Tips for Safe Medication Administration

The "Five Rights"

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he 5 Rights

Medication errors, or mistakes involving medications, are so common that in the medical profession we have the “5 Rights” to help us avoid them. The Five Rights are:

  1. The right dose
  2. The right medication
  3. The right patient
  4. The right route
  5. The right time

Basically, before a nurse or other healthcare professional gives a medication we ask ourselves, “Is this the right dose of the right medication given to the right patient in the right way at the right time?”

There should be one thing added to the list when giving medication in the home: the right storage.

This method has helped avoid a lot of accidents involving medicines in hospitals and other health care settings and can help you avoid accidents in your home as well. If you are in charge of giving medications to someone you are caring for, the “5 rights” is something you should be familiar with and start checking the moment you get the prescription from the physician.

Because there can be differences in the way medication orders are given and received in palliative care and hospice, I will try to include variations when appropriate.

Take Notes at the Doctor's Office or Nurse's Visit

When the doctor or nurse tells you to start giving a new medication, take notes. Write down the name of the medication, the dose you will be giving, and any instructions they give you on how to administer it. For example, when I am visiting a patient and inform them that they will be starting oral morphine solution at 5mg every 4 hours as needed, I instruct them to take their own notes in addition to the ones I will be writing down for them.

I tell them how the medication is dosed; for example, a concentrated solution of 20mg of morphine for every milliliter of liquid. I will tell them that 5mg of morphine is equivalent to 0.25ml. I bring a sample of the bottle and medicine dropper with me that our pharmacy supplies. I show them the dropper and draw up a sample dose of medication.

I may draw a diagram of the dropper that they can refer to later. I tell them what the medication is to be used for, how often to give it, and how to keep a record of what they gave. Hopefully their notes look something like this:

  • Oral Morphine Solution
  • 5mg or 0.25ml or ¼ of the dropper
  • Give every 4 hours if needed for pain
  • Write down date, time, and dose given

Take your own notes, even if the doctor or nurse writes down their own instructions for you. You will probably make better sense of instructions you wrote down versus those written by someone else. Taking notes also helps solidify the information in your memory.

Check the Prescription at the Pharmacy

Whether you pick up the medication at the pharmacy or it is delivered to your house, always check the medication before accepting delivery of it. Make sure it is the same medication and the same dose, or concentration, as the notes you took. Check that the patients name on the bottle is your patient. Also check that the instructions are the same as those you wrote down.

If the instructions vary at all, contact your healthcare provider to clarify before giving any of the medication.

Store the Medication Properly

Some medications have specific storage requirements to preserve their effectiveness. Insulin, some liquid antibiotics, and several other medications need to be refrigerated. Any type of medication in the form of a suppository will need to be stored in a cool place to keep them from getting too soft. Nitroglycerin needs to be protected from sunlight. Always check with the pharmacist for specific storage instructions for your medications and be sure to follow them.

It is also very important to store all the medications in their original containers. Pill cases seem like they would be convenient, and probably are, but once you fill them up it can be confusing to tell the medications apart. It is just much safer, if a little less convenient, to keep all the medicines in their own bottles.

Give the Right Dose

OK, you’re probably saying “Duh!” but hopefully you haven’t just skipped this part. While it’s common sense to give the right dose of medication, how to give the right dose may not be. For example, if a medication calls for a dose of 1 teaspoon, you may be tempted to break out your measuring spoons for baking or, worse yet, your stirring spoon (well, it is called a teaspoon, right?).

There can be wide variations in stirring spoons, and even calibrated measuring spoons, so it is best to always give the medication with the measuring device the pharmacist gives you.

Pills can be just as tricky. You may have a prescription that calls for ½ tablet of a medication. You may be tempted to simply bite the pill in half (I’m guilty of this too) but you would be much safer using a pill splitter. These can be purchased at your pharmacy or may be provided by your hospice or other healthcare agency. Capsules of medications shouldn’t be open and divided. Ever.

Give the Medicine Through the Right Route

If a medication is ordered to be given orally, that means your patient will need to swallow it. If swallowing pills is a problem for your patient, always tell your doctor or nurse. You may also ask the pharmacist if the medication comes in a liquid form. You should never crush a medication and put it in something, like applesauce, unless the doctor, nurse, or pharmacist tells you it’s OK.

Some medications are extended release, meaning that they give a set dose of medication at regular intervals throughout the day. Crushing these types of pills would allow a large dose of medication to be delivered all at once.

Another word of advice: If a medication is ordered as a suppository, don’t try to get your patient to swallow it.

I’ve seen this happen and it’s not pretty. A suppository is only to be given in the rectum. If you are unsure how to give one, ask someone to show you. It’s really a simple thing to do:

  • Have some gloves and lubrication handy for the task.
  • Put on your latex gloves.
  • Coat the suppository with the lubrication and gently insert it into the rectum.
  • If you meet any strong resistance, stop.
  • You should be able to slide it in easily until it’s “swallowed” by the rectum.

Keep a Medication Log

Your doctor or nurse may ask you to keep a log of any medications that are prescribed on an “as needed” (or “prn”) basis. These may be pain medications, drugs used to treat nausea and vomiting, etc. They will want you to write down the date, time, dose, and reason you gave the medication. This helps them to determine what symptoms are causing the patient trouble and what medications are effective in treating them.

It is also important for you to keep a record of the medications you give on a regular basis. Caring for someone is time consuming and stressful and it isn’t uncommon for caregivers to wonder if they’ve given a particular medication already. Keeping a log can take one burden from your heavy load.

A log can also come in handy if there is more than one caregiver or someone coming in to help temporarily. You won’t have to wonder if Aunt Mary already gave the medicine before she left to the store.

Use a word processor program, if available, and make a log that can be printed out when needed. You can also hand write a log and make copies at your local copy center.

Here is an example of a medication log for “as needed” or “prn” medicines:

Medication Log

Medication Log
Date/TimeMedication DoseSymptom Treated
11/26 9:00aMorphine Solution5mg/0.25mlPain (4/10)
11/26 2:00pMorphine Solution5mg/0.25mlPain (3/10)
11/26 8:00pMorphine Solution5mg/0.25mlPain (4/10)

In this example, the caregiver kept a record of what day and time the medication was given and how much. This type of log can help healthcare professionals determine how much of a medication a patient is given and its effectiveness.

Here is an example of a medication log for regularly scheduled medicines:

Pain Log
Friday 2/158:00aMetoprololX
""Morphine TabletX
"8:00pMorphine Tablet 

In this example, the caregiver has marked that they have given all the morning medications. If a new caregiver stepped in to take over at 9:00a, they could see that all the morning medications were already given and that the evening medication was not. A log like this can help prevent missed doses or overdoses of medications.

Taking simple steps such as following the “5 rights” and keeping accurate logs can help ensure the safety of your patient or loved one. Giving medications properly can enhance the comfort and quality of life of the one you are caring for.

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