Sometimes the five rights make us look dumb

Nurses General Nursing

Published

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.

Specializes in Med-Surg/Neuro/Oncology floor nursing..
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.

Specializes in Pediatric Critical Care.

Being in pediatric ICU, many of my patients aren't able to tell me their name and DOB...they are either sedated, or infants, or sedated infants.

To me, in my world, the "right patient" part of giving meds is satisfied by me being sure that I have the right patient. Whether that means confirming identity with the parent at the bedside, or asking an older child what their name and birthday is, or by knowing them because its the same intubated baby who I have been staring at for the last 11 hours since I first checked their name band and got report from the off-going nurse. In whatever way is appropriate to the situation, I just need to know that I have the "right patient".

Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Being in pediatric ICU, many of my patients aren't able to tell me their name and DOB...they are either sedated, or infants, or sedated infants.

To me, in my world, the "right patient" part of giving meds is satisfied by me being sure that I have the right patient. Whether that means confirming identity with the parent at the bedside, or asking an older child what their name and birthday is, or by knowing them because its the same intubated baby who I have been staring at for the last 11 hours since I first checked their name band and got report from the off-going nurse. In whatever way is appropriate to the situation, I just need to know that I have the "right patient".

Except that to TJC, "right patient" is determined by two patient identifiers (name and DOB). Obv in the NICU the way of doing that is different than with walkie talkies.

Specializes in Psych, Addictions, SOL (Student of Life).
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.

Eight Rights of. Medication Administration.

The Right Person.

The Right Medication.

The Right Time.

The Right Dose.

The Right Route.

The Right Position.

The Right Documentation.

The Right to Refuse.

But the OP while calling this one of the five rights is really asking about patient identifiers. We are required to use two patient identifiers when passing meds - Since I work with psych patients I usually go with their name and photo I also check the armband.

Hope this helps

Specializes in Critical Care.

We're actually up to 14 rights of medication administration now, and it should be noted that "right patient" just means there is some reliable means of assuring this is the correct person to be receiving this medication, it doesn't dictate that you ask the person's name and birthday with each medication.

I think there's a false assumption that these sorts of habitual routines reliably improve safety, when they often do the opposite. When something becomes too routine it no longer improves safety, I've seen nurses ask a patient their name and birthday out of habit, all the while not actually making a conscious check of this against the MAR. This is why ISMP has recommended that excessive use of double checks be avoided, it only weakens the effectiveness in terms of safety when it's overused.

Specializes in SICU, trauma, neuro.
Eight Rights of. Medication Administration. [/Quote]

We're actually up to 14 rights of medication administration now[/Quote]

Dang... the Rights are reproducing. :eek:

Eight Rights of. Medication Administration.

The Right Person.

The Right Medication.

The Right Time.

The Right Dose.

The Right Route.

The Right Position.

The Right Documentation.

The Right to Refuse.

But the OP while calling this one of the five rights is really asking about patient identifiers. We are required to use two patient identifiers when passing meds - Since I work with psych patients I usually go with their name and photo I also check the armband.

Hope this helps

Eight? Yikes! We had five in Texas. When I moved to California and took a test related to a job offer, they asked for seven.

Specializes in Pediatric Critical Care.
Eight Rights of. Medication Administration.

The Right Person.

The Right Medication.

The Right Time.

The Right Dose.

The Right Route.

The Right Position.

The Right Documentation.

The Right to Refuse.

The right position? I'm coming up empty on what this could be in reference to. If a med is supposed to be given with the patient in a sitting position?

Specializes in Pediatric Critical Care.
Except that to TJC, "right patient" is determined by two patient identifiers (name and DOB). Obv in the NICU the way of doing that is different than with walkie talkies.

Correct, and that is why I check with parents, name band, off-going nurse, etc. to confirm patient identity when I assume care. Thereafter, barcode scanning provides electronic confirmation that the name band matches the meds that I have. I see the name band, scan, look at the screen to see that the confirmation is correct. That confirms several identifiers all at once. I can't think of anything else to do to ensure proper identification, especially if family doesn't remain at the bedside. Luckily, in ICU, my patients don't usually have the opportunity to try to play tricks on me.

I guess my point is that 2 identifier patient ID confirmation doesn't necessarily have to follow a script "please recite your name for me". You need to confirm identity (2 identifiers), but in a way that makes sense for your care setting.

And of course, when you are training someone, you teach them the step-by-step "right way" so they can get off on the right track!

The first 5 Rights were very reasonable for their time, and are still relevant. Everything else is just...yet another embarrassment.

What foolishness some of these are.

One wonders why we must always move toward ridiculousness and excess rather than reason and equilibrium.

Correct, and that is why I check with parents, name band, off-going nurse, etc. to confirm patient identity when I assume care. Thereafter, barcode scanning provides electronic confirmation that the name band matches the meds that I have. I see the name band, scan, look at the screen to see that the confirmation is correct. That confirms several identifiers all at once. I can't think of anything else to do to ensure proper identification, especially if family don't remain at the bedside. Luckily, in ICU, my patients don't usually have the opportunity to try to play tricks on me.

I guess my point is that 2 identifier patient ID confirmation doesn't necessarily have to follow a script "please recite your name for me". You need to confirm identity (2 identifiers), but in a way that makes sense for your care setting.

And of course, when you are training someone, you teach them the step-by-step "right way" so they can get off on the right track!

These are good points. I presume the scan procedure could be said to "be" an acceptable (2) patient identifiers process.

I answered the way I did originally because I don't like the idea of an orienting nurse (especially) only having to do the name and birthdate thing verbally once a day. I'm not sure that's sufficient to really ingrain the idea and the importance of always making sure you know that you have the right patient no matter what nursing function you're doing.

Some places are very strict about overriding or circumventing the scan process, but some aren't. When you start making one shortcut and then two...etc., it's begging to make a mistake. When you ask the name and birthdate you learn/are reminded that you are making sure you have the right patient. When you use the scan process to ID a patient, there's a chance you don't even think of the actual ID process unless there's a problem with the scan - more likely you're thinking "will this scan properly today?" (lol). However, I see Muno has pointed out that one could ask the name and DOB without intentionally/appropriately IDing the patient as well, so I guess either method is no guarantee of intentionality.

Having read your answer and Muno's, I can see it both ways.

Specializes in Pediatric Critical Care.
These are good points. I presume the scan procedure could be said to "be" an acceptable (2) patient identifiers process.

I answered the way I did originally because I don't like the idea of an orienting nurse (especially) only having to do the name and birthdate thing verbally once a day. I'm not sure that's sufficient to really ingrain the idea and the importance of always making sure you know that you have the right patient no matter what nursing function you're doing.

Some places are very strict about overriding or circumventing the scan process, but some aren't. When you start making one shortcut and then two...etc., it's begging to make a mistake. When you ask the name and birthdate you learn/are reminded that you are making sure you have the right patient. When you use the scan process to ID a patient, there's a chance you don't even think of the actual ID process unless there's a problem with the scan - more likely you're thinking "will this scan properly today?" (lol). However, I see Muno has pointed out that one could ask the name and DOB without intentionally/appropriately IDing the patient as well, so I guess either method is no guarantee of intentionality.

Having read your answer and Muno's, I can see it both ways.

I agree. I know that when I was a new grad, I had that sort of thing totally ingrained into me....and then when barcode scanning came along, it was second nature to make sure that what I saw when I was scanning actually made sense. I think that it's important for new grads (and experienced nurses) to really internalize that they can't just go on autopilot, if that makes sense. Barcode scanning and all of our other tech safeguards are important, but our nurse brains must always stay engaged. :)

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