that arrange for medications to be transferred to another unit. All medications must be clearly marked with the name of the medication, dose to be administered, time the dose should be administered and the quantity of medication remaining.
When discharging a patient from a facility, any controlled substances should be administered before discharge and the patient given prescriptions for those medications after discharge. Only in very rare circumstances (ie. long transport times greater than the half-life of the medication) should a patient be given any controlled substance at discharge. Other non-controlled medications that are sent or transferred with a patient should be counted and documented with appropriate acknowledgements/signatures.
(1) Hanson A, Haddad LM. Nursing Rights of Medication Administration. [Updated 2020 Nov 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560654/