00:00:00
hey everyone it's sarah with
00:00:01
registeredness rn.com and in this video
00:00:03
i'm going to be going over the rights of
00:00:05
medication administration
00:00:06
and whenever you get done watching this
00:00:08
youtube video you can access the free
00:00:09
quiz that will test you on this content
00:00:12
so let's get started the purpose of the
00:00:14
rights of medication administration
00:00:16
is to help prevent medication errors now
00:00:19
as a nurse
00:00:20
we are the last safety net in medication
00:00:23
administration
00:00:24
because most of the time we are the ones
00:00:26
who give the patient the medication
00:00:28
so we always want to double check or
00:00:30
even triple check
00:00:31
the medication that we are giving the
00:00:33
patient by
00:00:34
following these rights now these rights
00:00:38
are very helpful
00:00:39
and as a nurse i have actually caught
00:00:41
many medication errors by just following
00:00:44
these rights of medication
00:00:45
administration for instance i have found
00:00:48
a medication that was ordered on a
00:00:49
patient
00:00:50
pharmacy put in the wrong dose or the
00:00:52
wrong frequency
00:00:53
or a physician had accidentally put in a
00:00:56
medication order on a patient that was
00:00:57
meant for another patient
00:00:59
and i simply just looked at that
00:01:00
medication i was like why is this
00:01:02
patient being ordered this medication so
00:01:04
i was following the right reason
00:01:05
turns out it wasn't even for that
00:01:07
patient also whenever i've went to
00:01:10
remove medications
00:01:12
from like a system that was created to
00:01:14
help prevent medication errors the pixis
00:01:16
system
00:01:17
it actually dispensed me with the wrong
00:01:18
medication and what had happened
00:01:20
was that the medication it had dispensed
00:01:22
me with had a very similar name to
00:01:24
another drug so whoever
00:01:26
had stalked the system had accidentally
00:01:29
put in the wrong medication
00:01:30
so errors do happen even in today
00:01:34
whenever we have all this technology
00:01:36
that's supposed to assist us with
00:01:37
medication administration so we always
00:01:39
want to make sure
00:01:40
that we stick to the basics and we
00:01:41
follow these rights
00:01:43
now the rights of medication
00:01:45
administration have really evolved over
00:01:47
the years
00:01:47
we have the five basic rights that
00:01:50
really lay that foundation for what we
00:01:52
need to know whenever we're
00:01:54
administering medications but there's
00:01:56
other rights that have been added on
00:01:58
over the years just to help
00:01:59
increase our safety checks whenever we
00:02:02
are giving a patient medication
00:02:03
so you may have heard of the seven
00:02:05
rights the nine rides the ten rides and
00:02:07
etc so what i want to do is i'm going to
00:02:08
cover the five basic ones which help
00:02:11
layer foundation for medication
00:02:13
administration and then i want to talk
00:02:14
about the other ones that have been
00:02:16
added on over the years
00:02:17
so the first right we have is called the
00:02:20
right
00:02:20
patient and as a nurse we want to make
00:02:22
sure that we have the right
00:02:24
patient for this medication because
00:02:27
sometimes on a unit you're going to have
00:02:28
a set of patients
00:02:30
that have the same first name or the
00:02:32
same last name or even the same
00:02:33
first and last name you want to ensure
00:02:36
that this medication that you're giving
00:02:37
the patient is for the right
00:02:39
person so to do that we're going to
00:02:41
perform some safety checks
00:02:43
and we want to use at least two
00:02:46
patient identifiers so you could ask the
00:02:49
patient to state their first
00:02:50
and last name along with their date of
00:02:53
birth
00:02:54
and take that information that they've
00:02:55
given you and compare that to their
00:02:58
arm identification band that they're
00:03:00
wearing and then take it a step further
00:03:02
and
00:03:02
look in that medication administration
00:03:04
record the more
00:03:06
and see if that information matches up
00:03:09
next is the second right which is right
00:03:11
medication
00:03:12
now whenever you're performing your
00:03:14
safety checks for this right you want to
00:03:15
look at that order and you want to pay
00:03:17
close attention to
00:03:19
that medication name that was ordered
00:03:21
and compare that
