The nine rights
Most of the nurses in the medical settings will probably be very much aware of the five rights in medication administration that is the right patient, drug, dose, route and time (Eisenhauer et al, 2007). However, studied have shown that there is more to medication rights than the five rights (Cox, 2000), and this recommendation will focus on the seven rights as identified in recent years.
Identify the right patient
It is very much obvious that medication must be administered to the right patient for whom it has been prescribed for. However, having medications administered to the wrong patient is very common in the medical settings. A possible reason for this has been identified in the study conducted by Lisby et al (2005) in which it was shown that medical and surgical wards in a Danish university hospital recorded an alarming 36% of medication hat where administered to patients without any previous verification to determine whether the patient where right for the medication. The eventual outcome of such process is that patients will likely get administered with the wrong medication and this error can lead to the negative issues discussed earlier.
On that account, safe health care will start with the right patient as it is the only way in which the medication can actually be effective at the start. As such, it is recommended that nurses in the medical and surgical ward should be very conscious with this and ensure that they administer medications to the right patients. This can be done by eliminating the issue highlighted in the case of the Danish Hospital above by having a direct conversation with the patients and understanding what their issues are first before proceeding to administer any medication to them.
A number of indications have been made from researches that as many as one out of every three medications errors involves the patient being administered with the wrong medication (Selbst et al, 1999; LaPointe and Jollis, 2003). Nurses are not qualified legally to handle drug prescription and if they are not sure about the drug prescribed, they should not administer it without checking the correct name with the prescriber. The issues of wrong drug administration can emanate from the nurse not seeing the handwriting of the prescriber correctly or from wrong diagnosis as is the case of the nurse contained in this study. However, the focus is on understanding hot to increase the health of patients and this is by ensuring that patients are administered with the right medication, with the nurse having responsibility of ensuring that prescriptions are correct and clarifications should be made in cases where there are issues with respect to understanding the prescription.
Earlier in this case, a number of routes for administering drugs where mention with the types of drugs generally described to be either solid or liquid. Nurses are only allowed to administer drugs via the prescribed routes, but in some cases the prescriber can offer the nurse choices (IV/PO). On the ground that choices exist, the nurse needs to understand associated differences between these routes such as their rate of absorption or time of action. Understanding the right route is as important as any other process in drug administration because it is only through such that the nurse will be able to administer the drug in a way that it would yield reflex and immediate actions that will be used to achieve the intended outcome.
Researches have also found that one third or more of every medication error arises from wrong dosage being administered (LaPointe and Jollis, 2003; Tang et al, 2007). The significance of this figure implies that the need to be cautious while reading prescribe dosage. Wrong dosage is without a doubt of high threat to the safety of any healthcare. This is because under dose administration will potential flow down medical healing and can cause more harm to the safety of the patient, while over dosage will cause adverse effects, side reactions and even serious acute conditions to the patient, which makes it very important that nurses come to mind the need to administer the right dose for the patient.
In order to ensure therapeutic serum levels, medication must always be administered at the correct time. The administration of medication on wrong time is as such one of the ways in which medical error can occur. Findings from studies shows that the administration of drugs at the wrong time accounted for 31% of all medication errors (Dean, 2005), with antibiotics ranking the highest of group of drugs associated with medication error as a result of the fact that they commonly prescribed in the medical settings but administered at different times (Tang et al, 2007). On that account, it is evidence that the need to administer drugs at the right time is important and it is recommended that nurses should stick with the prescribed time in order to avoid medication related errors in the medical surgical wards.
Whenever a nurse administers a medication, it is expected of the nurse to sign the medication chart as prove that the medication has been administered. If the nurse reverts to signing the medication chart prior to the administration, then the nurse is at risk because the patent can refuse to take the medication, which leads to the chart stating a different thing form what actually went on. Additionally, the nurse might find it difficult to cancel out the already signed chart and it could be easily be perceived by the doctor that the patient is under the correct medication while as the patient is suffering from poor medication. The outcome can be very disastrous especially in cases whereby the patient needs the drug in order to remain active.
In the process of administering a medication, the nurse should make use of personal experience to ensure that the drug has been prescribed for the right reasons. For instance, it is not appropriate for a nurse to administer an antibiotic for a viral infection, nor it is appropriate for antiviral drug to be administered for a bacterial infection. Such minor issues can end up causing complications in the health of the patient as reduced reflex reaction can prevail as the patient will end up not being given the right medication. The outcome of such process is the main reason why it is necessary that nurses should take extra time to ensure that the right action is being undertaken and make necessary corrections in cases where they feel that the prescribed action is as supposed with respect to the issue that is being treated.
Medications are available in different forms and as such can be administered in different forms as well. For instance, paracetamol comes in different forms such as tablets, capsules, caplets, syrup, suppositories and ampoules for intravenous administration. The fact is that having medications in different forms can lead to some forms of medication being very confusing. Indeed, there is documented cases in which cough medication for oral administration have been administered mistakenly in an intravenous form (Cohen 2006). The issue in this case is that the prescriber didn’t specify any route for which the medication can be administered, leading to the medication being dispensed in a syringe by a pharmacist; the nurse was not familiar with oral syringe while the patient had an intravenous cannula, so the nurse had the assumption that the medication should be administered that way. Clearly, it can be seen that nothing is very simple in the process of administering a drug, which means that extra measure should be taken with respect to all processes involved in drug administration even to the extent of ensuring that the form of administration is correct.
Following every administered medication, the nurse should take extra time to monitor the progress of the patient with respect to the medication in order to ensure that the response is as expected from such drug. The process of monitoring the right response could involves cases such as measuring the patient’s blood glucose level, vital signs or other physiologic parameters like the urine output test (Wilson and Devito-Thomas, 2004). Once all other factors as discussed above are right, the response on its own will be right. if any negative response is noticed, the nurse should be quick to recheck other factors in order to ensure that the actual drug was administered to the right person, at the right time, via the right route, in the right form and complying with other right elements.
The nine rights