Editing Pharmacology (section)

== The Rights of Medication Administration ==

The traditional five rights, expanded in current practice:

# '''Right patient''': two identifiers, never the room number. Compare the identifiers to the medication administration record and the patient's identification band.
# '''Right drug''': check the label against the order. Beware look-alike and sound-alike pairs such as hydralazine and hydroxyzine, metoprolol tartrate and metoprolol succinate, insulin glargine and insulin lispro, celecoxib and citalopram.
# '''Right dose''': recalculate independently. Question any dose requiring more than two tablets or an unusually large volume.
# '''Right route''': never assume. Some drugs are fatal by the wrong route, for example vincristine given intrathecally, or concentrated potassium chloride given as an intravenous push.
# '''Right time''': most facilities allow a window of 30 minutes before or after the scheduled time for routine drugs. Time-critical drugs such as insulin, antibiotics, anticoagulants, and antiparkinson agents have tighter windows.
# '''Right documentation''': chart immediately after administration, never before.
# '''Right reason or indication''': the drug should match the diagnosis.
# '''Right response or evaluation''': did it work.
# '''Right to refuse''': a competent patient may refuse. Educate, document, and notify the prescriber.
# '''Right education''': the patient should know what the drug is for and what to report.

Perform '''three checks''' of the label: when removing the drug from storage, when preparing it, and at the bedside before administering.

'''Independent double check.''' Two qualified clinicians independently verify, without prompting each other, the drug, concentration, dose, pump settings, and patient identity. Required by most policies for insulin, heparin and other anticoagulants, chemotherapy, patient-controlled analgesia, epidural infusions, and all high-alert pediatric and neonatal drugs.