00:03:23
to what you have on hand what you've
00:03:25
been dispensed with
00:03:26
and look at that name from beginning to
00:03:28
end very carefully and
00:03:30
analyze it and make sure it matches and
00:03:33
the reason i really stress that is
00:03:34
because there are medications out there
00:03:36
that have very similar looking names and
00:03:39
if you take like a quick glance at it
00:03:40
you may miss
00:03:41
the difference and think it is that
00:03:43
medication for instance look at these
00:03:45
two drug names
00:03:46
we have acetazolamide which is a
00:03:49
diuretic
00:03:50
and then we have acetohexamide which
00:03:53
helps treat diabetes and
00:03:55
lower the blood glucose now if you just
00:03:58
quickly glance at these medications you
00:03:59
may
00:04:00
miss the difference and think it is that
00:04:02
medication that was ordered
00:04:04
now furthermore what you want to do
00:04:06
whenever you're going over this right
00:04:08
medication
00:04:09
is that you want to make sure that that
00:04:11
medication you're giving
00:04:12
isn't expired that it's within date that
00:04:14
it hasn't been damaged
00:04:16
tampered with or anything like that it's
00:04:17
good to go and give to the patient
00:04:20
and you just want to look at the
00:04:22
patient's allergies and
00:04:23
just ask them what they're allergic to
00:04:25
just to confirm that
00:04:26
and even take it a step further and ask
00:04:29
them
00:04:29
you know i'm giving you this have you
00:04:31
ever had this medication in the past if
00:04:33
it's not one of their home medications
00:04:34
that they take regularly
00:04:36
and ask them if they have well did you
00:04:37
do okay with it did you tolerate it okay
00:04:39
because that can
00:04:40
help tip you off as a nurse you know i
00:04:43
need to be watching out for some
00:04:44
potential side effects that could happen
00:04:46
that they may have had in the past the
00:04:48
next right is the right dose
00:04:50
so just like before with the right
00:04:52
medication you're going to look
00:04:53
at that order and you're particularly
00:04:56
paying attention to the dose that was
00:04:58
ordered
00:04:59
and you're going to compare that with
00:05:00
what you plan on giving
00:05:02
is this the right dose and many times
00:05:05
you're not going to be dispensed with
00:05:07
the right dose
00:05:08
you're either going to have to take the
00:05:09
medication and split that pill in order
00:05:12
to equal what was ordered
00:05:13
or you're going to have a vial of
00:05:14
medication and you only need to give
00:05:16
one meal it may have five but you only
00:05:18
need to withdraw one meal
00:05:20
or you may have a drip hanging and let's
00:05:23
say it's a heparin drip
00:05:25
and the ptt is a certain level and you
00:05:27
have to titrate that drip so you're
00:05:29
going to have to do some math in order
00:05:30
to determine based on that patient's
00:05:32
weight
00:05:32
with their ptt level with what you're
00:05:35
supposed to set the rate at
00:05:36
so you'll have to do some math so you
00:05:38
definitely want to double check your
00:05:39
math
00:05:40
and you want to get another nurse to
00:05:42
verify with some medications that's an
00:05:44
automatic thing you have to get another
00:05:46
nurse to sign off
00:05:47
on what you have calculated but if
00:05:49
you're ever unsure
00:05:50
it just only takes a second just find
00:05:52
another nurse have them double check
00:05:55
your math then we have the fourth right
00:05:58
which is the right route
00:06:00
so with this again look at that order
00:06:02
but this time pay close attention to the
00:06:04
way
00:06:05
that this medication needs to be
00:06:07
administered so the route
00:06:09
now today we can get medications various
00:06:12
ways
00:06:12
um most common way of course is through
00:06:15
the mouth
00:06:15
but we can also give them iv intravenous
00:06:18
we can give them sub q and the fatty
00:06:21
tissue of the skin
00:06:22
in the muscle im topically etc
00:06:26
so you want to make sure that you have
00:06:28
the right supplies for the way
00:06:31
that you have to give this medication
00:06:33
for instance if a patient's
00:06:35
getting something through the mouth
00:06:36
let's say they're getting a pill you
00:06:37
want to confirm that this patient can
00:06:39
swallow properly you want to make sure
00:06:41
that they have something to take the
00:06:42
medication with
00:06:44
