Medication administration has three identified components. Each component must be carefully monitored to prevent errors. The first component is providing medications for another person according to the five rights. The five rights of medication administration will be addressed later in this unit. Providing medications safely is the primary role of the medication aide. The second component of medication administration is recording medication provision. Careful documentation of each dose of medication provided to a resident is crucial in maintaining safety and accuracy of medication provision. The final component of medication administration is observing, monitoring, reporting and taking appropriate actions regarding desired effects, side effects, interactions and contraindications associated with the medication. This component of medication administration cannot be carried out by a medication aide. The people who can carry out this function include the resident if he or she is cognitively capable, a caregiver who is actively and intimately involved in care of the resident, or a licensed health care professional who has medication administration in his or her scope of practice such as an RN or LPN.
The Five Rights
Five Rights of Medication Administration
- Right Drug
- Right Resident
- Right Amount
- Right Time
- Right Route
To be sure of giving the medication to the right resident, check the medication storage container with the medication record for the resident’s name. Then use the procedure recommended by the employer to identify the resident. This method may include asking the resident to say his or her name and date of birth, using a picture of the resident, or checking an identification bracelet. The employer may approve other identification methods. Do not depend on calling the resident by name for identification because some residents will respond to any name.
To be sure of providing the right drug, the right amount and the right route, read the medication label three times and compare it with the medication record. The label is read when the container is removed from its storage compartment, when the medication is set up, and again before the container is returned to its storage area. Each time it is read, the label is compared to the medication administration record. Not only is the name of the drug read each time but also the dose, route and time. Names of drugs and routes will be expanded on later in this manual.
In general, the right time for administering a routine drug can be anytime from one hour before the time on the medication record to one hour after the assigned time. The facility’s policy could be a shorter period of time, or the facility could have a different policy. The medication aide should follow the facility policy. Medications given on an as-needed basis, known as PRN medications, do not follow this rule. Another exception to this rule is medication that must be given before or after meals. These drugs should be given as close to the specified time as possible. Review the facility policy to identify the correct time of medication administration.
Medication Errors
A medication error is any preventable event that may cause inappropriate medication use or resident harm while the medication is in control of the health care provider, the resident or the person assisting the resident. An error occurs when a drug is provided to a resident that does not follow the:
- Physician’s order
- Manufacturer’s directions for use
- Accepted standards of medication provision
The physician’s order must be followed exactly. The order should be a clear direction on how to provide the medication to the resident. If there is a question about the order, it should be clarified with the physician. A medication error occurs if the medication is given without a physician’s order. An error also occurs if there is a deviation from the five rights such as a missed dose or an incorrect amount.
Each facility has a procedure to follow if a medication error is found. Each medication aide should know this procedure. The medication aide should know how the employer wants the incident reported and documented.
Abbreviations and Measures
In order to provide medications safely, the medication aide must understand how drugs are measured. There are four systems used to measure medications: metric, apothecary, household and Roman numeral.
Metric The metric system is based on units of 10. There are three basic units of measure. The meter measures length, the gram measures weight, and the liter measures volume of a liquid. Based on these units, prefixes are used to make the measures larger or smaller.
For all practical purposes a milliliter (ml) and a cubic centimeter (cc) are the same. For documentation purposes it is recommended that “ml” be used in place of “cc” as a safe practice. The abbreviation “cc” is often misread as “u” for units when partially written. Milliliter and cubic centimeter can be used interchangeably when giving medications. This means if a label reads 500 ml and the medication record says 500 cc, they are the same measure. One liter is the same as 1,000 ml or cc, and one gram is the same as 1,000 mg.
