Why is the timing of medication administration important
Eight Rights of Medication Administration - Archer NCLEX Review
welcome everyone this video will cover
the fundamental topic of the eight
rights of medication administration I
know this information is very basic but
it is pertinent here and clicks exam you
will certainly have questions with these
topics embedded in them so let's get
started the first right is the right
patient this means that first and
foremost you must verify your patient's
name using to identify errs this could
be their name and medical record number
that's the most common combination you
also need to check their name on the
order for the medication and their
identification band usually on their
wrist that band has to be attached
directly to them not sitting on the
keyboard or attached to the bed but
attached directly to the patient you
also need the patient to identify
themselves by setting their name and
birth date if they're able to obviously
if somebody is in a coma
they are not conscious or maybe not in
the right state of mind this wouldn't be
appropriate but for most patients have
them state their name and birthday check
their band attached to their wrist and
verify their mrn okay our second right
is the right medication you will need to
verify the name of the medication check
the medication that label and check the
order be very cautious of any look-alike
sound-alike medications as with those
long generic names it can be quite easy
to confuse two medications that look
similar
so just remember for the right
medication to verify the name the check
the label of the medication and of
course compare all of that to the order
our third right is the right dose you
need to verify the dosage written in the
order and then you need to make sure
that that dosage is actually appropriate
for your patient so find a current drug
reference find the safe dosage range
remember this can be different with age
geriatric patients don't clear drugs
quite as quickly so they may need a
smaller dosage and same thing with
Pediatrics we always verify a pediatric
patient dose
way in kilograms to make sure that the
medication they are receiving is within
a safe dosage range remember also that
patients with renal insufficiency may
need lower doses because their kidneys
are not as effective in clearing the
drug from their system so you need to
calculate this dose check that it is
correct and have another nurse calculate
the dose independently to double-check
you're both getting the same answer this
means that the dose is appropriate per a
current drug reference and that the
milligrams are correct for the number of
milliliters you're administrating or
whatever the case may be so that is
right dose fourth we have our right
route you need to check the order for
the route that is ordered how the doctor
wants you to give this medication then
you need to ask yourself is it safe to
give the medication this way and can the
medication be given this way to this
patient for example do you have a
patient who's at major risk for
aspiration but the provider has ordered
a lot of Pio medications per mouth or
are they ordering IV medications and you
don't have IV access those are two
routes that would not work in that
situation also remember that dosage can
depend on the route so your previous
right the right dose will depend on this
right the right route next we have right
time you need to confirm that you are
administering the medication at the time
it is ordered but you also need to
verify the frequency with which you're
giving that medication for example do
they have IV Tylenol ordered every four
hours just because you're giving that
dose at noon when it is ordered it may
be too frequent for our example here
with acetaminophen or Tylenol if you're
giving that dose of Tylenol a thousand
milligrams at noon and it's ordered at
noon
q four well yes it's ordered at noon
you're giving it at the right time but
if you're gonna continue giving that q
four after a whole day
they would get 6,000 milligrams of
acetaminophen far more than the maximum
recommended dose of four grams or 4,000
milligrams so verifying the frequency is
just as important to making sure that
the dose is being given at the ordered
time you also want to double-check what
time the last dose of the medication was
given because if it was given late you
might need to adjust the time you're
giving this medication to make sure the
frequency remains safe and that you're
not giving it too close together all
right six we have our right
documentation I know you've heard this
before if it wasn't documented it wasn't
done this four means four medication
administration if you don't chart in
your MA are that you give that the team
will think the patient did not get that
medication and they might change dosage
or something depending on your actions
so you need to document these following
components the time you give the Med the
route it is ministered and any pertinent
vital signs so for route if you used an
IV document the access if you gave them
an injection what site did you use for
vital signs this is common sense
any thing that you're looking to change
and give a certain response to the
patient a before and after needs
documented so for this example
antihypertensives we need to document a
blood pressure also a side note you
should never ever pre chart medication
administration you never know what's
gonna happen that patient could throw up
the medication the IV that you're
supposed to be giving it in maybe went
bad and it's not working maybe the
patient or the family refuses you simply
don't know until that medication is
successfully administered what is going
to happen so don't ever preach art next
up we have the right reason I think this
is pretty self-explanatory but before
administering any medication you need to
always ask yourself why the patient
needs this medication look through their
history what conditions they have and
what the indications for this medication
are also is this an older
patient or a patient with a chronic
condition that has many many medications
or all of these medications still
indicated just some of them have
potential side effects when given
together or synergistic effects where
the dosages may need to be altered you
as the nurse are the primary patient
advocate so take the time to think
through these situations and raise
questions to the providers if it seems
like something is out of whack or
there's not a good indication for giving
this medication last but not least we
have right response so you have verified
your patient the medication the dose the
route the time the documentation you
gave the drug for the right reason now
you need to monitor the patient to
verify that they have the response you
are expecting so did that
antihypertensive lower the blood
pressure did your potassium supplement
increase their potassium level whatever
vital sign or lab value you're trying to
affect you need to watch it
and document document all of your
monitoring follow-up those lab values
take your vital signs and document them
show that your medication has had the
right response and if it hasn't contact
your health care provider
all right let's wrap things up with one
NCLEX question which of the following
fall under the right dose for the eight
rights of medication administration
select all that apply a using a drug
reference to verify the dose ordered is
appropriate B identifying the patient
using two separate identifiers C having
a second nurse and dependently calculate
the medication dosage or D double
checking the last time the medication
was administered
the correct answer was a and C a is
correct using a drug reference to verify
the dose ordered is appropriate is a
part of the right dose check in the
eight writes of medication
administration the nurse should always
verify that this dose is appropriate by
checking a current drug reference for
the medication and verifying what is
ordered is in the safe range and
remember this can be different for
different patient populations B it was
an incorrect answer because identifying
the patient using two separate
identifiers falls under the right
patient part of the right eight rights
of medication administration C was
correct having a nurse independently
calculate the medication dose a second
nurse is an important part of verifying
the right dose and D was incorrect
double-checking the last time the
medication was administered is a part of
the right time and staff so as you can
see these are fairly straightforward you
should be able to get these questions
right no problem as long as you review
what the rights are and kind of know how
to put them into practice let us know if
you have any questions about this though
and as always good luck with your
studying