and if they can't swallow what do you do
00:06:46
well can the
00:06:47
can the patient take the medication in a
00:06:49
pudding or an applesauce
00:06:51
or can the medication be crushed and you
00:06:53
give it to them that way so you want to
00:06:54
confirm
00:06:55
if you can indeed crush it and they can
00:06:57
swallow
00:06:58
or let's say you're giving it iv well
00:07:01
you want to make sure
00:07:02
your iv access works because sometimes
00:07:05
they don't work and
00:07:06
you've got to start a new one so you
00:07:08
want to flush it beforehand to confirm
00:07:10
that
00:07:10
give the medication and then flush it
00:07:12
again to make sure you've flushed it
00:07:14
through
00:07:15
or if you're giving this i am you want
00:07:17
to make sure that you're selecting the
00:07:19
appropriate size muscle
00:07:20
for this drug and that you have got the
00:07:23
right size needle
00:07:25
for that muscle or if you're giving it
00:07:28
topically on the skin
00:07:29
you want to look at where the previous
00:07:31
topical application was if the patient's
00:07:34
getting this
00:07:35
routinely you want to make sure that you
00:07:37
remove that
00:07:38
clean that area and then switch where
00:07:41
you put this so you always want to make
00:07:43
sure that you are just being prepared
00:07:45
with the route that you are giving this
00:07:47
medication and then next we have the
00:07:50
fifth right which is the right time and
00:07:52
the right frequency
00:07:53
so with this before you even give that
00:07:55
medication look in that mar that
00:07:57
medication administration record
00:07:59
and see when this was last given
00:08:02
especially if you're giving a prn
00:08:03
medication one of those as needed
00:08:05
medications
00:08:06
and make sure that the frequency that
00:08:08
the patient is receiving this medication
00:08:10
matches up with that original order
00:08:13
so make sure that the medications do
00:08:15
you're not giving it too
00:08:16
late or too soon and pay close attention
00:08:19
to those
00:08:20
time critical medications like
00:08:22
antibiotics anticoagulants
00:08:24
insulin etc because it's very important
00:08:27
at the times you give those
00:08:29
so review the policy at your hospital
00:08:31
that you're working because they're
00:08:33
going to outline
00:08:34
those time frames when you can give
00:08:36
medications when they're not too late or
00:08:38
too soon and these time critical
00:08:40
medications now let's talk about some
00:08:42
more rights of medication administration
00:08:44
that goes beyond those five basic rights
00:08:47
that i just covered
00:08:48
these are also things that you want to
00:08:50
do during medication administration
00:08:52
to ensure patient safety but to also
00:08:55
guide you
00:08:56
throughout the process okay so we have
00:08:58
the right reason
00:09:00
this means whenever you look at the
00:09:03
medication name
00:09:04
as you're giving meds you want to be
00:09:05
asking yourself okay
00:09:07
why is this ordered so think back to
00:09:10
pharmacology
00:09:11
think okay what does this medication do
00:09:15
um how does it work in the body what am
00:09:17
i monitoring for
00:09:19
and what could this be treating in the
00:09:21
patient a lot of times it's going to be
00:09:22
something that's in the patient's health
00:09:23
history so they come to the hospital
00:09:25
they have a history of diabetes so
00:09:27
you're giving them these medications
00:09:29
or there's something currently going on
00:09:31
with the patient and they need this
00:09:33
medication
00:09:34
to treat what's going on with them so
00:09:36
for instance
00:09:37
you have a patient they came to you they
00:09:40
are in right-sided
00:09:41
heart failure and they have fluid
00:09:44
throughout their body they're in fluid
00:09:45
volume overload they have
00:09:47
three plus pitting edema they can barely
00:09:49
breathe because they have so much fluid
00:09:51
in their lungs
00:09:52
you can hear crackles throughout so the
00:09:54
physician orders
00:09:56
iv furosemide lasix so
00:09:59
as a nurse you're going to say okay
00:10:00
right reason what am i thinking okay
00:10:03
we know that this is a loop diuretic how
00:10:05
it's going to work is it's going to
00:10:06
remove all this extra fluid that's
00:10:08
hanging out in this patient's body
00:10:10
into the urinary system so they're going
00:10:12
to be voiding a lot so i need to make
00:10:13
