–This is checked twice. First, when gathering the meds, and then again at the bedside. Ask the patient to state their name and check their ID band. Never use the room number as an ID. Consider a confused patient wandering into another’s bed. You say, “Good morning Mr. Smith!” and he doesn’t realize he’s not Mr. Smith but smiles and says, “Good Morning!” back at you. Check his band and also ask for his birth date.
– Know what the drug is typically used for. If it’s therapeutic effect does not match the diagnosis, question the order or at least further investigate. You may see generic and trade names. Double check the MD order.
– Oral? I.V.? The prescribing clinician makes that call but you might question or request to change the order depending on other factors; e.g., difficulty swallowing pills, a common issue with children and teens.
– Look up the usual or common dosages for the medication if you don’t know them. Question any amount that seems out of the norm. 1.25mg vs .125mg is significant.
– Typically you have 30 minutes before to 30 minutes after the prescribed administration time. You’ll need the extra time when you are looking up all those medications. Start 1/2 hr. early if you need to. For a PRN med, make sure enough time has passed since their last dose.
Right History and Assessment
– No history of allergy to the medication, right? Good. Contraindications? Are they pregnant? How about pre-medication assessments? Check to see if the med should be held if pulse or BP is too high or too low.
– At the bedside, educate your patient about the meds they are taking. Inform them of the expected therapeutic and side effects and ask if they have any questions. Keep in mind patients don’t sleep well in the hospital. I’ve found patients are too tired to care or try to comprehend much about their complicated care in the hospital. Offer to provide them with printed material to review when they are feeling better.
– Document it was done so it is not given twice. You should not sign off as “given” until it actually is. You might get bumped on the way to the patient’s room and the pills roll under the fridge or, the patient refuses. Then you call the pharmacy and explain you want another dose even though the record shows “given” or you’ll need to figure out how to “un-give” it in the MAR. If giving an injection, note where you gave it.
Right to Refuse Treatment
– The client has the right to refuse medication and/or treatment. As the nurse, it’s your duty to nicely explain the reasons for the med/tx, and any adverse effects that could happen if they don’t comply. If that doesn’t work, document that you informed the patient of the ill effects and the reason they give for refusing, if they state any.
– Note if the desired outcome is found in the patient.
Share your experiences below on how one or more of the 7 rights saved you from what could have been an adverse situation.