Medication Errors and Patients’ Rights of Medication Administration

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It’s estimated that medication errors are among the top three medical malpractice allegations in the United States. Up to half of these may have been preventable and often result from flawed systems. The Patients’ Five Rights of Medication Administration provides a handy mental checklist not only for nurses looking to prevent errors, but also for those reviewing medical records for standards of care.

The Prevalence of Med Errors In the US

Each year 7,000-9,000 occur due to medication errors and hundreds of thousands experience adverse reactions or complications related to a medication. Many of these go unreported. Costs for ongoing care for patients with medication-associated errors exceed $40 billion each year, with over 7 million patients affected.

In addition to costs, patients may experience psychological or physical pain and suffering and lose trust in the healthcare system.

The most common reasons cited for errors: Failure to communicate drug orders; illegible handwriting; wrong drug selection on drop-down menus; confusion over similarly named drugs; confusion over similarly packaged products; and errors involving calculating dosing units or weight

The Five Rights of Medication Administration

One standard in instruction for new nurses is the “Five Rights of Medication Administration. They are:

No. 1: Right patient. The name of the patient should match the name on the order. At least two identifiers should be matched. These frequently include the patient’s self-identification, a patient wristband, or a patient photo.

No. 2: Right medication. Labels on the medication should be double-checked against the medication order with special caution given to look alike-sound alike drugs (meds that have similar names or physical appearance).

No. 3: Right dose. The strength and dose of the medication should be checked against the order. The appropriateness of the dose should be confirmed with current drug reference guides as needed (especially important for pediatric dosing).

No. 4: Right route. The order should again be compared to the medication package. It should be confirmed that the patient can take the med by the ordered route (for example, a large pill the patient cannot swallow).

No. 5: Right time. The dose should be given at the correct time ordered. This includes checking the frequency and most recently given dose on as-needed (PRN) medications.

Additional Medication Rights

Over time, various experts have advanced additional rights to try to improve patient safety during medication administration.

The additional rights proposed include:

No. 1: Right documentation. Documentation of a medication administration should be done after the medication is given, not before. Charting should include the time and route. It may also include other medication specific information such as an injection site, relevant lab values, or relevant vital signs.

No. 2: Right reason. While many medications are commonly prescribed “off-label”, there still needs to be a sound rationale for the order. It must be more likely to benefit the patient than cause harm.

No. 3: Right response. Responses to medications should be monitored to make sure patients are having the desired effect. For example, did the patient’s blood pressure normalize while taking an antihypertensive?

No. 4: Right education. Patients should be given the correct education about what a medication is, why they are prescribed it, and the effects and side effects they might expect.

No. 5: Right to refuse. Legally competent patients have a right to refuse care. This should still be assessed and documented in the medical record with appropriate interventions. For example, the patient may need further education, or the prescriber may want to discontinue or change the order.

What This Means for Medical Experts

For those reviewing medical records, knowing the original five rights can help to spot potential deviations from facility policies and procedures or standards of care. Deviations will likely also have triggered medication error reporting protocols in most organizations.

Failure to adhere to these rights may or may not trigger medication error reporting, but they may violate an institution’s internal policies and procedures or represent a failure to follow the standard of care.


Mary Smallwood

Mary Smallwood is a USAF veteran, Registered Nurse, and Legal Nurse Consultant. She operates Smallwood Legal Nurse Consulting in North Florida where she uses her 25 years of nursing experience across multiple specialties to provide the legal community with expert medical record review, analysis, education, and reporting. She enjoys spending time with her family, running a small animal rescue, and serving as President of the Orlando chapter of the American Association of Legal Nurse Consultants.

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