Many medication errors can be prevented by correctly identifying the right patient. Patients in the hospital setting wear identification bands, whereas other facilities may use a photograph to identify the right patient.

Regardless of the identification method, the medication order must correspond to the identification of the patient. Checking identification and asking patients to state their names assists in reducing medication errors. It is also important to “listen” to the patient. If the patient states, “I don’t take a blue pill,” go back and check the medication order for correctness.

Medications can be ordered using their trade name or generic name.

It is the responsibility of the nurse to look up a medication before administration to ensure that the right drug is being administered.

It is the responsibility of the nurse to know the classification of the drug being administered and that the drug corresponds with the patient diagnosis. Many drugs have similar names.

It is also the responsibility of the nurse to know the side effects of the drug being administered. The nurse must be aware of any patient allergies before medication administration to ensure safety of the patient. Allergies should be clearly recorded on medication records or a patient should wear an allergy bracelet.

Because it is impossible to know all medications, the nurse can use a nursing drug reference to look up medications to ensure accuracy and prevent medication errors.

Medications are available in different dosages. It is the responsibility of the nurse to ensure that the right dosage is administered. The pharmacy may supply the exact dosage ordered or the dosage may need to be converted using a common equivalent or calculated based on the weight of the patient. If the medication must be reconstituted, the correct diluent must be used for reconstitution. If a patient is to receive a tablet but has difficulty swallowing, the nurse must obtain an order to have the medication changed to an elixir. Medication orders are to be administered exactly in the dosage ordered. A nursing drug reference assists with preventing medication errors by supplying information regarding the dosages of medications that can be safely administered to a patient based on age and weight.

Medications may be administered by different routes including oral (tablets, capsules, or liquid), parenteral (intradermal, subcutaneous, intramuscular, or intravenous), or cutaneous (skin and mucous membranes). Improper medication administration techniques (crushing an enteric-coated tablet, opening a capsule, or giving an injection using the wrong route) are considered medication errors. A nursing drug reference provides information regarding the routes that can be safely used to administer medication and eliminate medication errors. It is the responsibility of the nurse to use this information to safely administer the medication to the patient using the right route.

Medications are ordered and need to be administered at specific times to ensure the effective absorption of the medication. Failure to administer a medication on time or failure to document the administration of a medication is a medication error of omission. Some medications are ordered before meals (ac), after meals (pc), or at bedtime. Other medications may be ordered based on frequency of time (once a day [qd], twice a day [bid], three times a day [tid], or four times a day [qid]). A nursing drug reference provides the nurse with the appropriate information to ensure that the medication is effectively and safely administered to eliminate a medication error based on adsorption. Most facilities allow a window of administration that is usually 30 minutes before or 30 minutes after the prescribed time. It is the responsibility of the nurse to use this information to safely administer the medication to the patient at the right time.

Once you are able to interpret the important components of an order for medication, you can perform accurate calculations for the correct drug dosage by using dimensional analysis.

Documentation is the sixth “right of medication administration” and should be completed as soon as possible after the administration of the medication. Documentation is an important right that can prevent medication errors related to over- or under-medication. The general rule of documentation is “if you didn’t chart it… you didn’t do it” therefore medication should never be charted before administration of the medication. Documentation should follow medication administration and include documentation regarding refusals, delays, and responses (including adverse effects) of medication administration.

A Medication Administration Record or MAR is a document used to chart the administration of medication. In an effort to reduce medication errors related to misinterpretation of hand-writing, many health care facilities are now using an Electronic Medication Administration Record or eMAR. Documentation must occur on the MAR after the administration of a medication as well as if a medication is not administered. If a medication is not administered, the reason that the medication was not administered must also be written on the MAR. A sample MAR will provide an opportunity to practice the sixth right of medication administration using Exercise 4.2.

If an answer does not result in a whole number, but instead a decimal in the tenths (4.7) or hundredths (4.75), the answer can be rounded up or down to allow for administration of the medication. Some medications may not require rounding when the exact amount of medication calculated needs to be administered.