Question about the 6 rights of medication administration?

Clovery · Sep 29, 2012

Hmm that's an interesting question.

If you don't document, or document incorrectly, the patient may end up getting a double dose of a med. For example, another nurse may come along and see the patient hasn't had her morphine yet, and give her the same dose that you just did. So I think that's pretty dangerous.

Dose is pretty much the same deal. If the order is for 1.2 mL and you give 12, that's potentially fatal.

Of course the wrong drug is potentially fatal...

So that leaves us with route. Route is obviously important as well, but it's also the hardest one to mess up. No one with any common sense would try to push a 50 mL IVPB bag, or inject a Percocet, or give a suppository PO. I would choose "route" if I had this question. Because at least the right med is given, the dose is correct, and it's documented correctly. I'm trying to imagine a scenario that could actually occur where the nurse would choose the wrong route and it could be fatal. "Open up, Mrs. Jones, I need to squirt your insulin in your mouth." I'm sure there's something I'm not thinking of.

Let us know what the right answer is when you get your test back.

KelRN215, BSN, RN · Sep 29, 2012

I just had my first test. There was a question on it that my classmates and i are debating about. It asked which medication administration error would least likely result in being fatal or something like that. options were: right route, right documentation, right dose, right drug.
i picked documentation. others picked route.
for most questions i was just able to look up but i am not sure about this one and can't find the answer anywhere. what do you think?

What were the others' rationale?

Think about it like this:

Say you have a child with newly diagnosed seizures recently transferred from the ICU. You have an order for 45 mg of PO phenobarbital BID. The pharmacy sends liquid phenobarbital elixir 20 mg/5 mL so the dose is 11.25 mL. Liquid phenobarb is nasty and the mother says "just put it in his IV like they did downstairs." If you took this ORAL med and administered it via IV, what would happen? You could easily kill someone doing this. And yes, things like this have actually happened... a nurse in my old hospital got fired for attempting to give phenobarb elixir IV. Fortunately someone saw what he was trying to do and stopped him before he killed the child.

Here's a thread about that very situation: https://allnurses.com/nursing-issues-patient/avoiding-inadvertent-iv-782563.html

Administering something via the wrong route most definitely CAN kill someone. Incorrect documentation is more likely to hurt the nurse than it is to hurt the patient.

Stephalump · Sep 29, 2012

I'd go with documentation. All four have the potential to start the fatality ball rolling, but documentation errors are more removed. You or someone else can catch and correct a doc error. Once you give a baby his tube feeding through his IV line....

strawberryluv, BSN, RN · Sep 29, 2012

I'd choose right documentation, all the others present a real and actual risk for fatality. Right documentation

affects the nurses more than they do the patients.

Esme12, ASN, BSN, RN · Sep 29, 2012

Hmm that's an interesting question.
If you don't document, or document incorrectly, the patient may end up getting a double dose of a med. For example, another nurse may come along and see the patient hasn't had her morphine yet, and give her the same dose that you just did. So I think that's pretty dangerous.
Dose is pretty much the same deal. If the order is for 1.2 mL and you give 12, that's potentially fatal.
Of course the wrong drug is potentially fatal...
So that leaves us with route. Route is obviously important as well, but it's also the hardest one to mess up. No one with any common sense would try to push a 50 mL IVPB bag, or inject a Percocet, or give a suppository PO. I would choose "route" if I had this question. Because at least the right med is given, the dose is correct, and it's documented correctly. I'm trying to imagine a scenario that could actually occur where the nurse would choose the wrong route and it could be fatal. "Open up, Mrs. Jones, I need to squirt your insulin in your mouth." I'm sure there's something I'm not thinking of.
Let us know what the right answer is when you get your test back.

If you give a drug by the wrong route but at the right dose can be fatal. for example.....the order is Morphine 10 mg's IM and you give Morphine 10mg's IV....they will stop breathing. If you give tube feeding in the IV you will kill someone.

I say documentation. If you fail to document you gave it...and someone comes behind you and tries to give them....patients are very likely to say "I already had that medicine". Or if you document the medicine as given and forget the patient will usually call and ask where their meds are. The chance of a fatality is much less likely.

rubato, ASN, RN · Sep 29, 2012

I must agree with everyone. Documentation for sure!

PediLove2147, BSN, RN · Sep 30, 2012

Absolutely documentation! I think a few people gave VERY good examples of why.

nef203 · Oct 1, 2012

I'd go with documentation... Then again I dont start nursing school til Jan!

Lucidity · Oct 1, 2012

documentation was the correct answer

RNTutor, BSN, RN · Oct 1, 2012

Thanks for coming back to share the correct answer, and not leaving us in suspense! I think I would have picked documentation, too.

But this is a perfect example of a question where it's sooo easy to read too much into a question. If you just take it at face value, then obviously writing something incorrectly is less harmful than the other options. But when you start "reading into" the question then you start worrying that another nurse would try and give the medication again if it was undocumented, even though it doesn't sound like that's what the question was asking. Very interesting!

psu_213, BSN, RN · Oct 1, 2012

Well, I would have to vote for documentation for the reasons already mentioned.

However, I don't really understand the point of the question. Wrong route probably has more potential than wrong documentation to be fatal, but wrong documentation can lead to something fatal (e.g. 'doubling up' on a medication dosage) while wrong route is not always fatal (for example, is giving 2 mg morphine IM rather than IV likely to be fatal? probably not). The issue is that these are all probable and each of the rights, if missed, could be fatal or could be no big deal. It seems to me that this question on serves to try and maximize certain rights an minimize others; yet all the rights are, in my book, equally important.