Rights of Administration
Right patient (2 identifiers — name, DOB, MRN). Right drug (check order, allergy, indication). Right dose (calculate, double-check high-risk). Right route. Right time. Right documentation. Right reason. Right response. Additional: right to refuse, right education. Barcode scanning when available. NEVER administer without verifying all rights. Question unclear, incomplete, or unusual orders — call prescriber.
Error Prevention
Minimize distractions during medication preparation. Use barcode scanning. Double-check high-alert medications (insulin, heparin, chemo). Independent double-check for: IV vasoactive, insulin infusions, PCA programming. Standardize processes. Use Tall Man lettering for look-alike/sound-alike drugs. Store look-alikes separately. Avoid abbreviations (U, IU, qd, qod). Report near-misses — learn from them. Just culture — focus on system, not individual blame.
High-Alert Medications
Insulin, anticoagulants, opioids, chemo, concentrated electrolytes (KCl, hypertonic saline), IV vasoactive (epinephrine, norepinephrine), sedatives (midazolam, propofol), neuromuscular blockers, methotrexate (oral). Prevention: independent double-checks, standardized concentrations, smart pumps with dose error reduction software, limited access (not in floor stock), warning labels, separate storage. Insulin: most error-prone — always double-check with second RN. Heparin: double-check, standard concentrations.
Important Notes
- ALWAYS use at least two patient identifiers before administering medications — never use room number alone.
- Insulin is the most error-prone medication — always have a second RN independently verify the order, dose, and pump settings.
Clinical Tips
- Question any medication order that seems unusual — unclear, incomplete, or outside normal dosing — call prescriber before administering.
- Report near-misses, not just errors — they reveal system weaknesses before patients are harmed.
Summary
Medication safety requires the rights of administration, error prevention strategies, and special handling of high-alert medications with independent double-checks.
