Medication Administration

The rights

Older texts list five. Most Canadian programs now teach ten, and the exam tests the additions as often as the originals.

Right	The question you ask
Patient	Two identifiers — never the room number
Medication	Does the label match the order?
Dose	Is this a reasonable dose for this person?
Route	Is this form giveable by that route?
Time	Within the acceptable window?
Documentation	Charted after giving, never before
Reason	Why is this person on this drug?
Response	Did it do what it was meant to?
To refuse	The patient may decline
Education	Do they know what they're taking?

Right to refuse trips people up. A competent adult may refuse any medication. You educate, you document, you notify the prescriber. You do not persuade, hide it in food, or give it anyway.

The three checks

Check the label against the order:

1. When you take it from the drawer or cart
2. When you prepare or pour it
3. Before you give it, at the bedside

Three checks against one source is not three checks. The order is the source of truth each time.

Two identifiers

Name and date of birth, or name and medical record number. Never the room number and never the bed number — patients move, and that is precisely when errors happen.

Ask the patient to state their name rather than asking "Are you Mrs. Kaur?" Unwell people say yes to almost anything.

High-alert medications

These cause disproportionate harm when they go wrong, and most require an independent double-check:

• Insulin
• Anticoagulants (heparin, warfarin)
• Opioids
• Concentrated electrolytes, especially potassium chloride
• Chemotherapy
• Neuromuscular blocking agents

Never give concentrated potassium chloride as an IV push. It is fatal. It is always diluted and infused, and this is one of the most consistently tested single facts in nursing pharmacology.

Before you give it

Some drugs need an assessment first, and skipping it is the error:

Drug	Check first	Hold if
Digoxin	Apical pulse, full minute	< 60 bpm in an adult
Beta blockers	Heart rate and blood pressure	Per parameters ordered
Antihypertensives	Blood pressure	Per parameters ordered
Insulin	Blood glucose	Hypoglycaemic
Opioids	Respiratory rate, sedation	RR < 12 or heavily sedated
Warfarin	INR	Above range

When an error happens

1. Assess the patient first. Always. Not the chart, not the phone.
2. Notify the prescriber
3. Complete an incident report
4. Document the facts in the chart — what happened, what you assessed, who you notified

The incident report is a quality document, not part of the medical record. Do not chart "incident report filed" in the patient's notes.

Reporting an error is not optional and it is not a character failing. Systems improve from reported errors and cannot improve from hidden ones.