9 rights of medications

[Jonesskky RN]

some nurses are not aware of the 9 Rights of Medications but it's helpful if you want to decease the errors associated with dispensing medications and improve your nursing care. I'm sharing this information because it's great for new nurses and nursing students to be aware of... Furthermore, every medication given should at least follow the first 5 rights but some medications are very important in other areas so more rights were added:

1. right patient
   
   
2. right time and frequency
   
3. right dose
   
4. right route of admission
   
5. right drug
   
6. right dilution or compatibility (important for antibiotics)
   
7. right flow rate (important for insulin and Heparin drips)
   
8. right monitoring (important for potassium, Dilantin, nitrogen drips, etc.)
   
9. right documentation (very important for tPa, conscious sedation) and the right documentation usually includes forms to help or know the "right monitoring"
   

Teaching the 9 rights of medications could decrease problems or med errors and I believe it should be practice more often, I'm just curious about what others may think will help since it's becoming a bigger problem in my hospital

[Meriwhen, ASN, BSN, MSN, RN]

The 9 rights are good...but IMO it should be 10. You're missing the right to refuse a medication, both on the part of the nurse and the patient.

Unless under court order, a patient has the legal right to refuse any medication even if doing so would be detrimental to his health. Of course, the nurse shouldn't just say "OK" to the patient's refusal and leave it at that. It's up to the nurse to educate the patient, make sure he understands the consequences of not taking the medicaiton...and if he still refuses to document the education and the refusal. Nurses are sometimes so focused on making sure all of the meds are done so they can check the MAR off, that they forget about the patient's autonomy.

Likewise a nurse has the right to refuse to administer a medication that she considers to be unsafe for whatever reason. For example, if my patient's BP is 80/40 there's no way in hell I'm giving them clonidine, or I'm not giving them more Vicodin if they've already had 4g of Tylenol today. I'd refuse and let the MD know why I'm doing so.

[Jonesskky RN]

I had a nurse who didn't want to give someone a Catapress patch because the blood pressure was like 100/50 but the doctors were concerned about rebound hypertension and sometimes Catapress is given for withdrawal symptoms so critical thinking skills must always be used...not just for medications.

[Meriwhen, ASN, BSN, MSN, RN]

I had a nurse who didn't want to give someone a Catapress patch because the blood pressure was like 100/50 but the doctors were concerned about rebound hypertension and sometimes Catapress is given for withdrawal symptoms so critical thinking skills must always be used...not just for medications.

We use clonidine all the time in detox. Works beautifully on a lot of withdrawal symptoms, particularly those of opiate w/d. 100/50 isn't too low for a patch IMO, especially since we're getting their VS hourly or so. But if the pressure is too low, the general consensus among our MDs is that we'd rather deal with any rebound HTN and withdrawal symptoms than have a patient's pressure bottom out, especially since clonidine also lowers the HR too.

[LaurenNicoleRN]

Another "right" that should be added to your list is "Right circumstance"

Wou

[LaurenNicoleRN]

oops..forgive the sleepy nurse who was typing too fast and hit enter idk what else I was going to say i've lost my train of thought..like i said right circumstance haha!

[Daisy_08, BSN, RN]

#10 - right to refuse!

#11 - right site

[carolmaccas66, BSN, RN]

The rights of meds has got ridiculously wrong. You do not need 10 or 15 rights!

This is why errors happen, cos students/nurses are trying to learn and integrate too many things at once. Keep it simple with the 5 rights - you don't need how to dilete, right site, etc, etc. That's just pedantics. You are trained to read the order and your drug book. If anything, the last RIGHT should be 'the right to go ask an instructor if unsure and need help re medictions'.

It has all got out of hand. We never had 9 or 10 or 15 rights when I was a student & we survived just fine. A lot of teaching re medications should be about common sense as well. And if unsure, DO ASK A SENIOR NURSE, and do not give any medication if unsure.

[comm]

How about we stick to the original 5 of route dose med patient and time. The point of the list was to be succinct, the more complicated it gets the more errors are made in remembering it. like adding to many parts to a mnemonic. There could be pages of additions to this but it becomes cumbersome and useless. All I see is expansion on the existing 5.

Right dilution -

is part of having the right dose, too dilute then it is incorrect etc.

Right flow rate -

is the same thing, too much too fast is the wrong dosing

Right monitoring? -

Monitoring and assessing is standard nursing practice and doesn't need to be included in this list. If monitoring was on this list than we might as well add, right notification to the MD, right lab draws afterward, right follow up assessment, right report to the oncoming shift. i mean really....?

Right documentation -

again, part of standard nursing practice the original point of the 5 rights was to prevent medication errors, not to be an extensive list of all our nursing duties

Right circumstance -

again that is redundant as it falls under the right medication. Being that standing orders or policy dictates in x circumstance you give y medication.

Right site -

this again falls under right route. Where something is administered, is part of the route

Right to refuse -

Seriously? I've always hated this one. Its a given they have the right to refuse as forcibly doing something to anyone is a crime, and of course you have the right to refuse as you are not a slave and should have a modicum of self awareness. If you need a rule or guideline to tell you that you have the right to be self aware than I question your ability to practice medicine.

Point being is that this list was suppose to be a quick down and dirty checklist. all this extra fluff just makes us as professionals sound pompous.

[comm]

omg thank you thank you so much for being a sane person.

[txbornnurse]

I know this is a very old post but I have to point out a major pet peeve of mine in this sentence fragment.."dispensing medications ".

Nurses do not dispense medications; we administer medications. There is a significant difference in the two activities.

Off my soapbox now.