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In addition to the traditional “five rights” of medication administration, the nurse has six rights concerning safe medication administration: AAAA; BBBB; CCCC; DDDD; the right to administer medication safely; and the right to stop, think, and be vigilant when administering medications.
- a. the right to a complete and clear order
- b. the right to have the right drug, route, and dose dispensed
- c. the right to access to information
- d. the right to policies to guide safe medication administration
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The traditional five rights of medication administration are AAAA. Experience indicates that five additional rights are essential to professional nursing practice: BBBB.
- the right client
- the right drug
- the right dose
- the right time
- the right route
- the right assessment
- the right documentation
- the client’s right to education
- the right evaluation
- the client’s right to refuse
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Ensuring that the nurse has the right client is essential. The Joint Commission requires AAAA forms of client identification before administration. Identification of the
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client must take place BBBB the nurse administers a medication.
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Only drugs with complete orders should be administered. A complete order contains the following information: AAAA, BBBB, CCCC, DDDD, EEEE, FFFF, and GGGG.
- a. date and time the order is written
- b. drug name
- c. drug dosage
- d. drug route of administration
- e. frequency of administration
- f. special instructions for withholding or adjusting dosage based on nursing assessment
- g. health care provider’s signature
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The right dose includes the AAAA and BBBB. This includes the nurse’s responsibility regarding CCCC.
- a. right dose within guidelines for the drug
- b. client’s physical status such as weight and renal function
- c. correct drug dose calculations
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The right time is AAAA. Nurses must have knowledge of the effects of BBBB and foods on the drug. Drug dosing CCCC altered to fit a client’s lifestyle if appropriate.
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Nurses must also be aware of medications that DDDD to ensure that the drugs are given to maintain these blood levels.
- a. the time the dose should be administered
- b. certain diagnostic tests
- c. may be
- d. must maintain therapeutic blood levels
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The right route is necessary for AAAA. This includes the nurse’s knowledge of patient BBBB regarding the route. Nurses must also ensure that oral medications CCCC.
- a. appropriate absorption
- b. limitations
- c. are swallowed by the client
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The right assessment includes the nurse’s collecting AAAA; BBBB; CCCC; right evaluation requires that client DDDD; and the client’s right to refuse a medication. The
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nurse’s responsibility is to EEEE.
- a. appropriate assessment information before administering a medication
- b. right documentation of the medication administration
- c. right to education or the client receiving accurate and thorough information about all medications
- d. response to medication be assessed and documented
- e. determine the cause for refusal and reeducating the client as necessary
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A medication error is defined as
“any preventable event that may cause or lead to inappropriate medication use or harm to a patient.”
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Medication errors may occur at any time during the cycle of AAAA. Changes have been made to prevent errors in each of these areas.
- administration
- ordering
- transcribing
- preparing
- administering
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Computerized order entry systems are becoming widely used. Most use AAAA that allows client information to be part of a database scanned before medication administration.
a bar coding system
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Other examples of safety risks in medication administration include:
- pill splitting
- buying medications on the Internet
- “look-alike, sound-alike drug names.”
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The Joint Commission has put forth a list of AAAA that have greater risk of being misinterpreted or misread.
abbreviations, acronyms, and symbols
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The Joint Commission has also devoted AAAA of its National Patient Safety Goals to increased medication safety.
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