sure that they can get to the bathroom
00:10:14
easily and they have access to it
00:10:16
and let them know that this is going to
00:10:18
be occurring it's normal
00:10:19
and i want to make sure that we're not
00:10:21
dehydrating them like removing too much
00:10:24
fluid so we want to be looking at their
00:10:26
vital signs like their blood pressure
00:10:28
their heart rate and we want to make
00:10:31
sure that we're not wasting too much
00:10:33
potassium because we know that loop
00:10:35
diuretics
00:10:36
waste potassium so physicians are going
00:10:39
to be ordering
00:10:40
routine labs on these patients and your
00:10:43
job is to look at
00:10:44
those lab results as they come in and
00:10:46
make sure they're within normal limits
00:10:48
so before you give them their next dose
00:10:50
of lasix
00:10:51
make sure that their potassium is in
00:10:53
normal
00:10:54
limits a lot of times they're going to
00:10:55
be taking some more potassium
00:10:58
like potassium supplements but we want
00:11:00
to make sure it's good enough because we
00:11:01
don't want to make their potassium level
00:11:02
just
00:11:03
sink too low and a normal potassium is
00:11:05
about 3.5 to 5 milli equivalents per
00:11:07
liter
00:11:07
and then we have the right assessment
00:11:10
okay so
00:11:11
before you give any medications you you
00:11:14
look at the medications
00:11:15
with the right reason but you also want
00:11:18
to ask yourself okay what information do
00:11:20
i need to know
00:11:21
before i actually give this patient this
00:11:23
med because you don't want to give them
00:11:25
this
00:11:25
medication and be like oh no i shouldn't
00:11:28
have gave them this because
00:11:29
this isn't good so let me give you an
00:11:32
example your patient's taking a beta
00:11:34
a beta blocker this helps um this will
00:11:36
slow down the heart rate
00:11:37
so you want to make sure before you give
00:11:40
them this beta blocker that their heart
00:11:41
rate was in
00:11:42
within normal limits before you actually
00:11:44
gave it to them so make sure they're not
00:11:46
experiencing severe bradycardia or
00:11:49
let's say your patient is due to get
00:11:51
some warfarin which is an anticoagulant
00:11:53
coumadin
00:11:54
you want to make sure that you looked at
00:11:55
their latest inr result make sure it's
00:11:58
within parameters of where that
00:11:59
physician
00:12:00
wants them to be and if it is
00:12:03
you can administer it if not you need to
00:12:05
notify the physician
00:12:07
then next you would want to make sure
00:12:09
you're giving the
00:12:10
right education to the patient so this
00:12:13
is a great time
00:12:14
during whenever you are giving
00:12:16
medications to be educating your patient
00:12:18
about these drugs routinely instead of
00:12:21
just throwing this
00:12:21
all on them at discharge because it can
00:12:23
be very overwhelming
00:12:25
so you want to go over the name of the
00:12:27
medication you're giving the patient
00:12:29
um the generic name and the brand name
00:12:31
as well
00:12:33
the frequency how many times a day
00:12:35
they've been getting this
00:12:36
if they are going to go home on it how
00:12:38
many times they would be taking it
00:12:40
the times you've been giving it there
00:12:41
why they're taking it what's the purpose
00:12:43
of this what is this treating
00:12:45
the dose that they're taking and what is
00:12:47
normal versus abnormal
00:12:49
like what should they be monitoring
00:12:51
themselves for like
00:12:53
common side effects versus this is not
00:12:55
good you need to report this to your
00:12:56
physician
00:12:57
and how to administer it let's say that
00:13:00
they're going to be going home
00:13:01
on lovenox and oxaparin so you want to
00:13:04
make sure that you
00:13:06
have demonstrated them how to administer
00:13:07
that and you watch them
00:13:09
do that so they'll be prepared whenever
00:13:11
they go home to take
00:13:12
these medications and the next we have
00:13:15
the right documentation
00:13:17
so this is when we will document the
00:13:19
information
00:13:20
that is needed for whenever we are
00:13:22
giving medications
00:13:23
and this is going to be after
00:13:25
administration and remember to always
00:13:27
document
00:13:28
because there's a saying that says if
00:13:29
you didn't chart it you didn't
00:13:31
do it because if no one can see it
00:13:34
there's no way to tell
00:13:35
that you had done it even though you did
