1. Safe Medication Administration
Chapter 7
Safe Medication Administration

2. Medication Administration Record (MAR)
Although some differences among health care facilities, MARs are more similar than they are different

3. MAR Similarities
Large column usually on left-hand side of MAR form that contains:
Drug names
Both scheduled and as needed (prn)
Drug dosage
Frequency of drug administration

4. MAR Similarities
Usually three columns designated for documenting medication administration for day, evening, and night shifts

5. MAR Similarities
Space for precautions related to administration, such as checking:
Pulse
Blood pressure
Body weight

6. MAR Similarities
Column for initials of person transcribing medication from order sheet to MAR
May include “start” and “stop” columns
Indicate what day and time medication is to be started and stopped

7. MAR Similarities
Area where all staff initials identified with full name and title
May be one sheet (front and back) or two sheets to separate scheduled and prn medications

8. Six Rights of Medication Administration
Right drug
Right dosage
Right route
Right time
Right person
Right documentation

9. Right Drug Check every drug three times: When drug is located
Just before opening or pouring medication
Immediately prior to administration

10. Right Dosage Compare to average dosages
Metric dosages containing decimals are of particular concern

11. Right Route Oral Sublingual Drops Topical Under tongue
For eye, ear, and nose
Topical

12. Right Route
Transdermal
Inhalation
Creams
Suppositories

13. Right Route Parenteral routes Intravenous (IV) Intramuscular (IM)
Most common
Intramuscular (IM)
Subcutaneous
Intradermal

14. Right Time Standard time
12:00 a.m. for midnight to 11:59 p.m. for one minute before midnight
Times are duplicated during 24-hour period
Only a.m. and p.m. differentiate

15. Right Time Military time
0001 for one minute after midnight to 2359 for one minute before midnight
No duplication in numbers

16. Right Time Military time
After one o’clock in the afternoon, 12 hours added to each time until midnight
e.g., 1300 = 1:00 p.m., 1700 = 5:00 p.m., 2200 = 10:00 p.m.

17. Right Person Most important nursing intervention
Check ID band and read both surname and first name
Perform every time medication given
No exceptions

18. Right Documentation
When medication administered, must be documented immediately
Never record before administered
MARs are immediate reference for medication administration
Must be maintained up-to-the-minute

19. Right of Refusal Partner with client
If client questions medication, consider client correct until proven otherwise
Client also has right to refuse medication

20. Medication Errors
Estimated 100,000 people die each year from medication errors
Occur during:
Prescribing
Transcribing
Calculating
Administering

21. JC “Do Not Use” List U IU QD, Q.D., q.d., or qd Write “unit”
Write “International Unit”
QD, Q.D., q.d., or qd
Write “daily”

22. Joint Commission “Do Not Use” List
QOD, Q.O.D., q.o.d., or qod
Write “every other day” MS
Write “morphine sulfate”
MSO4 or MgSO4
Write “magnesium sulfate”

23. JC “Do Not Use” List Omit trailing zero Use zero before decimal number
e.g., write X.0 mg as X mg
Use zero before decimal number
e.g., write .X mg as 0.X mg

24. ISMP List
More in-depth listing developed by Institute for Safe Medication Practice (ISMP) in cooperation with Food and Drug Administration (FDA)
Can be located at:

25. Errors in Abbreviations
Use of abbreviations identified by Joint Commission and ISMP as error-prone
e.g., write drug frequency q2h as “every 2 hours”

26. Errors in Writing Metric Dosages
Using trailing zero
Failing to place zero in front of decimal fraction
Illegible prescriptions

27. Actions When Medication Errors Occur
Report as soon as discovered
Institute necessary remedial measure immediately
Determine reason for error
Prepare incident/accident report
Institute corrective policies/procedures to prevent recurrence, if possible

28. Preventing Medication Errors
Avoid two biggest factors in medication errors:
Distraction
Fatigue
Exercise extreme caution when administering medications

29. Preventing Medication Errors
Always use Six Rights of Medication Administration
“Routine” medication administration should never be routine

30. Preventing Medication Errors
MARs are immediate reference for medication administration
Must be maintained up-to-the-minute

31. Medication Errors
Can be held legally responsible if wrong drug or dosage given
Regardless of source of error