Safe medication administration
Medication errors are among the most common causes of preventable harm in healthcare. Systematic checks protect patients. For study only, not clinical guidance: always follow your programme, current local protocols, and supervising clinicians.
The rights of medication administration
Nurses check the 'rights' before giving any medication: right patient, right drug, right dose, right route, right time, and right documentation. Many programmes add right reason, right response, and the patient's right to refuse. Checks are done at several points, not just once.
Medication reconciliation
Medication reconciliation compares a patient's current medicines with new orders at admission, transfer, and discharge, to catch omissions, duplications, and interactions. It is a major patient safety goal because errors often occur during transitions of care.
High-alert medications
High-alert medications carry a heightened risk of serious harm if used in error. The Institute for Safe Medication Practices lists examples including insulin, anticoagulants (heparin, warfarin), opioids, concentrated electrolytes such as potassium chloride, and chemotherapy. Many hospitals require independent double checks for these.
Error-prone abbreviations
Some abbreviations cause errors and are on The Joint Commission's 'Do Not Use' list: 'U' for units (mistaken for 0 or 4), 'IU', 'QD' and 'QOD', trailing zeros (1.0 mg misread as 10 mg), and missing leading zeros (.5 mg misread as 5 mg). Write 'units', 'daily', '1 mg', and '0.5 mg'.
Dosage calculation basics
A common formula is \(\text{dose} = \frac{\text{desired}}{\text{have}} \times \text{quantity}\). If the order is 500 mg and tablets contain 250 mg each, give \(\frac{500}{250} \times 1 = 2\) tablets. For liquids: ordered 125 mg, available 250 mg per 5 mL, give \(\frac{125}{250} \times 5 = 2.5\) mL.
Weight-based dosing
Many drugs, especially in children, are dosed by weight. If a child weighing 20 kg is prescribed 10 mg/kg, the dose is 200 mg. Always convert pounds to kilograms (1 kg = 2.2 lb) and check that the calculated dose falls within the safe range for that drug.
IV rates
For an IV pump: rate (mL/h) = volume / time. 1,000 mL over 8 hours runs at 125 mL/h. For gravity drips: drops per minute = \(\frac{\text{volume (mL)} \times \text{drop factor (gtt/mL)}}{\text{time (min)}}\). With a drop factor of 15 gtt/mL, 1,000 mL over 8 hours is \(\frac{1000 \times 15}{480} \approx 31\) drops per minute.
Reporting errors
If an error occurs, the first priority is the patient: assess them and inform the provider. Then report through the institution's incident system. A 'just culture' focuses on fixing system problems rather than blaming individuals for honest mistakes, while holding people accountable for reckless behaviour.
Key takeaways
Check the rights of medication administration at several points. Reconcile medications at every transition. High-alert drugs such as insulin, anticoagulants, opioids, and concentrated potassium need extra checks. Avoid 'Do Not Use' abbreviations, trailing zeros, and missing leading zeros. Use desired/have x quantity for doses, weight-based calculation for children, and volume/time for IV rates. After an error, assess the patient first, then report.
Flashcard
Patient, drug, dose, route, time, documentation
Check your understanding
An order reads 750 mg. Tablets contain 250 mg each. How many tablets should be given?