How to ensure your staff are administering medication safely-r’s of medication

Care staff are often called upon to deliver medication in health and social care settings. In this case, paying attention to the 7 rights of medication becomes very important. This is also referred as the 7 r’s of medication administration.

Staff often face the challenge of administering medication accurately amidst busy schedules and competing demands from patients.

There are a number of key areas staff need to ensure they understand when administering medication, and it’s useful for them to have reminders of this alongside any training given, to keep refreshing best practice.

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Key Learnings: The seven rights of administering medicines are: Right patient, right medication, right dose, right route, right time, right documentation, right reason. They are very important for care workers, nurses, support workers and other health officials responsible for different types of administering medicines.

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Controlled and uncontrolled drugs

Misuse of drugs legislation explains in full extent how to use and handle controlled drugs. Meaning you can treat them differently from uncontrolled drugs. Examples of controlled drugs are morphine patches, and benzodiazepines e.g. diazepam.

Staff must be aware of the specific storage and administration requirements for controlled drugs, ensuring that they know how to handle and administer these medications properly.

Your organisation should have a medication policy, and there should be a specific section on controlled drugs:

• who will administer them,
• how they are administered,
• where they will be stored,
• how they will be disposed of and who has access to them.

Our Safer Management of Medicines course will talk you through everything you need to know about controlled drugs.

Different routes of medication

There are a number of ways medication can be given. Most patients take their medication orally, in tablet or liquid form.

These are not the only ways. There are ways.

Common routes of medication in health and social care include:

• Transdermal – Through a patch, for example a pain relief or a smoking cessation patch.
• Topical – Often used in social care – such as a cream applied to the skin
• Rectal – Medication inserted into the rectum through a suppository or enema.
• Otic – Administered by drops into the ear
• Ophthalmic – Placed in the eye through drops, a gel or an ointment

Social care settings, such as residential care and nursing homes, often use controlled drugs. Common examples include the following. There are a number of other routes of medication which we’ll cover on the course.

The seven Rs: What are the 7 r’s of medication administration?

This is a really good reminder for staff to get medication administration right.

The seven rights of administration of medicine are what health and social care staff should run through before administering any medication to a resident or service user.

Giving medication is an important part of safe patient care.

The ‘7 rights of medication administration’ were expanded from the original 5 rights to promote patient safety and support effective treatment.

1️⃣ Right patient:

Ensuring you have the right patient is the first and arguably most important step in medication administration.

Verify that the medication is intended for the correct patient by checking their identification and confirming their identity.

Administering medication to the wrong person accounted for 8% of medication administration errors in 2023. (Source: Patient Claim Line UK)

Best practices:

• Always use at least two patient identifiers (e.g., name and date of birth)
• Ask the patient to state their name, rather than confirming a name you provide
• Check the patient’s ID band
• When possible, use barcode scanning technology

What can go wrong? Administering medication to the wrong patient can lead to adverse reactions, missed doses for the intended patient, and potential harm to both patients involved.

2️⃣ Right Medication

Administering the correct medication is essential for effective treatment and patient safety.

Mistakes from giving the wrong medication made up 18%, showing the importance of careful checks and educating staff to avoid these errors.

Best practices:

• Check the medication label three times: when taking the medication from storage, before preparing it, and before administering it
• Verify the medication against the prescription or medication administration record
• Be familiar with both brand and generic names of medications
• If in doubt, double-check with a colleague or pharmacist

What can go wrong: Giving the wrong medication can lead to adverse reactions, treatment failure, and potentially life-threatening situations.

3️⃣ Right Dose

Ensuring the correct dose is crucial for medication efficacy and patient safety.

In 2023, 23% of medication errors were due to wrong doses. Anyone is charge of giving medication should follow the standard process to reduce errors.

Best practices:

• Double-check all calculations
• Use the correct measuring tools
• Be aware of ‘high-alert’ medications that require extra caution
• Understand common dosage ranges for medications you frequently administer

What can go wrong: Incorrect dosing can lead to treatment failure if too low, or toxicity and adverse effects if too high.

4️⃣ Right Time

Administering medication at the correct time ensures consistent therapeutic levels and optimal treatment efficacy.

