Nurses must use at least two (2) unique identifiers other than the room number prior to any procedure, including the administration of medication. Examples of unique identifiers include the client‘s first name, middle name and last name, a password or unique code number assigned to that person upon admission, the client‘s full date of birth in terms of month, day and year, a photo and a barcode encoded with two (2) or more unique identifiers. Is the task specific and should it be legally and ethically delegated (e.g., administering a routine drug instead of administering a controlled drug)? A nurse‘s responsibilities under the NMC Medication Management Standards (2016) can usually be summarized in “5 rights” that lead the nurse to easily consider these points. The right patient must receive the right dosage of the right medication through the right route at the right time. This has been extended by some experts to the “7‑right rule” or even the “9‑right rule” to cover other aspects of drug administration covered in this section. These rules extend the “5‑right rule” by also checking that the correct form of the drug has been prescribed, that the drug is being administered for the right reason, and that the patient is showing the correct response. After all, after administering the drug, the nurse must fill out the correct documentation. These rules are illustrated below in Figure 1. All medication prescriptions are evaluated by the nurse for accuracy and appropriateness. Here are some of the things that are considered and evaluated: The American Nurses Association (ANA) is a professional organization that represents the interests of the country‘s 4 million registered nurses and is at the forefront of improving the quality of health care for all.  The ANA has developed the Code of Ethics for Nurses as a guide for the performance of nursing duties in a manner consistent with the quality of care and ethical obligations of the profession.  Several provisions of the Code of Ethics affect how nurses should administer medications ethically.
A summary of each provision of the Code of Ethics and its impact on drug administration is provided below. Risk factors associated with medication errors and other medical errors such as a bad patient or bad surgery at the site are discussed below: Caregivers should therefore start a new drug with the lowest dose possible, and then slowly increase the dose over time until the therapeutic effect is achieved. The starting dose may be as low as half the recommended adult dose. The nurse informs a patient about the medication before discharge. The nurse provides a document with instructions and a list of current medications. The nursing teacher‘s role in providing students with clinical scenarios that force nursing trainees to make decisions in unclear clinical situations, act as a competent member of an interprofessional team, and practice with advanced modes of medication administration was cited as a central role in referring future caregivers to medication administration rights.  For more information on administering intravenous fluids and medications and starting an intravenous line, see the “Educating the Client on the Rationale and Care for a Venous Access Device” section of this NCLEX-RN Review Guide. Just as nurses know the five rights of medication administration, they should also know what rights they have when administering medication. These “Six Rights for Medicating Nurses” will hopefully guide nurses as they continue to care for patients despite these turbulent times.
The Chapter 2 Controlled Drug Storage and Disposal Case Study scenario now continues to include the correct administration of a controlled drug. As a reminder, Clare is a nurse who recently received a new shipment of controlled drugs and then prepared a dose of 25 mg of morphine sulfate for her patient Mary. This medication was prescribed to Mary by the attending physician as an analgesia for pain associated with Mary‘s advanced breast cancer. Clare‘s actions are observed by another nurse, Fiona, in accordance with controlled medication regulations (monitoring, management and utilization), NMC medication management guidelines, and her hospital‘s local protocols and procedures. Clare has already performed the correct disposal procedure for the 5 mg of excess morphine sulfate contained in the original ampoule in accordance with these rules. The client should be educated on the safe and correct method of self-administration of medication. In addition to the training mentioned above, some clients may also need to learn special procedures such as proper use of an inhaler, taking insulin, mixing insulins, administering an intramuscular injection, or self-administering probes. Eye medications are used using a sterile technique, which is one of the few means that require more than medical asepsis or clean technique. The administration of the drug should be immediately recorded clearly and accurately in the patient‘s notes, with the nurse signing and printing the patient‘s name and recording the date and time of administration of the drug. If the drug was not administered deliberately, for example, if the nurse felt the need to question its administration to the prescribing physician, or if the patient refused it, this should also be noted in the notes with the reason. Nurses are required by law to ensure that they clearly record this information.
This should also be done if the registered nurse has delegated the administration of medication to another person, but this will be discussed in more detail later in the chapter. Safe medication administration will be discussed in more detail in the next chapter. Drug orders are often manually transferred to a Medication Administration Record (MAR) or Medex if the facility does not use computerized prescription entry. According to the NMC Code (2015), nurses may prescribe or administer medications within the limits of their training, the law, and any local or national guidelines. This includes compliance with the specific restrictions on the administration of controlled drugs discussed in the previous chapter. In accordance with prescribing rules for other health professionals, nurses should not prescribe to a person with whom they have a close personal relationship or prescribe medication for themselves unless absolutely necessary. Nurses have achieved this patient involvement by educating them about their medications and the importance of their involvement during medication administration to build trust and respect.  Many studies highlight the value of nurses‘ clinical reasoning skills, defined as the ability to think about a clinical situation as it unfolds, as well as the concerns and context of the patient and family.  Safe medication administration requires much more than the five rights and medication management to avoid costly mistakes. The literature is beginning to show more and more evidence that new efforts to maintain safety should also highlight the emergence of nurses‘ clinical thinking as an element that drives nurses to become highly competent in their profession.  Competence is measurable in the presentation of clinical and pharmacological knowledge, clinical experience, and the ability to perform comprehensive situational assessments of the patient prior to drug administration.
 The sites of intramuscular drugs are the gluteus maximus, deltoid muscle, lateral vastus, rectus femoral muscle, and ventrogluteal muscle. The gluteus maximus muscle and deltoid muscle are NOT used for infants or young children under 3 years of age. One of the recommendations to reduce medication errors and damage is to use the “five rights”: the right patient, the right medication, the right dose, the right way, and the right time. If a medication error occurs during the administration of a medication, we quickly blame the nurse and accuse her of not respecting the five rights. The five rights should be accepted as the goal of the medication process, not the “anything and everything” of medication safety. Implements INTERVENTIONS by withholding metoprolol at this time, documenting the drug retention incident, and notifying the provider. Sam then makes sure she gives Phil clear instructions on the tasks he needs to do.