Comprehensive Nursing Pharmacology Q 8
The nurse is administering an antibiotic to her pediatric patient. She checks the patient’s armband and verifies the correct medication by checking the physician’s order, medication Kardex, and vial. Which of the following is not considered one of the ten “rights” of drug administration?
A. Right dose
B. Right route
C. Right effect
D. Right time
Correct Answer: C. Right effect
Nurses are responsible for ensuring safe and quality patient care at all times. As many nursing tasks involve a degree of risk, medication administration arguably carries the greatest risk. Research on medical administration errors (MAEs) showed that there is a 60% error rate mainly in the form of wrong time, rate, or dose. Some medication errors cause permanent disability and for others the errors are fatal. Follow these 10 rights of drug administration to ensure safe patient care. The 10 medication administration rights include: right drug, right patient, right dose, right route, right time and frequency, right documentation, right history and assessment, right drug approach and right to refuse, right drug-to-drug interaction and evaluation, and right education and information. Effect is not included.
Option A: Check the medication sheet and the doctor’s order before medicating. Be aware of the difference between an adult and a pediatric dose. Incorrect dosage, conversion of units, and incorrect substance concentration are a prevalent modality of medication administration error. This error type stems from nurses giving a patient an incorrect dose of medications, even if it is the correct medication and the patient’s identity is verified, without first checking to ensure it is the correct strength for the patient. This may be due to misplaced decimals, errors in arithmetic, or incorrect conversion between two units. Studies that have emphasized observing positive behaviors nurses have adapted to help reduce medical errors include consulting with pharmacy personnel, using calculators to assist in arithmetic, or in some cases, cross-consulting with patients or their families about usual doses they administer at home.
Option B: Check the order if it’s oral, IV, SQ, IM, etc. Medications can be given to patients in many different ways, all of which vary in the time it takes to absorb the chemical, time it takes for the drug to act, and potential side-effects based on the mode of administration. Some common routes include oral, intramuscular, intravenous, topical, or subcutaneous injection. It is crucial that nurses remain educated and up to date on newer medications or less commonly administered medications to learn how they are safely delivered to patients before being asked to do so in clinical practice. Additionally, nurses must have at least a minimal basic understanding of the physiology influencing drug absorption rates and time of drug onset, as these principles relate to medication administration.
Option D: Check the order for when it would be given and when was the last time it was given. Often, certain drugs have specific intervals or window-periods during which another dose should be given to maintain a therapeutic effect or level. A guiding principle of this ‘right’ is that medications should be prescribed as closely to the time as possible, and nurses should not deviate from this time by more than half an hour to avoid consequences such as altering bioavailability or other chemical mechanisms.