Five Ways to Avoid Med Errors
This post is cheating a little, because I didn’t come up with the five ways. Nurses learn them on the second day of nursing school, if not the first day—the five rights of medication administration. They are as follows:
- Right patient
- Right drug
- Right dose
- Right route
- Right time
However, medication errors still happen, and not infrequently. Nurses are busy, and we are getting busier with increasingly sicker patients who require increasingly dangerous medications. The five rights deserve a little extra attention. It never hurts to go back to the basics.
The right patient. Do you check your patients’ armbands? I start every single assessment this way (“please tell me your name, birthdate, and drug allergies”), often to eye-rolling annoyance, but I catch misbanded patients and those with erroneous registration information. It’s a simple thing that gets left out. If your hospital uses scanners, for heaven’s sake scan the bracelet and not a bar-coded sticker lying around on the counter. If the patient is misbanded or not banded you’ll be stopped right there.
The right drug. Pharmacy departments like to mess around with “tall man” lettering and easily confused medications, and that’s good, but there are sneakier ways to get tripped up here. Do you grab a vial out the Pyxis and not check the label because you’ve grabbed Zofran out of that slot every single shift for 5 years and it has a blue label? Bummer if it was stocked wrong and you just overdosed your patient on Dilaudid. Does the drug make sense for your patient? If not, check. Docs can click the wrong box and order the wrong drug or order the right one on the wrong patient.
The right dose. Ah, the magic of calculators. But first, check labels. Pharmacy may switch things up on you. Ours likes to keep us on our toes by switching 50- and 100-mcg Fentanyl syringes. Happily, they stick green dosage warning labels everywhere. If you’re not using the entire unit dose, double-check. If you’re giving it to a child or if the drug is a pressor, insulin, or heparin, double-check with another nurse. The right dose also includes rates for IV fluids. Were fluids at 100 mL/h ordered but you bolused it? Bummer if that sends your patient into heart failure. Check, check, and double check, and if the ordered rate doesn’t match what seems reasonable for your patient’s condition, ask!
The right route. Lots of drugs come in multiple forms these days, especially with the current drug shortages, but even in general physicians occasionally order drugs via an unusual route. If in doubt, ask. If you have never given the drug via that route (e.g., you are giving a drug IM that you usually give IV), use the power of your drug reference of choice and read about it. Anyone ever given dexamethasone by fast IV push? The effect is notably different from when it is given orally (it causes intense rectal itching).
The right time. Usually there is a window during which medications are considered “on time.” Aside from keeping the bureaucracy happy, though, giving medications at the right time may not be exactly when they are ordered. Nursing judgment is required. Probably do not, for example, give that Cardizem bolus to your patient whose heart rate is now 60 and BP is 86/40, even if it was ordered for “now.” For some medications, timing is unusually critical; for pneumonia, sepsis, and chest pain/stroke protocols, “now” actually does mean now. These folks need antibiotics, fluids, or whatever right now. Now. (And please document exactly what time you gave it, for everyone’s sake.)
These are things nurses know but rush through. If we take a few extra seconds—it really is seconds—we can give patient safety a huge boost.
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