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10 Rights of Medication Administration

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10 Rights of Medication Administration

You've heard of the '5 Rights of Medication Administration', some experts claim this should be expanded to the '10 Rights of Medication Administration'.

When it comes to the safe administration of medications you can never be too careful, especially as up to 10% of patients experience unwanted side-effects or reactions and research shows that administration errors make up 60% of all drug errors. The rights of medications administration are there not only to reduce

The rights of medications administration are there not only to reduce harm caused by medications errors but also protect the interests of the patient and the Nurse administering.

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The 10 Rights of Medications Administration

1. Right patient

  • Check the name on the prescription and wristband.
  • Ideally, use 2 or more identifiers and ask patient to identify themselves.

2. Right medication

  • Check the name of the medication, brand names should be avoided.
  • Check the expiry date.
  • Check the prescription.
  • Make sure medications, especially antibiotics, are reviewed regularly.

3. Right dose

  • Check the prescription.
  • Confirm appropriateness of the dose using the BNF or local guidelines.
  • If necessary, calculate the dose and have another nurse calculate the dose as well.

4. Right route

  • Again, check the order and appropriateness of the route prescribed.
  • Confirm that the patient can take or receive the medication by the ordered route.

5. Right time

  • Check the frequency of the prescribed medication.
  • Double-check that you are giving the prescribed at the correct time.
  • Confirm when the last dose was given.

6. Right patient education

  • Check if the patient understands what the medication is for.
  • Make them aware they should contact a healthcare professional if they experience side-effects or reactions.

7. Right documentation

  • Ensure you have signed for the medication AFTER it has been administered.
  • Ensure the medication is prescribed correctly with a start and end date if appropriate.

8. Right to refuse

  • Ensure you have the patient consent to administer medications.
  • Be aware that patients do have a right to refuse medication if they have the capacity to do so.

9. Right assessment

  • Check your patient actually needs the medication.
  • Check for contraindications.
  • Baseline observations if required.

10. Right evaluation

  • Ensure the medication is working the way it should.
  • Ensure medications are reviewed regularly.
  • Ongoing observations if required.

Points 1 to 5 are the '5 Rights of Medication Administration' as per the NMC and Nice Guidelines in the UK. Points 6-10 are unratified checks that have been suggested by multiple US nursing boards and research panels to enhance patient safety. 

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Education

NMC launches new educational standards to 'shape the future of nursing'

Part of the changes includes the removal of the cap on the number of hours students can spend on simulation activities.

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by Ian Snug.
NMC launches new educational standards to 'shape the future of nursing'

Student nurses will start to train against the new standards from January 2019.

Last week the Nursing and Midwifery Council (NMC) launched 'ambitious' new standards of proficiency that set out the skills and knowledge the next generation of nurses need.

Alongside the new proficiencies, the NMC has introduced a more modern and innovative approach to the way universities and their practise partners train nurses and midwives - the NMC claim these changes will allow greater independence of assessment, and greater innovation by placement providers.

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The NMC has also removed its standards for medicines management and instead encourages employers to instigate rigorous medicines management procedures.

Unlimited simulation.

Finally, part of the changes includes the removal of the cap on the number of hours students can spend on simulation activities - despite concerns this could reduce the total amount of time student nurses could spend on placements.

The new standards represent two years’ work and have been developed alongside nurses - as well as students, educators, healthcare professionals, charities and patient groups from across the UK.

Jackie Smith, NMC Chief Executive and Registrar, said: “Our new standards represent a huge leap forward. They raise the bar for the next generation of nurses and not only match the demands of the role but the ambition of the profession. This is vital as in the coming years many thousands of new professionals will join our register, delivering care to millions of people.

“We’ve also overhauled the way universities train nurses and midwives. They’ll be given more flexibility to harness new ways of working and embrace technology so they can equip the nurses and midwives of tomorrow with the skills they need to deliver world class care for years to come.”

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Education

Do I really need to count a patients respiratory rate for a whole minute?

Just four breaths either side of the normal range could be indicative of impending clinical deterioration.

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by Matt Bodell.
Do I really need to count a patients respiratory rate for a whole minute?

Some staff feel that sixty seconds can be better spent.

It is well documented that the respiratory rate is the least accurately recorded vital sign but yet it can be the most important.

Reseach suggests that many students and registered nurses believe they are enhancing patients' outcomes by performing tasks other than counting a patient's respiratory rate for the full sixty seconds.

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The research, completed by Flenady et al, suggests that this debate isn't rooted in laziness but instead staff believe they are enhancing patients' outcomes by performing tasks other than counting a patient's respiratory rate.

Do I really need to count for a whole minute?

Yes! It is vitally important you count a patients respiratory rate for the full sixty seconds rather than counting for a shorter period and multiplying, or worse, estimating.

Respiration has differing patterns and without observing these for a whole sixty seconds you are unlikely to obtain an accurate measurement.

Do I really need to count a patients respiratory rate for a whole minute?

The critically unwell patient also sometimes tend to have apneic episodes and counting for a short period may not reveal these until a patient is in full respiratory arrest.

Just four breaths either side of the normal range could be indicative of impending clinical deterioration.

Finally, documenting an inaccurate respiratory rate could, potentially, have legal implications.

How should I count a respiratory rate?

You should count each full cycle of inspiration and expiration for a full sixty seconds.

Anecdotally, it is better to count a patients respiratory rate when a patient when they are not aware you are doing so - this ensures a patient is less conscious about their breathing and thus their respiratory rate is more natural.

Why is respiratory rate important?

Haemostasis and the bodies compensatory mechanisms mean that a change in respiratory rate could be one of the first indicators of deterioration in physiological condition.

Changes to a patients respiratory rate can indicate a number of things such as hypoxia, neurological or metabolic changes.

Picking up on these changes early should lead to earlier medical intervention and therefore better patient outcomes.

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Education

Student nurses to receive ‘political lobbying lessons’

The session is designed to equip students with practical skills and knowledge they can use to develop a good relationship with their local MP.

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by James M.
Student nurses to receive ‘political lobbying lessons’

Nursing students will learn how they can work with MPs to promote the nursing profession in a new training session organised by the RCN.

Members of the RCN’s student committee and student information officers - the RCN’s representatives in universities - will learn their way around the UK parliament and the government from the UK Parliament Outreach and Engagement Service.

The session is designed to equip students with practical skills and knowledge they can use to develop a good relationship with their local MP.

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The RCN’s public affairs team will talk through the college’s approach to engaging with parliamentarians, especially the crucial role members can play. The team will explain different tactics and approaches students can take as well as what they can ask MPs to do to show their support for nursing staff in their constituencies.

Janet Davies, chief executive and general secretary of the RCN, said: “To work effectively, any union must be able to engage MPs and ministers.

“We know our members make the most powerful advocates for the profession. When frontline nursing staff sit in front of parliamentarians, you can see they listen.

“It’s through the hard work of members that vital issues such as safe staffing, harassment and health policy reach the top of the agenda.

“When nursing faces challenges on every front, the RCN wants to make sure our advocates are fully-equipped.”

Charlotte Hall, chair of the students’ committee, said: “Student nurses represent the future of the profession. Learning to engage with MPs is vital if we are to effectively shape that future and ensure the best possible care for patients.

“With these skills, committee members and student reps will be able to help other nurses make their voices heard on behalf of the profession and patients.”

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