(Cohen, 2000; Kastango, 2003; IOM, 2004b). Most medications are now administered in unit dose form to minimize the amount of compounding by nurses. Ideally, medications should be kept in the dispensing container and in their individual packages until they reach the bedside so as to decrease the risk of their being confused with another patient’s drug. In addition, it is standard practice for the drug label to be read three times prior to administration—when obtaining the drug from the storage area; when preparing the dosage at the bedside; and after administration, when discarding the package (Cohen, 2000; Manias et al., 2005)—although there is some support for registered nurses’ competence to perform single-checking (Jarman et al., 2002). Averting errors also requires careful attention to dosage and route when preparing medications. For example, pediatric and chemotherapy doses should indicate milligrams per kilogram (mg/kg) or milligrams per meter squared (mg/m2) in order to leave little margin for error (Cohen, 2000). Nurses must also ensure that drug infusion or administration devices are functioning properly and programmed accurately to ensure that the dose and infusion rate are correct (Smetzer, 2001; Fields and Peterman, 2005; Nicholas and Agius, 2005). These nursing activities are indispensable to patient safety.
Perhaps most important, the nurse is often the last professional to evaluate the appropriateness of the medication that has been prescribed. In fact, a study of medication errors found that nurses were responsible for intercepting 86 percent of all errors made by physicians, pharmacists, and others involved in providing medications for patients (Leape et al., 1995). Nurses’ involvement and vigilance during the preparation process is thus central to accurate medication administration.
Medication administration is founded on what are termed the “five rights”—the right drug, in the right dose, by the right route, at the right time, to the right patient (Manias et al., 2005; Nicholas and Agius, 2005; Schull, 2005; Manasse and Thompson, 2005). While achieving the five rights is essential to safe medication administration, more complex factors must also be considered to ensure positive outcomes. First, medications can be administered via a number of different routes and formulations—oral tablet, capsule, or liquid; intravenous solution; intramuscular injection; inhalant; eye/ear drops; topical cream or solution; transdermal patch; or other means—depending on the patient, drug, and condition. Without attention to this issue, for instance, a liquid intended for oral dosing might be administered intravenously. Excessive variations in dosing regimens (e.g., multiple sliding scales for insulin dosing, as needed), use of high-risk drugs (e.g., anticoagulants, narcotics), and the proliferation of new drugs and devices add significantly to the intricacies of the administration process (Greengold et al., 2003; USP, 2003). In addition, the severity of a patient’s medical condition and the presence of comorbidities further increase the