Beyond the "5 Rights" of medication administration...

  1. What are some helpful hints that you can share about giving medication that has helped you prevent medication errors in your job? I'm talking beyond right dose, right med, right time, right route & right patient? Do you have a tried and true method that you follow each and every time?
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  2. 23 Comments

  3. by   TazziRN
    I think about why the pt is here and is this med right for the problem? If I'm covering for someone else and medicating a pt I don't know, I look at the chief complaint. If I can't figure out why the pt is getting a particular med, I ask the doc before I give it.
  4. by   caliotter3
    If you are distracted for some reason, go back to the MAR, and make sure you go through all the steps from where you left off so you don't inadvertently make a mistake. And do your utmost to make certain that you do not get distracted during your med pass.
  5. by   LuvMyGamecocks
    I don't have a method (still in school)...for whatever it's worth, our school is teaching the 6th right of meds...Right Documentation.
  6. by   Antikigirl
    When I have a med pass to do I do one thing first...set my mind into thinking that each individual pass will be a separate event that I concentrate on...that way I am not distracted by thinking of how many I have to do, or that person that gets mad if you are a minute late! That helps! Best to have a clear mind focused on one thing at a time in these cases!

    Okay...it is different in all places actually...typically how the meds are dispenced to you. Bubble packs, Rx bottles per pt, Pixis, Pharmacy bringing dailys, and sometimes even bulk bottles for PRN's or common meds used by several pts (typically I see this in LTC). BUT, no matter the method...there is a way to do this safely!

    I do my 5 rights (actually there are anywhere from 6-8 dependant on your school of training), and I get my meds and SIGN the MAR as I put them into the cup! I do this so I know what is in that cup incase something distracts me or something comes up...as it always does during med pass...LOL! If someone doesn't take it, or it is dropped, I still have to circle the initial and explain so signing at this point is the way to go (I had someone argue with me on that...I won!). Go through each pill carefully and once it is signed for focus on the next till you are done! Concentrating on each pill for each individual pass is the best way to go...time consuming at first...but I do it quickly now...

    For Pixis, I get the pill out, put a small dot in the corner of the MAR square for my initials so I know I got it out of Pixis. Then when I actually pop the pills into the cup I sign. That saves on time for me if I can't find a med in pixis, or forget my place on the MAR...a dot means I already got it out ...the sign and pop is a double check in essence to make sure I did it right!

    My rule, if it wasn't popped out or given...never sign. Go back over your MAR during the day to make sure you didn't miss anything, and with this habbit, if there is a missing spot...you will know you didn't give it instead of wondering!

    For those that like to do the whole pass and sign later...when I was training med pass I would sneek in and remove a bubble pack...and sure enough...the person passed without it and signed later for it...BIG BAD! Sign as you pop, that way if something is missing you know! (or my fav...spill the cup before you are done...easier to look on the mar that guess that pill!).
    Last edit by Antikigirl on Feb 15, '07
  7. by   muffie
    i write their meds on my assignment sheet and cross them off as i pour them

    i review the whole med cup before i go to give them

    i circle in pencil on the mar the meds i have to give when cross-checking them with the kardex first thing in the am

    i review them all with the pt [this really works, pts will say " what about my such and such pill ? " oops

    these easy steps really help me
    they are not really time consuming
    thankfully my floor is not nuts withs too many meds

    hope this helps
  8. by   pickledpepperRN
    Also in addition to the very imortant 5 rights to ensure the correct ordered dose is give it is important to ensure the medication is appropriate.
    I know you do this already.
    Check allergies.
    Check labs, don't give potassium without knowing the most recent K+ result.
    Know the vital signs. The usual exables are that we don't give Digoxin when the pulse is below 50 or give antihypertensives to a hypotensive patient without reporting to the physician.
  9. by   Antikigirl
    At work now, since I work hospital I actually have a separate sheet that I mark my meds and tx on...it is a hourlly graph form, and is filled out after report when I can get to the charts and fill it out!

