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THE "6 RIGHTS" IN DRUG ADMINISTRATION

MEDICATION ADMINISTRATION

All nurses should practice the "6 rights" of medication administration. There have been many safeguard established to ensure the rights are followed. One is the process of scanning the patient and the medication at the bedside. Many institutions have adopted this system of scanning medications.
1. log into the hospitals software
2. find you patient's profile in the EMAR
3. scan your patient's armband
4. scan the barcode on the medication
If there are any problems the software will alert you to a "right that is about to be violated". It will also assist you with double checking your dosage, time and route of administration.

RIGHT PATIENT

1. Verify patient by checking his or her identification bracelet/armband.
2. Ask the patient his or her name. Do not call the patient by name. Some clients will answer to any name. Ask for his or her date of birth (not always required).
3. Check the name on the patient's medication label or profile in the EMAR.

RIGHT DRUG

1. Check the drug label three times: a) at the first contact the the medication bottle. b) before pouring the medication . c) after pouring the medication
2. Check that the drug order is complete and legible. If it the order is incomplete or not legible, contact the physician or charge nurse.
3. Know the medication action.
4. Check the expiration date. All outdated drugs should be thrown away or sent back to the pharmacy, whichever is the policy of the facility.
5. PATIENT QUESTIONS...If the patient questions the drug, recheck and check again the medication and the doseage. If you are in doubt see assistance from another health care provider.

RIGHT DOSE

1. Be able to calculate the medication doses using the ration and proportion, basic formula fractional equation.
2. Know how to calculate drug dose by body weght (kg) or by body surface area.
3. Know the recommended dosage range for the drug. If the nurse believes the dose is incorrect or not within the therapeutic range, a supervisor, pharmacist or the ordering physician should be contacted and all communication should be documented.
4. Recalculate drug dose and have a colleague recheck the dose.
5. Some facilities require the following drugs to be checked by a colleague:

RIGHT TIME

Medications should be given at a specified time to maintain a therapeutic drug serum level. A dose given too soon can cause toxicity and missed doses can nullify the drug action and its effect.
1. Administer the drug at the correct time(s). Medications can be given 1/2 hour before or after the time prescribed.
2. There are specific cirecumstances that may cause a delay or ommission of a medication such as: labortory or diagnostic tests.
3. Administer drugs that are affected by foods either 1 hours before or 2 hours after meals.
4. Know the medications half-life.
5. Anitbiotics should be administered at regular intervals.

RIGHT ROUTE

The right route is necessary for the approptriate absorption of the medication.
1. PO (by mouth)
2. SL (sublingual)
3. buccal (between gum and cheek)
4. TP (topical)
5. IH (inhalation)
6. instillation (in nose, eye, ear, tectum, or vagina)
7. 4 parenteral routes: interadermal, subcutaneous, intramuscular and intravenous

KNOW THE APPROPRIATE LAND MARKS FOR THE INJECTABLE MEDICATIONS.
KNOW THE APPROPRIATE SIZE OF NEEDLES FOR THE LAND MARK CHOSEN.
KNOW HOW TO USE APPROPRIATE STERILE TECHNIQUE.

DOCUMENTATION

Document on the MAR the time the drug was given and the nurse's initials.
Documentation should be done immediately.
If the drug is "refused" by the patient there is a place to note the refusal on the MAR or EMAR.
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