Best practices:

• Adhere to prescribed administration times
• Understand the importance of timing for specific medications (e.g., before or after meals)
• Be aware of the facility’s policies on acceptable time ranges for medication administration
• Do a proper hand-over note with specific details

What can go wrong: Incorrect timing can lead to subtherapeutic or toxic drug levels, drug interactions, and reduced treatment efficacy.

According to a report in 2023, 14% of medication errors happened because drugs were given too early or too late. Poor communication and lack of training were major causes of these timing mistakes.

5️⃣ Right Route

Using the correct route of administration is necessary for medication efficacy and patient safety.

Best practices:

• Verify the prescribed route against the medication order
• Ensure you’re competent in administering medication via the prescribed route
• Be aware of medications that can be administered via multiple routes and the implications of each

What can go wrong: Administering medication via the wrong route can lead to reduced efficacy, adverse reactions, and in some cases, severe harm or death.

6️⃣ Right Documentation

Right documentation is vital for continuity of care and legal protection. Accurate records help healthcare providers share information, improve communication, and ensure compliance with legal and regulatory standards.

Best practices:

• Document administration immediately after giving the medication
• Include all necessary details: medication name, dose, route, time, and any relevant patient responses
• Follow your facility’s policies on documentation
• Never document administration before actually giving the medication

What can go wrong: Poor documentation can lead to missed doses, double dosing, and legal issues in case of adverse events.

7️⃣ Right Reasons

Understanding and verifying the reason for each medication is an important safeguard against errors. You should ensure the medication is given for the right reason or condition.

Key practices:

• Know the common indications for medications you frequently administer
• Verify that the medication ordered aligns with the patient’s diagnosis and treatment plan
• If the reason isn’t clear, consult with the prescriber or pharmacist

What can go wrong: Administering medication without a valid reason can expose patients to unnecessary risks and side effects.

Some organisations are expanding these to include additional rights, such as the right response, the right education, and the right to refuse. Safe and accurate medication delivery is vital for protecting patients and achieving successful outcomes.

The seven R’s of administering medication serve as a robust framework that emphasizes patient safety, accurate care delivery, and effective communication in healthcare settings.

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Interested in Medication Administration? Get in touch with our course advisors at 01782 563333 or email us at enquiries@caringforcare.co.uk for course information and expert guidance on your healthcare journey.

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Infographics: 7 R‘s of administering medicines

Why is the 7 rights of medication administration important?

The right of medication administration is of utmost importance as it forms the foundation for safe and effective healthcare practices.

Ensuring the right of medication administration involves adhering to essential principles before giving any medication to a patient.

The importance of the right of medication administration lies in several key aspects:

1. Patient Safety: Adhering to the five r’s significantly reduces the risk of medication errors, prioritizing patient safety above all else.
2. Effective Treatment: Administering the right medication (also right type of medication) in the correct dose and route at the proper time enhances treatment efficacy, leading to improved health outcomes.
3. Avoiding Adverse Reactions: The right of medication administration helps prevent adverse drug reactions that could arise from using the wrong drug or incorrect dose.
4. Building Trust: Demonstrating a systematic and careful approach to medication administration builds trust with patients, promoting treatment adherence.
5. Legal and Ethical Obligations: Following the five Rights aligns with legal and ethical responsibilities, ensuring compliance with professional standards of care.
6. Reducing Healthcare Costs: Avoiding medication errors through the right of medication administration can save healthcare systems from the financial burdens associated with managing adverse events.
7. Professional Development: Emphasizing the importance of the right of medication administration encourages continuous education and professional growth, fostering competence and accountability.

Checking the MAR Chart and Medical Labels

Essentially a staff member is checking that they have the right drug and dose based on a person’s records. They also need to check that the person in front of them is also the person the medication is for.

A good way of doing this is to have a recent photograph with the medication administration record (MAR) chart. Then, check this against the person in front of them.

The person administering also needs to check the medication label and MAR chart to make sure they are giving the medication at the right time of day.

Administering some medication requires strict timing, such as every four hours, thus it is crucial to check the timings before administering.

The right route is checking that the resident should be receiving the medication orally or topically, and making sure that is what they are administering.

The label from the GP, which staff should have printed or copied onto the MAR chart, should have this information.

