The 7 Medication Rights: Preventing Errors As A USRN

The 7 Medication Rights were established to promote medication safety and eliminate the risk of serious adverse medication errors that have the potential to lead to patient harm or death. Medication errors occur with an estimated 5-25% of all medication administrations. In the event of a serious medication error, any individual or organization that is found to be negligible, could face fines, termination, and even criminal charges. By following the 7 Medication Rights, you can significantly reduce the risk of performing a medication error. These include:

1. Right Patient

2. Right Medication

3. Right Dose

4. Right Time

5. Right Route

6. Right Reason

7. Right Documentation

The 7 Medication Rights And Considerations

These 7 rights should be strictly followed with each and every medication administration, as a medication error can take place if any of them are ignored. To prevent a medication using the 7 Medication Rights, use the following considerations:

1. Right Patient: Confirm the patient's identity using 2 identifiers (e.g. date of birth, MRN, name), often by examining the patient's ID band and asking the patient an identifying question, such as "can you tell me your date of birth please?"

2. Right Medication: Confirm the medication you are administering matches the practitioners order(s) and is found in the medication administration record (MAR).

3. Right Dose: While some health care facilities will deliver medications that are pre-drawn in a syringe or bubble pack, always confirm that the doses match the orders. If the dose or volume seems unusual (e.g. 15ml of Tylenol for a two month old patient), question the dose with the practitioner. You should also look up the safe dosing minimum/maximum limits for a medication specific to the population that you are administering it to.

4. Right Time: It is important to not only ensure that medications are administered within 30 minutes of the prescribed times, but to also review when the last dose of that medication was administered to ensure that too much medication isn't being administered in too short of a time span. For example, if the previous dose of Tylenol was given 2 hours late at patient's request, all doses will then need to be rescheduled to 2 hours later.

5. Right Route: Most medications can be given via multiple routes, however, the dosing is often different for a medication being give orally versus Intravenous, therefor, it is important to always administer the medication using the proper route to prevent over/under dosing.

6. Right Reason: A medication must only be administered for the reason that it was prescribed. For example, if Tylenol was ordered as needed for fevers, and it is given for pain instead, this is considered a medication error, even if the prescribed medication and dose are given. Knowing why you are giving a medication is critical to preventing medication errors.

7. Right Documentation: Proper documentation is imperative. Every orders details should be reviewed and the administration of a medication should be documented properly. If it isn't documented, it is said not to have happened. Failing to document a medication administration, could lead to a dose being given again and a medication error taking place. Follow-up documentation may also be required for certain medication administrations such as re-assessing pain 60 minutes after an analgesic is given to determine its effectiveness.

Common Contributors to Medication Errors

1. Distraction: Up to 75% of all medication errors occur as a result of distraction. When you are preparing or administering medications, you should refrain from having conversations with colleagues or being in a loud environment.

2. Distortions: The use of abbreviations, poor writing, or improper translation can all lead to medication errors taking place.

Considerations for Medication Administration

1. Understand the metric system: The US medical system uses the metric system for medication dosing and administration. It is important to understand the different units of medications that will be used, such as micrograms, grams, milliliters, etc. Weight-based dosing will be in kilograms and height-based dosing will be in centimeters.

2. Patient age considerations: Pediatric patients will be ordered medications using weight-based dosing (e.g. 10mg/kg/dose every 6 hours orally), while adults will use generic dosing (e.g. 350-700mg every 6 hours orally).

3. Know what lab values can be affected by the prescribed medication: Knowing the liver and kidney function enzymes are important, especially if a patient is receiving medication that could further injure these organs (e.g. IV Vancomycin or NSAIDS) or be impacted by their inability to break them down (e.g. Electrolytes). As a result, toxicity can occur if the body is unable to break down and excrete medications.

4. Complete patient and family medication teaching: Every patient and family will have varying levels of health, medication, and medical literacy. It is important to meet them where they are in their understanding of this information in order to best support them. For patient's who primarily speak a different language, such as Spanish, teaching and handouts should be done with an interpreter and translated for them. Pharmacists will often participate in medication teaching as well.

5. Avoid abbreviations and trailing zeros: Abbreviations can lead to preventable medication errors. Ensure the practitioner writes or types out the full order to prevent this (e.g. writing “every six hours” instead of “Q6H”). Trailing zero's should also be avoided as they could lead to giving doses that are 10x what is intended. For example, 2.0mg of morphine could easily be mistaken for 20mg of morphine.

6. Co-sign high-alert medications: All narcotics, anticoagulants, benzodiazepines, sedatives, and high-risk electrolyte replacements, among other medication categories, should be double checked and co-signed to prevent medication errors.

7. Report errors: Reporting errors is critical to examining what and how a medication error took place in order to make a policy or procedural changes that can prevent a similar error from taking place again in the future.

8. Question medications if the indication or dosing is unclear: Always know what the medication is that you are giving, why you are giving it, and if the dose is appropriate for the indication and patient’s age or size.

9. Ensure proper monitoring is in place: Ensure you are performing the proper pre- and post-medication administration monitoring, such as taking a blood pressure prior to administering a beta blocker, monitoring a patients EKG rhythm while infusing potassium intravenous, or frequently checking a patient's heart rate and respiration rate after administering a narcotic.

Sources

• Aspden P, Wolcott J, Bootman JL, Cronenwett LR, editors. Preventing Medication Errors: Quality Chasm Series. Washington DC: The National Academies Press; 2007

• Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 health care facilities. ArchInternMed. 2002;162(16):1897–903. doi: ioi10605 [pii]; Institute of Medicine

• Smeulers M, Verweij L, Maaskant JM, de Boer M, Krediet CT, Nieveen van Dijkum EJ, Vermeulen H. Quality indicators for safe medication preparation and administration: a systematic review. PLoS One. 2015 Apr 17;10(4):e0122695. doi: 10.1371/journal.pone.0122695. PMID: 25884623; PMCID: PMC4401721

• Tariq RA, Vashisht R, Sinha A, et al. Medication Dispensing Errors And Prevention. [Updated 2022 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519065/