Medication Administration: Are the Five Rights Enough?

Career Advice, Job Seeker

By Ashley Holechek, MBA, MSN, RN, Clinical Nurse Manager at Medical Solutions

My darling toddler rarely cries. That’s not a brag, it’s the acronym my classmates and I used to remember the “Five Rights” of medication administration while studying in nursing school.

The Five Rights

Most clinicians responsible for administering medications are familiar with the Five Rights: Right Medication, Right Dose, Right Time, Right Route, and Right Client. For safe, correct medication delivery in the clinical setting, clinicians must administer the correct medication, in the correct dose or concentration, via the correct route, at the correct time, to the correct patient or client. A mistake in any of these areas will result in a medication error.

Proper medication administration is especially important to maintain when you’re on a new travel nursing job! You’re getting accustomed to a new facility, new co-workers, and sometimes new policies, so it’s crucial to stay focused on the basics of patient safety.

The FDA receives over 100,000 reports of suspected medication errors each year. These errors may result in life-threatening situations or death, disability, complications in pregnancy, or birth defects. A recent study from Yale University estimates there are approximately 7,150 deaths related to hospital error each year. Reducing the amount of medication errors each year could help to decrease the number of preventable deaths related to medical errors.

One outstanding issue when relying on the Five Rights to ensure safe medication practices is that it does not account for human error. While the Five Rights have been considered the gold standard of medication administration for many years, we know the higher the census and acuity of patients at the hospital, the busier clinicians become with day-to-day patient care responsibilities. Many medication errors are made each year by extremely busy caregivers when the clinician administering the medication believed they were administering the medication correctly. For example, a nurse may have read the medication label and believed they had the correct medication, when in fact they did not.

Barcode Medication Administration

While it’s impossible to completely mitigate the risk of human error, technology can provide additional tools and resources to considerably reduce the risk. Barcode medication administration (BCMA) is a method shown to be effective in decreasing medication errors in clinical settings. Many facilities that have an electronic medical record also utilize BCMA as part of their standard practice. This technology works by scanning a barcode on the patient’s wristband then scanning the medication. The electronic medical record will verify the medication to ensure it matches the medication and dose that was ordered, and the correct patient was scanned. It can also take into account the vital signs of the patient or require verification from a second clinician for some medications deemed high risk.

Presently, medication safety is a hot topic in the medical community. Many clinicians are familiar with the medication error and subsequent criminal charges brought against RaDonda Vaught, a Tennessee nurse who received national attention after a fatal medication error. Although many factors contributed to this unfortunate situation, in this instance barcode/medication scanning wasn’t utilized prior to the administration of this medication. If BCMA technology was utilized, this situation may have had a different outcome.

The Leapfrog Group, a nonprofit founded by private healthcare experts, is a trusted national leader and advocate in hospital transparency. This group estimates that the hospitalized patient is exposed to at least one medication error daily, and that the use of BCMA is associated with reducing medication administration errors by up to 93%.

While BCMA can assist in reducing medication administration errors, this technology only works if it is utilized and used correctly. Of hospitals that report information to the Leapfrog Group, 97.8% have implemented BCMA technology in at least one inpatient unit, with most hospitals using the system in all applicable units. Still, only 34.5% of reporting hospitals fully met all requirements of the BCMA standards. Those four standards include:

  • implementing BCMA linked to the EMR in 100% of the applicable units
  • scanning both patient and medication bar codes in 95% of bedside medication administrations (in equipped units)
  • using a BCMA system that includes all elements identified as best practices by Leapfrog
  • and implementing all five best practice processes to prevent workarounds of the BCMA system.

Because clinicians do still have the option to use workarounds, 42% of facilities are failing to meet the benchmark of scanning both the patient and medication in at least 95% of bedside administrations. When medication scanning is bypassed, patients are put at risk and the clinician does not take advantage of a useful safety check.

Keep Medication Administration Safe

There’s significant room for improvement in adherence to utilization of BCMA systems. As clinicians, it’s our responsibility to ensure patient safety. Utilizing safety checks such as BCMA in addition to the Five Rights can decrease medication errors and increase patient safety. If you’re a clinician responsible for administering medications, don’t forget to scan your patient and your medications — it just might save a life!

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