Five rights of medication administration...

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Specializes in Psych, Case Management, Care Coordination.

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?

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Specializes in Medical and general practice now LTC.

Wish it was 5 rights where I work. We are using 11 rights

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Specializes in Psych, Case Management, Care Coordination.

Well, at work we have the 5 Rights, but so far in my classes, I've read about 5 Rights, the 5+5 Rights, and the 6 Rights. The 5 for work are Right drug, dose, consumer, route, time...and documentation...which is actually 6, so why they keep saying 5 is beyond me.

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Specializes in Psych, Case Management, Care Coordination.

And, as far as rights go, it seems to me that across the age groups the rights should be all the same, aside from taking into consideration the ability to understand and therefore the informed ability to refuse, for example, a very young child or an elderly patient who is low functioning/non responsive? (I am sure those are not the correct terms, but I'm at work, in bed, and dealing with major allergies, my brain function is a

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Specializes in Emergency.

I would also think that the right weight might come into play.....most pediatric drugs are weight based as are some adult meds. (It's just a guess!)

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Specializes in Psych, Case Management, Care Coordination.
I would also think that the right weight might come into play.....most pediatric drugs are weight based as are some adult meds. (It's just a guess!)

I don't know about a "right", but this is definitely one of the considerations in regards to med admin in children vs. adults vs. geriatrics.

Also, I don't know why my last post cut off.

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Specializes in Psych, Case Management, Care Coordination.

Or rather, "a potential difficulty".

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Think about how you determine the 5 rights. What about an infant...can they answer your questions? What if the elderly persons is confused? How do you identify that they are who they are? Does a 11 year old need the same questions as a two year old? How would you approach the ages differently? With children the right dose does depend on the right weight....so does some adult doses like heparin.

1. Right Medication

- Is this the medication the provider ordered? of course you check you orders

2. Right Dose

- How may milliliters, tablets, or does are to given? this is by weight for many drugs especially children. Is the dose ordered appropriate?

3. Right Time

- What time of day should the medication be taken? looking up the drug is necessary

4. Right Route

- Should the medication be given by mouth, via feeding tube, or is it an injectable medication?

5. Right Patient

- Is the medication for this patient or is it for someone else? How do you determine this and how does age, mentation change your approach? Can you ask a infant their birth date? What about a confused adult? How do you address this? How do you adapt your response to the pedi population according to age?

Tell me what you think???

http://www.eec.state.ma.us/docs1/regs_policies/FiveRightsMedAdmin/The5RightsofMedicationAdminis.htm

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Specializes in Psych, Case Management, Care Coordination.
Think about how you determine the 5 rights. What about an infant...can they answer your questions? What if the elderly persons is confused? How do you identify that they are who they are? Does a 11 year old need the same questions as a two year old? How would you approach the ages differently? With children the right dose does depend on the right weight....so does some adult doses like heparin. 1. Right Medication - Is this the medication the provider ordered? of course you check you orders 2. Right Dose - How may milliliters tablets, or does are to given? this is by weight for many drugs especially children. Is the dose ordered appropriate? 3. Right Time - What time of day should the medication be taken? looking up the drug is necessary 4. Right Route - Should the medication be given by mouth, via feeding tube, or is it an injectable medication? 5. Right Patient - Is the medication for this patient or is it for someone else? How do you determine this and how does age, mentation change your approach? Can you ask a infant their birth date? What about a confused adult? How do you address this? How do you adapt your response to the pedi population according to age? Tell me what you think??? http://www.eec.state.ma.us/docs1/regs_policies/FiveRightsMedAdmin/The5RightsofMedicationAdminis.htm

But aren't all the rights the same, no matter the age? It's a matter of applying the rights correctly depending upon the individual patient, isn't it? The right medication, ordered by the doctor, must be given, in the right dosage, at the right time, via the right route, to the right patient. The rights themselves don't change. For example, a medication that is ordered for a pediatric patient, but not packaged for pediatric patients - I would need to provide the correct dose. Determining the right pediatric patient might be more challenging, ask a parent or caregiver if present? Check armband, if present? Verify photo of patient in chart against patient, if present? (I worked in a youth residential treatment facility, and this was a way our nurse verified correct patient.) Verifying a geriatric patient may also be done via photo in the chart in some settings?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

right.....but you can ask a teen their birth date. You have to determine of the dosage is correct for the weight. Name bands are good...if they are present (and they should be). Pictures and family/parent are also good checks. I worked for a facility that had non verbal pedi patients have the parents wear the same armband like they do in the nursery so that identification is assured....I liked that.

Example: I was a nursing supervisor can called to start an IV on a 7y/o 78lb child. When I got the IV I started the IVF and went to start the IV antibiotic and noticed the dosage....it was WAY TOO MUCH for that child. It was the right antibiotic, the right kid, the right route......it was NOT the right dose. I knew adults could get that dose but not a small child. Upon checking the pharmacy figured the dose assuming it was 70kg...or 140lb patient and NOT a 30kg child or 78 lbs....a HUGE difference. The difference of the dose was 1gm/1000mg for an adult and 200mg for the child. This antibiotic is toxic to the liver. This higher dose was given for 4 days...thank goodness the child suffered no harm.

The rights do not change...but how you verify does. You have some good examples.

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Specializes in Psych, Case Management, Care Coordination.

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

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Glad to help!

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