Guest Author - Cheryl Pombriant, R.N.
There are times in a nurse's career when they may need to go back to the basics of nursing and review the very fundamentals of nursing. The very first thing a new nurse has drilled in to her or him before they give medication is The Five Rights of Safe Drug Administration. One of the oaths physicians take is to “do no harm” to a patient. However, this is an oath that everyone working in health care should abide by and follow with a passion.
It is easy to go about the day and have so many deadlines and time restraints. Health care facilities may be short staffed because of call outs or worse yet, budget restraints that have forced the facility to reduce their workforce. Ultimately it is the patient that may suffer as a result of rapid changes and challenges confronting health care.
However, if nurses can just take enough time to stop for a few minutes and think, what is best for the patient? The answer will always be clear. So, what is best for the patient? Again, the most important thing to remember is to do no harm. When giving medications to a patient in any setting, it is best to remember the basics of giving medication safely so there will be no errors or adverse events. Thus preventing harm to a patient.
So what are the patients’ rights regarding safe administration of medications? At one time there were only five rights. The right patient, right medication, right dosage, right route, and right time.
Now there are The Ten Rights of Safe Drug Administration. The other five rights are right documentation, right education, right to refuse medication, right assessment, and right evaluation.
Let’s use an example of a patient to receive Lopressor 25mg orally.
The order is written for John March to receive Lopressor 25mg orally twice a day for a diagnosis of hypertension. The order is transcribed to the medication administration report (MAR) or the electronic MAR.
The process should start here by having another nurse check that the order was transcribed correctly to the MAR, and the patient is not allergic to Lopressor or any other medications. As the medication is removed it should be checked that in fact the patient you are dispensing it to is John March, the medication is Lopressor, the dosage is 25mg orally, and the time to be given is correct. If you are able to take the medication order with you to the bedside, do so. Identify the patient by his name; ask to have him repeat his name, checking his identification band at the same time, along with correct date of birth. It would also be acceptable to ask if the patient has any allergies and to tell the patient what medication he is being given, the dosage and the route. Hopefully while this is all being performed the nurse is doing a quick visual assessment of the patient.
Imagine this patient is elderly and frail, but alert and oriented. All the above rights are completed correctly. The nurse has educated the patient by teaching what the medication is prescribed for and why the physician has ordered it. However, the initial visual assessment has revealed the patient to be more fatigued and appears lethargic. Vital signs are taken and questions are asked regarding how the patient is feeling. The blood pressure is 90/50 and the heart rate is 50. The patient states he does not think he wants to take the medication because he is already feeling “not himself.” The assessment and evaluation of the patient and medication has suggested potential adverse effects of Lopressor. Thus, suggesting the dosage should be placed on hold at this time and to notify the physician immediately. Documentation supports the clinical findings. New orders have been ordered with parameters for heart rate and blood pressures so the medication can be withheld if needed.
Now imagine if you will that the dosage for Lopressor was still 25mg but it was given as an intravenous dose. The nurse did do a quick visual assessment but felt she was too busy to do vital signs and a more thorough assessment. The patient stated he did not feel quite himself and did not want any medication, but because he was frail and elderly the nurse dismissed his comments. The Lopressor was given intravenous and the patient immediately became dangerously hypotensive and bradycardic. Resuscitative measures were needed and the patient was transferred to the ICU.
All of this because the right route, right assessment, right evaluation, and right to refuse medication were not performed. It does not matter the reasons why the medication was still given and why the 10 rights of medication safety where not abided by.
What matters is harm was done to the patient and what was best for the patient was not considered. When in doubt always ask yourself theses two questions. Could this do harm to my patient? Is this what is best for my patient? These two questions will always guide you in the right direction.