Five rights of medication administration...

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The following is a discussion question I'm to answer:

"Compare and contrast the five rights of medication administration for pediatric patients, adult patients, vs. geriatric patients. Give specific examples of potential difficulties specific to each patient population. Include applicable nursing interventions for overcoming these difficulties."

I'm familiar with the 5 rights, in general, but not quite sure how they compare between the age groups. It's the only part of the question I am unsure of. Thoughts?

Specializes in Pedi.
Thank you, Esme! I think the parents wearing an armband is a great idea!

This was specifically not allowed at my pediatric hospital. We tried to suggest it because some kids- no matter what you did- would not keep their ID bracelet on.

Specializes in Psych, Case Management, Care Coordination.
This was specifically not allowed at my pediatric hospital. We tried to suggest it because some kids- no matter what you did- would not keep their ID bracelet on.

Out of curiosity, can you share with me how you went about verifying your patients for meds if their armband was gone?

Specializes in Pedi.
Out of curiosity, can you share with me how you went about verifying your patients for meds if their armband was gone?

Most of the time with pediatric patients there is a parent or guardian around who can verify that the child in the bed is, indeed, Johnny Johnson DOB 1/1/11. Developmentally appropriate children over the age of 2 or 3 should be able to tell you their name. Of course it wasn't really the developmentally appropriate verbal patients who were ripping/biting their ID bracelets off.

We were required to scan ID bracelets for medication administration so what most people commonly did was stick the bracelet to the bed. This was officially not allowed either, but it was done all the time.

Specializes in Psych, Case Management, Care Coordination.

Thanks for sharing! :)

Specializes in Psych ICU, addictions.

Do not forget right #6: the right to refuse.

Specializes in Pedi.
Do not forget right #6: the right to refuse.

There's one that's different in pediatrics. A child will try to refuse a shot when you walk in with it but he doesn't have that option. Theoretically parents can refuse on a child's behalf but if they're trying to refuse medication deemed essential, it gets tricky. No one's going to argue with the parent who's refusing the post-op Colace that's just ordered for anyone, for example, but if they try to refuse insulin for diabetes, inhalers for asthma or chemotherapy for standard risk leukemia, expect a lot of drama and possibly the courts or CPS to step in.

If the person is a child the parent is allowed to identify them by name to the nurse. I am not sure about the confused elderly patient though I believe looking at the arm band is best.

Specializes in Psych ICU, addictions.
Out of curiosity, can you share with me how you went about verifying your patients for meds if their armband was gone?

In psych, we use pictures: every patient has a photo taken upon admission, and these photos are kept in the EMR, the med room and the nurses' station. We may also have other staff verify the patient's identity.

Specializes in Pedi.
In psych, we use pictures: every patient has a photo taken upon admission, and these photos are kept in the EMR, the med room and the nurses' station. We may also have other staff verify the patient's identity.

I never thought of this before but you must encounter some interesting issues in psych when it comes to this kind of thing. Do you ever have patients who just refuse to tell you their names? Or patients with Dissociative Identity Disorder who, in their dissociative state, tell you their name is something else because they really believe that to be the case? Like if you're trying to give Amanda Jones, DOB 1/1/80 her medication and you ask her to verify her name and DOB and she tells you she's Susan Johnson DOB 6/6/86?

Specializes in Psych ICU, addictions.
I never thought of this before but you must encounter some interesting issues in psych when it comes to this kind of thing. Do you ever have patients who just refuse to tell you their names? Or patients with Dissociative Identity Disorder who, in their dissociative state, tell you their name is something else because they really believe that to be the case? Like if you're trying to give Amanda Jones, DOB 1/1/80 her medication and you ask her to verify her name and DOB and she tells you she's Susan Johnson DOB 6/6/86?

All patients are given wristbands, but some do manage to get them off. And we do have those that won't share their names whether because they don't want to tell, and some patients will try to jerk a nurse's chain (for fun or for spite) and say they're another patient...that's where the pictures come in handy. We ask patients their name and DOB but also verify all patients' identities with the pictures.

As far as those who don't know who they are due to DID, delusions, amnesia, whatever...in addition to the pictures, we try to identify them through the police, staff or other person(s) who may be familiar with them. Until we are able to positively ID them, they're called John/Jane Doe. Most are identified within a couple of days...however, we had one John Doe with us for 100+ days. He kept telling us he was someone famous.

Specializes in NICU, PICU, PACU.

On the peds floor we would put it on their ankle, the tend to like to pick at things on their arms. They would not let us band the parent, heck when someone delivers and daddy isn't in the room that band gets destroyed and he has to be ID'd by the mom, his photo ID scanned into computer and he has to have Photo ID on him at all times lol

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