Nurses are Masters at the Fine Art of Caring

Five Rights of Medication Safety

©2012-present Kathy Quan RN BSN PHN ALL Rights Reserved

There are Five Rights to Medication Safety. Some facilities and medical texts indicate a few more, but these five are common to all versions.

Nurses and other healthcare professionals are expected to adhere to these rules to avoid medication errors and ensure medication safety in hospitals, skilled nursing facilities, clinics and practitioner's offices. A nurse should NEVER administer any medication s/he is unfamiliar with. Access to apps and the Internet provide resources to prevent this event from happening. Utilize all the resources available.

These are rules that nurses need to teach to patients as well. Patients should learn to adhere to the 5 Rights of Medication Safety. How many times has there been a horror story (or near miss) about how Mary Jones accidentally took her husband Mike's medication by mistake? Some pharmacies are now color coding medication bottles for their clients to help avoid such errors. Even the best efforts are not always fool proof. Following the 5 Rights of Medication Safety, this type of scenario can be avoided.

Right Medication:
Is this the medication the practitioner ordered?
Is this a generic version?
Right Dose:
How many tablets or doses are to be taken each day?
Has the proper dose for height and weight been calculated? (Essential in pediatrics!)
How many times each day?
How long does the patient need to continue to take the medication?
Right Time:
What time of day should the medication be taken?
What about food?
Should it taken before a meal, with a meal, after a meal, or with a snack?
Right Route:
This includes such items as how to take the medication.
Is it to be swallowed or chewed?
Can it be crushed if necessary?
Take with a sip of water or a full glass?
Does it come in liquid form?
If it's an IV med, and the patient or caregiver is administering, have they been adequately instructed? Do they have access to help if needed 24/7?
Right Patient:
Is this the patient's medication or is it for someone else?
Never take someone else's medication.
Always ID your patient before administering medications.

Many additions to this list of Rights have been suggested including the Right to accurate documentation, drug-to-drug interactions, refuse medications, have a second opinion, have a history assessment, appropriate education and information. Some nurses have made the suggestion of adding "autonomy" as a right which would combine several of these points into one.

Medication errors are all too often the result of carelessness. Taking and giving medications is an act that needs to be done carefully and taken quite seriously. All efforts need to be made to avoid errors. If patients or caregivers have questions they should contact the nurse, practitioner or pharmacist.

Each time a new medication is ordered, the patient and caregiver should review this information with the prescribing practitioner or office nurse. The pharmacist should also review it with them when the prescription is dispensed. Using ONE pharmacy helps reduce errors such as multiple meds with similar action or the same medication in different formats (i.e. lisinopril is the same a zestril or prinivil). One pharmacy can also catch contradicted medication errors or potential drug interaction issues with multiple practitioners ordering medications. If family members or other caregivers are involved in the administration or dispensing of medications they need to understand these steps in order to avoid medication errors.

Look-alike and sound-alike drugs need to be reviewed carefully to ensure the right medication is being administered. Never assume!

Medications can be pre-dispensed in a variety of medication boxes or bubble packs with information about administration such as days of the week, as well as times of the day written on them. These help to ensure patients take the appropriate medications at the right times. They also make it obvious if a dose has been missed. Errors of omission can be just as dangerous as giving the wrong medication or dose. Medication boxes should be set up carefully and monitored for compliance.

Medication reconciliation is part of every nurse's responsibilities for quality, safe patient care at each encounter.

This article first appeared on Suite in 2006. That site no longer exists. It has been updated in 2018.