Sometimes the five rights make us look dumb

  1. Do you REALLY ask every patient to state their name and date of birth before every medication that you administer? I was doing it for a while, and I always prefaced it with "for your safety, can you please state your name and date of birth", check against the wrist band and go on. Part of my problem is that I work nights, and sleep is hard enough to come by in the hospital as it is. But, early on, I had a few patients respond with different variations of "how dumb are you that you can't remember who I am?" And I see their point. Once we've done the initial identification, and they haven't even moved out of bed, I am pretty sure that I can identify them accurately- at least for the next eight hours, and especially when I've had them 5 days in a row. Additionally, I've got some patients on antibiotics spaced two hours apart all night- I can scan their bracelet, the IV bag, and start it without even waking them, so the name and date of birth part- not so much happening every time. I've got an orientee now, and I want to set someone else off on the right track, so I just want to know how others practice. And what are your thoughts on balancing common sense with the by-the-book safety aspect.
    Last edit by Brian S. on Jan 26
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    About JBMmom, MSN, RN

    Joined: Jun '09; Posts: 552; Likes: 1,140

    57 Comments

  3. by   BSNbeauty
    When I'm giving meds to the same patients all night I find that asking them once is sufficient. I also ask once for allergies and explain side effects .
  4. by   Sour Lemon
    It depends on what I'm giving, how much potential it has to cause harm, how familiar I am with the patient, etc. I think they actually have seven rights in California ...couldn't tell you what they are though.
  5. by   Buckeye.nurse
    Maybe confirm with the patient that their name and date of birth on the wrist band is correct at the start of your shift, and then visually match their wrist band to the medication before you hang it? It should be a pretty easy step since you are scanning their band anyway, and it is less disruptive to the patient than asking them again.

    I feel that matching the wrist band to the *med* is the most important step. I want to make sure I brought the med for the correct patient to the room. Many times any old Zosyn will scan right, but I don't want to have accidentally grabbed room 4's antibiotic for room 5. Hence matching the band to the med.

    Incidentally, I always match a lab label to my patient's wrist band before I place the label on specimens as well. One of my OCD worries has always been that I will mis-label a specimen, and this sets my mind at ease
  6. by   klone
    Quote from JBMmom
    Do you REALLY ask every patient to state their name and date of birth before every medication that you administer? .
    I do before every time I give a med, but not for every medication (e.g. if they're getting three meds at the same time, I don't ask before each med). But yes, every single time I give a med.
  7. by   JKL33
    Aside from everyone's personal preferences, you should be teaching an orientee to ask with each "occasion." By that I mean ask once when you are in the room on one occasion to give 3 meds. But if you are giving a med and then an hour later giving another, the ID verification should be repeated. We all must get into a deeply-ingrained habit of doing this step when we have separate occasions and have been doing 50 other things in-between those occasions.

    The orientee can adapt his/her practice after training is complete and the rules have been drilled in and well incorporated. Not before.
  8. by   PeakRN
    There are plenty of times that I do not ask the patient for their name and DOB. From a critical care standpoint my patients cannot often tell me their names and birthdays, I do not ask sedated patients before giving an antiemetic, hanging fluids on septic patients... et cetera. When I give outpatient chemo I know all of the kids personally so I don't ask them, but I'm definitely making sure that the infusion I have is theirs. I definitely don't ask for name and date of birth when I'm out in the field giving protocol/standing order meds, I'd really look like an idiot.

    On the rare occasion that I'm upstairs in the hospital resourcing I ask every patient, and they often dislike repeating their name for the umpteenth time that day. But that is not my home, I don't feel comfortable giving meds without asking, and I would rather look like and idiot than make a med error. I think it largely depends on your experience and comfort level, do you believe that you are reasonably safe from making a med error without asking?
  9. by   elkpark
    Not as dumb as a med error makes you look. It's no big deal to explain to people, if they ask, that this is a safety measure for their protection.
  10. by   JBMmom
    Quote from elkpark
    Not as dumb as a med error makes you look. It's no big deal to explain to people, if they ask, that this is a safety measure for their protection.
    I agree, which is why I preface the question with "For your safety..." But when patients are on the verge of anger, I'll reconsider on an individual case basis. Thanks.
  11. by   SaltySarcasticSally
    If I have the same person 3 shifts in a row, no I do not ask every time. I will always the first big med pass no matter how many times I have them. I will always scan the ID band and med, every time. Coming from a LTC background where we didn't have that safety, I love it.
  12. by   JBMmom
    Quote from SaltySarcasticSally
    If I have the same person 3 shifts in a row, no I do not ask every time. I will always the first big med pass no matter how many times I have them. I will always scan the ID band and med, every time. Coming from a LTC background where we didn't have that safety, I love it.
    I'll never forget one of my first med passes on the dementia unit in LTC. Everyone takes their ID bands off, and I had been asking staff to identify the patients before I gave the meds. I went into one room and the woman was in bed so I got the meds together. As I'm walking towards her, one of the aides walks in as says " Mrs. X, what you doing in Mrs. Y's bed?", I was completely freaked out. Until I knew them all, I made someone else say every person's name to ID them before I gave anything.
  13. by   Ruby Vee
    Quote from JBMmom
    Do you REALLY ask every patient to state their name and date of birth before every medication that you administer? I was doing it for a while, and I always prefaced it with "for your safety, can you please state your name and date of birth", check against the wrist band and go on. Part of my problem is that I work nights, and sleep is hard enough to come by in the hospital as it is. But, early on, I had a few patients respond with different variations of "how dumb are you that you can't remember who I am?" And I see their point. Once we've done the initial identification, and they haven't even moved out of bed, I am pretty sure that I can identify them accurately- at least for the next eight hours, and especially when I've had them 5 days in a row. Additionally, I've got some patients on antibiotics spaced two hours apart all night- I can scan their bracelet, the IV bag, and start it without even waking them, so the name and date of birth part- not so much happening every time. I've got an orientee now, and I want to set someone else off on the right track, so I just want to know how others practice. And what are your thoughts on balancing common sense with the by-the-book safety aspect.
    Teach the orientee what the policy says, and teach her to follow the policy. When she's on her own, she may deviate from the policy but hopefully you've encouraged her to err on the side of caution.
  14. by   Munch
    Quote from elkpark
    Not as dumb as a med error makes you look. It's no big deal to explain to people, if they ask, that this is a safety measure for their protection.
    THIS. Asking a patient for their info doesn't require any extra effort. A coding patient from getting the wrong medication certainly will. I'll never forget when I was in the ED one time as a patient the transport people took me for someone else's CT scan. I'm a neurosurgery patient so taking me for a CT scan wasn't something so out of the ordinary or unexpected.

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