a. Interpret the physician's order accurately (i.e., name of drug). 
    b. If the drug is unfamiliar, seek information from an authoritative source.    
    c. Read labels of drug containers accurately.
    d. Question the prescribing physician about the order if it is unclear or if the drug seems inappropriate for the client's condition.
   
2. Right dose
   
    a. Interpret abbreviations accurately. 
    b. Interpret measurements accurately. 
    c. Calculate doses accurately. 
    d. Measure doses accurately. 
    e. Question the prescribing physician about the dosage if it seems inappropriate for the client or does not fall within the margin of safety.
   
3. Right route

    a. Check that the medication can be given by the route prescribed.
    b. Give medications only by the route prescribed.
    c. Use correct techniques for all routes of administration. 
  
4. Right time
     
    a. Schedule administration of a drug to maximize therapeutic effects and minimize adverse effects.
    b. Omit or delay doses as indicated by the client's condition.

5. Right client

    a. Check identification bands on institutionalized clients to ensure the name and number match exactly those on the medication administration record every time a medication is administered. 
    b. Verify identity of ambulatory clients.
    c. It is recommended that all clients be asked to state their names, in addition to other checks, when possible.

6. Right documentation

    a. Assess physician's order to ensure that it is clear and complete. 
    b. Verify the record used for reference in preparation and administration of the drug with the original physician's order to ensure accuracy once per day.
    c. Record the medication immediately following its administration on the official record.
    d. PRN medications are often additionally recorded on unit report sheets or boards.
   
Guidelines for Safe Medication Administration

   1. Know and apply the medication policies of the hospital or agency.
   2. Research the medication completely.
   3. Give only medications for which the physician has written and signed the order.
   4. Check with the head nurse or physician when in doubt about any medication.
   5. Make certain that the data on the medication administration record or card correspond exactly with the label on the medication and the physician's order.
   6. Have another nurse check calculations.
   7. Concentration is essential to safety. Do not converse during drug administration unless seeking help.
   8. Use the "six rights" consistently.
   9. Ensure medications are stored safely.
 10. When giving more than one medication to a patient, the following order should be used:
       Give tablets and capsules followed by water or other liquid; then give liquids diluted with water as required. Cough medicine is given undiluted and is not followed by liqulds. Sublingual and buccal tablets are given last.
 11. Remain with patient until all medication has been swallowed.
 12. Complete all required documentation promptly. 

Teaching Clients about Oral Medications

  1. Read all directions, warnings, and interactions about the drug.
  2. Most medications should be taken with a full glass of water to enable the drug to be dissolved and begin working more quickly.
  3. Medications should never be combined with alcohol. 
  4. Do not mix medications in hot drinks. The hot temperature can destroy some drugs, and the tannic acid in hot tea can reduce the absorption of certain medications.
  5. Do not mix medications in food unless specifically ordered.
  6. Vitamin and mineral supplements can interfere with drug absorption. 
  7. Store medications in their original containers in a dry location.
  8. Store all medications out of reach of children.
  9. Do not keep drugs for long periods.
10. Do not start or stop drugs without consulting the physician.
11. Develop a routine time and place for taking medications. 

Nursing Process in Medication Administration

I.  Assessment

    A.  About the drug...
         1.  Is the order complete?
              (patient, drug, dose, route, time, signed) 
         2.  Is the order appropriate?
               -  Why this drug for this client at this time???
               -  Are there any interactions among prescribed drugs?
               -  Are there any contraindications for this client?
               -  Is the dose appropriate for this client?
               -  Is this route appropriate for this client?
               -  Is scheduled time appropriate for this drug?
         3.  What should be observed for and reported?

    B.  About the client ...
         1.  Medication history
               - past and current medications
         2.  Biophysical condition
               - weight, vital signs, gait, age, medical history, drug history 
         3.  Psychosocial condition
               - memory, comprehension, emotional status 
         4.  Compliance 	
               - factors influencing

II.  Nursing Actions

   1.  Prepare and administer drugs accurately.
        a.  Apply the six rights of drug administration.
        b.  Use correct techniques for different routes of administration.
        c.  Follow label instructions regarding mixing or other aspects of giving specific drugs.

    2.  Teach clients about their drug therapy
        a.  General instructions (see "Standard patient teaching about oral medications" on this page).
        b.  Instructions related to specific drugs
             i.   Name of the drug(s)
             II.  Purpose of the drug
             iii.  Dosage schedule
             iv.  Method of administration
             v.   Adverse reactions or side effects to be reported
             vi.  Miscellaneous instructions, such as safety measures and storage for a particular drug

III.  Evaluation
      Observe, record, and report ...
        a. therapeutic effects
        b. side effects and adverse effects
        c. suspected drug interactions