00:13:37
do it and
00:13:38
documenting is a great communication
00:13:41
tool for other people
00:13:42
who are going to be taking care of that
00:13:44
patient for instance let's say
00:13:46
the other shifts coming on and or the
00:13:48
patient's being transferred to another
00:13:50
unit or the patient's going home
00:13:52
this communicates to the other nurse
00:13:55
what medications the patient's been
00:13:56
taking and the last dose and this is
00:13:58
really important
00:13:59
let's say for those prn medications a
00:14:02
patient needs some pain medication
00:14:04
well the nurse can look back at your
00:14:06
documentation and see when you gave it
00:14:08
last and is it due
00:14:09
can they have it again so whenever you
00:14:12
are documenting
00:14:13
some things you definitely want to
00:14:14
include you want to include the name of
00:14:15
the medication you gave the dose
00:14:18
the time you gave it the route you gave
00:14:20
at the site let's say it's one of those
00:14:21
medications like a fentanyl patch
00:14:23
and you put it on the right
00:14:27
side of the body let's say the right arm
00:14:29
or something like that
00:14:31
that tells the nurse who has to
00:14:32
administer the next fentanyl patch where
00:14:34
to go to remove the previous fentanyl
00:14:36
patch
00:14:37
so she can remove that and then apply
00:14:39
the new one so that's very helpful
00:14:40
and any data that needs to be recorded
00:14:44
whenever you
00:14:45
are giving a medication like any lab
00:14:47
levels and we talked about that over
00:14:48
here
00:14:49
any vital signs if the patient's
00:14:52
having pain medication you need to know
00:14:56
the patient's description like words
00:14:58
they're using to describe is a throbbing
00:15:00
stain
00:15:01
cramping uh the location of the pain
00:15:03
their pain rating on a scale
00:15:06
one to ten and follow up
00:15:09
with uh like that pain rating let's say
00:15:12
you gave him some morphine
00:15:13
well you're going back to evaluate it
00:15:14
did the morphine help and see what their
00:15:16
pain rating decreased to
00:15:18
then we have the right to refuse so
00:15:21
patients always
00:15:22
have the ability to tell you that i
00:15:24
don't want this medication so
00:15:26
if you are facing that with a patient
00:15:28
just make sure you have taken the time
00:15:30
to educate them
00:15:31
about why this medication is prescribed
00:15:34
and ask them why they don't want to take
00:15:36
it investigate it because it may be
00:15:38
really simple and maybe they just didn't
00:15:41
know something about
00:15:42
this particular medication and you just
00:15:44
can explain that to them and they're
00:15:45
like oh okay yeah i understand now
00:15:47
i'll take it but whatever the reason is
00:15:50
always make sure you document this
00:15:52
thoroughly and communicate it to the
00:15:55
the prescribing physician if the patient
00:15:58
does refuse to take it
00:15:59
and then lastly we have the right
00:16:01
evaluation
00:16:02
so as a nurse you're definitely going to
00:16:05
want to make sure that this medication
00:16:06
is having the right effect on this
00:16:09
patient
00:16:10
so again this release you can go back to
00:16:13
the right reason whenever you're
00:16:14
thinking of the right reason of the
00:16:15
medication
00:16:16
you're thinking okay how this medication
00:16:18
works on the body
00:16:19
what it's going to do and this is going
00:16:21
to help you with your right evaluation
00:16:24
so example let's say your patient had
00:16:27
uncontrollable atrial fibrillation so
00:16:29
you had to start them on a cardism drip
00:16:32
what is the right evaluation of this
00:16:34
drug how as a nurse do you expect
00:16:36
this drug to be working for this patient
00:16:37
well it should be slowing down that ray
00:16:39
it should start controlling that atrial
00:16:42
fibrillation and it could even help get
00:16:44
them back
00:16:44
to normal sinus rhythm so you'll be
00:16:46
looking at their
00:16:47
heart heart rate their rhythm on that
00:16:50
cardiac monitor
00:16:51
you're also going to be making sure
00:16:53
we're getting the right effect on their
00:16:54
blood pressure
00:16:55
so make sure their blood pressure is
00:16:57
within normal limits
00:16:59
so that helps guide us with that now
00:17:01
don't forget to access the free quiz
00:17:02
that will test you on this material and
00:17:05
thank you so much for watching
