Administering Medications & Injections

Snapshot: This article reviews fundamental principles and guidelines for medication administration, including your basic rights and responsibilities as a nurse. Note: This information is for reference purposes only; always follow your institution’s guidelines and all applicable laws when administering medications.

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Medication Administration General Principles Medication Administration Steps Rights of Medication Administration The Three Checks

Medication Administration General Principles

  • Know the purpose and expected outcomes of the medications you administer. This should go without saying, but not all nurses follow this important rule. Simply because a physician prescribed a particular medication doesn’t mean it’s automatically appropriate for your patient. One of your key responsibilities as a nurse is to catch errors at the bedside – and this means you must know whether the medications your patient will be receiving are appropriate.
  • Become a master of the medications you administer on your unit. While you should know the purposes and expected outcomes of all the medications you administer, you should aim to make yourself a true expert on the medications most commonly prescribed for your patient population. This will make you more familiar and more confident with common medications, and will more easily allow you to catch errors.
  • Learn the generic names and trade names of medications. It isn’t logical, but most medications have both generic names and trade names. Generic names are usually a shortened version of a chemical name, such as “Acetaminophen” (which is short for N-(4-hydroxyphenyl) acetamide. Trade names are the “brand names” for drugs created by pharmaceutical companies, such as “Tylenol.” Knowing both the generic and trade names of medications will help you to properly identify them and understand them when patients or physicians refer to them.
  • Don’t let patients administer their own medications at the bedside. Sometimes, patients will come to the hospital with their own “home medications.” Unless your organization specifically allows this, don’t let patients administer medications this way. Most organizations mandate that whatever medications a patient receives are prescribed by physicians at the hospital and dispensed by a nurse to ensure correct documentation, and for safety.
  • Don’t leave medications for patients to administer to themselves at the bedside. This is important because it’s easy to get busy during “med passes” and, especially for patients who take longer than usual to swallow, to leave medications for  Unless your organization specifically allows it, don’t do this. Just because you’ve left a medication for a patient to take, doesn’t mean that he or she will actually take it. Moreover, if the patient is an aspiration risk, he or she may be at risk for choking unless the medication is taken correctly.

Medication Administration Steps

  • Gather equipment. Check each medication order against the original physician’s order according to agency policy. Clarify any inconsistencies. Check the patient’s chart for allergies.
  • Perform hand hygiene. This is the most basic and important step in universal precautions, and is key to preventing nosocomial (i.e. hospital-acquired) infections.
  • Prepare medications for one patient at a time. Don’t rush this, or make the mistaking of mixing up medications between patients. It may sound basic, but this is one of the most common ways that medication errors occur.
  • Compare the label with the order. Make sure the medication label matches the order. Then, check it again just to be sure.
  • Don’t let people interrupt you when you’re pulling meds. You don’t need to be brusk, just politely say, “I can speak with you as soon as I’m finished.”
  • Check the expiration dates and perform calculations, if necessary. Your pharmacy should not be dispensing expired medications, but it’s good to check. You should also check this before performing calculations for concentrations, drip rates, etc. if indicated. Often, it’s helpful to have another RN independently double check your calculations.
  • If applicable, always check both medication amounts and rates on pumps. Just because you’re using a a pump, this doesn’t mean you get to “check out” your brain. It’s surprisingly easy to make errors this way. For example, a decimal place that is moved one place to the left or the right in the course of programming a pump could result in a 10-fold over- or under-dose medication error.
  • Transport medications to the patient’s bedside carefully, and keep the medications in sight at all times. Never allow another nurse to carry medications you have dispensed for you. When you remove a medication, it should be secure and within your site at all times.
  • Identify the patient using the patient’s identification band. Ask the patient to state his or her name and date of birth, and double check it with your order. Do not say, “you must be Mrs. Smith.” Let the patient tell you.
  • Complete necessary assessments before administering medications. Check the patient’s allergy bracelet or ask the patient about his or her allergies. Explain the purpose and action of the medication to the patient.
  • Perform hand hygiene and put on clean gloves. Unless you can empty pills directly into a cup, you should always have on gloves when administering medications.
  • Select an appropriate administration site. This depends on the route of the medication; for injected medications, see the sections below.
  • Assist the patient to the appropriate position for the site chosen. Patients taking oral medications should be seated in a high Fowler’s position. Drape as needed to expose only the area of the site to be used if administering an injection.
  • Let patients see the medications they’re getting, and briefly explain them. Even if patients routinely take a particular medication, it’s a good idea for them to know what they’re getting. You don’t need to go into great detail; but it’s useful to at least state the name of each medication and, in a phrase or two, what it’s for.

Rights of Medication Administration

The following seven “rights” are the key considerations every nurse must take into account when administering a medication to a patient. That is, every time a nurse administers a medication it should be:

  1. The right medication
  2. The right patient
  3. The right dosage
  4. The right route
  5. The right time.
  6. The right reason
  7. The right documentation

The Three Checks

A medication label or package should be checked three times during medication preparation and administration. The label should be read:

  1. When the RN checks the medication administration record (MAR) immediately before retrieving the medication
  2. When the RN selects the medication package or container from the medication drawer
  3. Immediately before the RN administers the medication to the patient, or immediately after drawing the medication up into a syringe or other delivery device prior to medication administration