Clinical Quick Reference Monthly Newsletter / February 2023 – Medication Rights & The “Five R’s”
Clinical Quick Reference Guides - Clinical Concept Review/Medication Rights
This guide will review traditional patient rights related to the medication administration process.
What Are The Five “R’s”?
Guiding tenets of safer medication administration are based on the observance of a patient’s rights concerning the provision of therapeutics. These “rights” of medication administration are sometimes referred to as the Five R’s.
Educators and theorists have discussed including an additional four to six new rights. This guide will serve as a review of the traditional and globally accepted five rights. More recent research into medication rights will be discussed in closing.
The Five “R’s” of Medication Administration
1. The ‘Right Patient’
This patient right involves checking to ensure that the patient being given a particular medication or treatment is the patient for whom the drug was prescribed.
The medical professional should read the label on the medication container and cross-match it with records and the script.
Check wristbands at inpatient venues, or ask about identification. Some facilities have patient pictures included in the medical record.
Be sure to check your organization’s policies and adhere to them. Checking patient identity is a crucial step in providing safe care.
2. The ‘Right Drug’
The healthcare professional double checks the medication to be administered, ensuring that it is identical to the drug prescribed.
During this process, care must be used to be sure that generic names or drugs with similar spellings are VERY closely reviewed.
Studies support the practice of clinicians writing out the full generic name of a medication. There is also evidence that providing the indication for a prescription can help minimize errors.
Difficult to read handwriting and unapproved abbreviations can greatly increase the likelihood of errors. When in doubt, check it out. Do not provide a medication when unsure.
Additionally, check for allergies. If able, ask the patient if they have ever taken the medication before.
3. The ‘Right Route’
Medications can be given in a variety of ways. From a simple pill, to a high-tech patch system.
Common routes of administration include:
oral
intramuscular
intravenous
topical, and/or
subcutaneous
With so many administration sites and technologies being implemented (e.g. central venous catheters, epidurals, PCA pumps, etc.); it is crucial for professionals to familiarize themselves with the equipment and procedures necessary to best assist their patients.
Tips:
Stay educated regarding newer medications
Learn how new, or less commonly prescribed treatments are safely delivered
Be sure to have at least a basic understanding of drug absorption rates and the time of drug onset.
4. The ‘Right Time’
Healthcare professionals need to give medications at the time intended by the physician.
Well-prepared clinicians understand that particular therapeutics may interact with other medications, internal chemical mechanisms, supplements, and even certain foods.
Before giving any medication, read all literature included with the prescription, and educate yourself about potential effects, interactions, and known side effects.
Make sure to:
Give medication within the time frame indicated in the prescription or order (organizations and governing bodies have standards to address this).
If a medication is to be given by infusion, such as intravenous medications, make sure it is administered at the correct rate.
When in doubt, seek clarification. Reach out for additional guidance. Never give anything when unsure. This process might include speaking with the original prescriber, a supervisor, a pharmacist, etc.
Remember: when in doubt--- reach out.
5. The ‘Right Dose’
Clinicians and other healthcare providers must carefully obtain and review each prescription.
Medication errors are frequently related to nurses and technicians giving the incorrect dosage or concentration of medication. Despite identifying the correct patient, medication, route and time, an error can occur because of a simple conversion or math error.
Carefully review all labels and orders to provide meds safely.
Researchers have demonstrated that eliminating the use of abbreviations (e.g., “mcg” and “mg”) and instead writing out full terms (e.g., micrograms and milligrams) helps to reduce errors.
When using stock medications, ask yourself: is the bottle of drugs being used a multi-dose package? Closely examine labels to distinguish between single and multi-dose packaging. Be sure to handle multi-dose bottles with care, especially insulin and vaccinations. Store properly and guard against cross-contamination in inpatient and clinic settings.
Pharmacy consultation and calculator use have proven effective in lowering calculation errors.
Always follow the policies outlined in your organization's procedures for med administration; if you have any questions or concerns, ASK!
Errors Still Occurring?
Despite best efforts, medication errors are still a concern in modern healthcare. Inadequate training, disorganized practices and diminished workplace safety can negatively impact the medication administration process.
In addition to the five globally accepted “rights,” a number of theorists have proposed the adoption of four to five more medication administration rights, with the aim of lowering the rate of errors.
Research Into Modern Medication Administration Rights
Elliot, M. and Lui, Y.; published an article in the British Journal of Medicine (2010), recommending four additional rights:
the right documentation,
the right indication for prescription,
the right patient response,
and the right form of administration within a given route
Later, Cook and colleagues, et al, proposed another combination of “rights:”
the right to have legible orders,
the right to accurate medication dispensing,
the right to timely information access,
the right to supportive procedures, and
the right to address problems within the therapeutic administration system.
Helpful Video:
Disclaimer: The above study guide represents study materials. Always seek and follow the advice of your medical provider for any acute or chronic medical issues or questions. Always adhere to and follow the recognized protocols of your program or supervising agency.
Article Resources:
CDC
FDA
NIH
STAT PEARLS