How to use this essential checklist to help you practise safely by preventing your own medication errors and spotting when a prescriber may have made a mistake
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An estimated 237 million medication errors occur in the NHS in England every year, according to the Care Quality Commission (CQC).
The RCN says in its guidance on medicines management: ‘Whether or not you are a prescriber, medicines management and the administration of medicines is a key part of the nurse’s role.
‘A nurse administering a medicine must have an overall understanding of the medicine being administered and seek advice if necessary from a prescriber or a pharmacist.’
From 5Rs to 10Rs – improving patient safety of medicine administration
To support safe drug administration, many organisations including the Nursing and Midwifery Council (NMC) initially advocated using five Rs or ‘rights’ as a cornerstone of good nursing practice. But over the years, and based on developing expert knowledge and opinion, these have gradually expanded to ten.
For nursing students in particular, they are invaluable, says University of South Wales senior lecturer in adult nursing Clare Churcher. ‘Students can get excited about medication administration, but really quite nervous about doing it too,’ she says. ‘Having the ten Rs is important because it gives them a checklist they can use throughout their career.’
‘Remember those writing prescriptions can make errors. It’s important to check the appropriateness of the medication and the prescribed dose. If it doesn’t look right, do the calculation yourself and get someone to check it’
Clare Churcher, senior lecturer in adult nursing, University of South Wales
It’s vital to remember that even at busy times when there are shortages of staff, students should always accompany a registered nurse on a drug round and never administer medications on their own, cautions Ms Churcher.
The 10 ‘rights’ of medicine administration
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Senior lecturer in adult nursing Clare Churcher explains how to practise the 10 Rs, and the rationale behind each ‘right’:
- Right patient Check the individual’s name, both on their prescription and wristband. If possible, ask the person to identify themselves and ideally use two or more identifiers – for example date of birth. It’s important to be careful, not least because there can be times when you have people on the ward with the same or a similar name.
- Right medication Check the name of the medication, its expiry date and the prescription. Make sure you avoid brand names and look at the name of the medication itself. You should also ensure medications are reviewed regularly
- Right dose Check the prescription and confirm the appropriateness of the dose, using the British National Formulary (BNF) or local guidelines. If necessary, calculate the dose and have another nurse do the same. Remember those writing prescriptions can make errors. It’s important that nurses check the appropriateness of the medication and the dose that’s been prescribed. If it doesn’t look right or you have a concern, do the calculation yourself and get someone to check it
- Right route Check the order and appropriateness of the route prescribed, whether tablet, liquid, injection or other method. Confirm the patient can take the medication by that route. Some patients may have difficulties swallowing, for example, so they can take a liquid medication but tablets are problematic. Nurses will understand the patient’s capabilities
- Right time Check the frequency of the prescribed medication and double-check you are giving it at the correct time, bearing in mind some medications, such as those used to treat Parkinson’s, are time-sensitive. To help prevent missed, extra or untimely doses, confirm when the last dose was given by checking the patient’s medication chart and also asking the patient themselves
- Right education Check to see if the patient understands what the medication is for and ensure they know they should contact a healthcare professional if they experience any side effects or adverse reactions
- Right documentation Document medication after it has been administered and not before. It’s really important the prescription chart is signed after the patient has taken their medication. You need to make sure it has happened. If it isn’t written down, it hasn’t been done. It protects both nurses and their patients
- Right assessment Check that your patient needs the medication that’s been prescribed, checking for any contraindications and the patient’s history for drug reactions and allergies. It may mean that baseline observations are needed, before the medication starts
- Right evaluation Ensure the medication is working the way it should and that it’s reviewed regularly. Carry out ongoing observations, as needed. For example, if pain isn’t being controlled effectively, it may need to be looked at again, with another medication added
- Right to refuse Ensure you have the patient’s consent to administer medications. If someone has capacity they have the right to refuse medication. There will be incidences when that capacity is in doubt, for example if the patient has dementia. We need to look then at what we do in their best interests. For those who are refusing medication and have capacity, it’s important to find out why. There may be an underlying reason, such as experiencing an allergic reaction. All medications carry side effects, so sometimes we need to help with another medication.
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Lynne Pearce is a health journalist