    I will cross off items I do ONLY when I do them..again another good way for a double check!
  10. by   Anagray
    I open all my meds at the bedside as I am giving them. This is my third check and in this way I avoid a) wrong dosage prescribed (some patients know their meds and will correct me or question me) b) a patient can not say - Oh no, there is no way I am taking lasix or my toporol today! - and i am stuck with a cup of meds trying to figure out which is which - they are all white and small.
    Natasha
  11. by   NurseCherlove
    In addition to signing off the MAR at the time I place each pill in the cup, I also tell the A&O patients what I am putting in the cup as I am putting them in. That way, they can ask me "what is that for?" or they can say, "I take 2 of those ya know", etc. And if I am having a pretty smooth morning (i.e. have the time), I like to quiz the patients with every pill I put into the cup..."Do you know what X is for or why you're taking X?" Also, if I see a high dose BP med or multiple BP meds, I always ask the patient if they also take X at home and for how long, etc. I may even step out of the room and go and trend the patient's VS and previous MARs where BP meds are concerned if the BP is marginal or low and there are multiple BP meds listed. My reason: Well, honestly, when there is more than one physician on a case, I think they sometimes just start looking at the patient from only their perspective (specialty) and things can get overlooked (but we all know who would get the blame for such:stone ). I'm getting worse and worse about asking docs things like, "Do you really think he needs X?" or "Wouldn't X be more beneficial than that because of ...?" - some appreciate it and some REALLY do not :roll
  12. by   UM Review RN
    Quote from NurseCherlove
    In addition to signing off the MAR at the time I place each pill in the cup, I also tell the A&O patients what I am putting in the cup as I am putting them in. That way, they can ask me "what is that for?" or they can say, "I take 2 of those ya know", etc. And if I am having a pretty smooth morning (i.e. have the time), I like to quiz the patients with every pill I put into the cup..."Do you know what X is for or why you're taking X?" Also, if I see a high dose BP med or multiple BP meds, I always ask the patient if they also take X at home and for how long, etc. I may even step out of the room and go and trend the patient's VS and previous MARs where BP meds are concerned if the BP is marginal or low and there are multiple BP meds listed. My reason: Well, honestly, when there is more than one physician on a case, I think they sometimes just start looking at the patient from only their perspective (specialty) and things can get overlooked (but we all know who would get the blame for such:stone ). I'm getting worse and worse about asking docs things like, "Do you really think he needs X?" or "Wouldn't X be more beneficial than that because of ...?" - some appreciate it and some REALLY do not :roll

    I do this too. I tell the patients who do know their meds that we want them to be proactive and tell us if they're having any questions or concerns about a particular med. I also ask directly if they recognize the pills.

    One patient freaked out when I gave her two different brands of Iburofen, same dose, because they looked so different. Good thing I hadn't opened the package, so I could prove to her they were the same pill, same dose, just a different company.

    As uncomfortable as it was to have to go through that experience, I was glad that she noticed and said something and I assured her that she did the right thing to call it to my attention.

    We want patients to be proactive, to question, and to know about their medications.
  13. by   RunningWithScissors
    As previous posters have also said, I give all my attention to the patient and each med I am unwrapping as I give it. This patient at this particular time gets 100% of my attention. I do not allow myself to be distracted, either at the Pyxis or as I hand the meds to the patient.

    When you look at each med as an individual event, unwrapping it, and thinking about why the patient is getting it, it forces you to slow down and hopefully catch mistakes, like oops, this med is supposed to be cut in half, or did I check the SBP or K level?

    Also, taking the MAR with you and signing each med off after they are given helps you remember stuff you forgor (this med is in the bin instead of the Pyxis, I have to go get it, etc.)
  14. by   ginger58
    We've taken up a policy of no one talking to you while removing meds from the Pyxis.

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