PRINCIPLES OF DRUG ADMINISTRATION

The 10 RIGHTS of Drug Administration:

1. Right patient
2. Right drug
3. Right dose
4. Right time
5. Right route
6. Right assessment
7. Right documentation
8. Right to education
9. Right evaluation
10. Right to refuse

A. Right Patient

*Nurse must do:

-Verify patient
-Check ID bracelet & room number
-Have client state his name
-Distinguish by 2 clients with same last names

B. Right Drug

*Medication order may be prescribed by:

a. Physician
b. Dentist
c. Podiatrist
d. Advanced practice registered nurse (APRN)

*Components of a drug order:

1. Date & time the order is written
2. Drug name (generic preferred)
3. Drug dosage
4. Frequency & duration of administration
5. Any special instructions for withholding or adjusting dosage
6. Physician or other health care provider’s signature or name if TO or VO
7. Signature of licensed practitioner taking TO or VO

*Nurse must do:

•check med order is complete & legible.
•know general purpose or action, dosage & route of drug
•compare drug card with drug label three times:
1. at time of contact with drug bottle/ container
2. before pouring drug
3. after pouring drug
 * 4 Categories of Drug Orders:
1. Standing Order / Routine Order
-ongoing order
-may have special instructions to base administration
-include PRN orders

Ex. digoxin 0.2 mg PO q.d., maintain blood level at 0.5 – 2.0 ng/ml

2. One-time (single) order

-given only once, at a specific time

Ex. Cefixime 2mg IM at 7 AM on 12-1-05

3. PRN order
-given at client’s request & nurse’s judgement for need & safety

Ex. Mefenamic Acid 500mg q 4h PRN for pain

4. STAT order
-given once, immediately

Ex.Morphine 2mg IV STAT

C. Right Dose

*Nurse must do:

-Calculate and check drug dose accurately.
-Check PDR, drug package insert or drug handbook for recommended range of specific
drugs.
-Check heparin, insulin and IV digitalis doses with another nurse.

(Stock- method vs Unit-dose method)

D. Right Time

*Nurse must do:

-Administer drugs at specified times.
-Administer drugs that are affected by foods, before meals.
-Administer drugs that can irritate stomach, with food.
-Drug administration may be adjusted to fit schedule of client’s lifestyle, &activities. &
diagnostic procedures.
-Check expiration date.
-Antibiotics should be administered at even intervals.
E. Right Route

*Nurse must do:

-Assess ability to swallow before giving oral meds.
-Do not crush or mix meds in other substances before consultation withphysician or
pharmacist
-Use aseptic technique when administering drugs.
-Administer drug at appropriate sites.
-Stay with client until oral drugs have been swallowed.

F. Right Assessment
-Get baseline data before drug administration.

G. Right Documentation
-Immediately record appropriate info
Name, dose, route, time & date, nurse’s initial or signature
-Client’s response:
Narcotics
Analgesics
Antiemetic
Sedatives
Unexpected reactions to meds.
-Use correct abbreviations & symbols.

H. Right to Education
-Client teaching:
Therapeutic purpose
Side-effects
Diet restrictions or requirements
Skill of administration
Laboratory monitoring
-Principle of Informed Consent

I. Right Evaluation
-Client’s response to meds.
-Effectiveness
-Extent of side-effects or any adverse reactions.

J. Right to Refuse
*Nurse must do:
-Determine, when possible, reason for refusal.
-Facilitate patient’s compliance.
-Explain risk for refusing meds & reinforce the reason for medication.
-Refusal should be documented immediately
-Head nurse or health care provider should be informed when omission pose
threat to patient.