The staff member needs to make sure they also have the right MAR charts for the person they are giving medication to.

So checking name and DOB for example against a care file. Staff members should check the chart in front of them before administering, as staff sometimes make up charts in advance.

Finally, the resident has a right to refuse to take their medication.

Sometimes we give medication covertly, but only in exceptional circumstances with prior involvement from a GP and after associated capacity processes and best interest decisions have occurred.

Otherwise, if a person refuses medication, we should document the refusal and seek medical or management advice.

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Recent development on medication: 8r’s of medication:

The eight R’s of medication is the “right to refuse”.

It refers to the patient’s right to decline or refuse medication or treatment. Even if a healthcare professional has prescribed it.

As healthcare providers, it is important to respect the patient’s choices and freedom.

It is important to provide them with information about the risks and benefits of the medication or treatment. Including any alternative options that may be available.

The healthcare provider should closely monitor patients who refuse medication or treatment and consider alternative interventions if appropriate.

We should discuss the 5 Rs of medication administration or the 7 Rs of medication administration, but the right documentation is just one more addition to the rights of medication administration.

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How the Medication R’s Expanded to 10 R’s of Medication.

The origins and use of the 10 Rights of Medication Administration are not entirely clear from research. However, here is a summary of the history of these rights.

• The core concept of “rights” in medication administration has existed for decades, though earlier versions had fewer elements.
• By the 1960s, nursing practice had agreed on the five rights (right patient, drug, dose, route, time) and widely used them in nursing education.
• By the 1980s, sources referenced additional rights, like right documentation and reason, bringing the list to 7 Rights.
• During the 1990s, the full 10 Rights expanded to also include right action/method, response, refusal, and education.
• The 10 rules for giving medicine were widely followed in nursing and medication safety practices by the 2000s. Some sources cite the Joint Commission incorporating them into standards by 2006.
• While expanded over the years, the 5 original Rights have remained foundational.

So in summary, while an exact origin is unclear, the core five rights existed for decades before gradually expanding to the comprehensive 10 Rights framework we know today, with key developments occurring in the 1980s and broader adoption during the 1990s and 2000s.

So what are the 10 rights of medications?

Healthcare workers follow the 10 r’s for giving medicine to make sure they give the right medicine to the right person at the right time.

These rules protect patients, respect their rights, and make sure the medicines are right for their needs.

Knowing and following these rights of medication is important for providing good healthcare.

1. Right Patient – Confirm patient identity matches the name on the medication label using two labels (e.g. name, DOB, medical record number). Prevents potential adverse events from giving medications to the wrong patients.
2. Right Drug – Check medication name, strength, and formulation on label with the medication administration record (MAR) to ensure the exact prescribed drug is administered. Prevents medication errors.
3. Right Dose – Verify prescribed dose on MAR matches dose prepared for administration to prevent over or under dosing errors. Right formulation is also key.
4. Right Route – Check appropriate route (IV, oral, topical etc) is used for administering medication. Following correct route is vital for calming effect and safety.
5. Right Time – Give medications at prescribed times or within defined time windows (e.g. within 30 minutes before or after scheduled time) to maintain therapeutic levels.
6. Right Documentation – Charting details like medication name, dose, route, time in patient record provides legal proof of treatment delivery while tracking response.
7. Right Action – Perform all preparation, double-check, administration, and monitoring steps correctly according to clinical standards and hospital policy.
8. Right Reason – Verify medication indication or diagnosis to ensure proper therapeutic usage vs unapproved usage without clinical indications.
9. Right Response – Assess for expected therapeutic effects as well as adverse events or reactions after administration to determine medication is tolerated and working.
10. Right Education – Provide required instructions about medication use, precautions, side effects, storage etc. to the patient for safe and appropriate usage.

Documenting medication administration correctly

We’ve talked about the importance of documenting administration correctly. This is for a number of reasons.

The health and care regulator, the Care Quality Commission (CQC) will check the documentation on inspection, and this could affect the rating that your organisation receives.

In controlled drug use, incorrect documentation can also lead to breaking the law.

On a more day-to-day level, a robust documentation system will benefit both staff and residents as shifts change and different people receive training to administer medication.

Lots of pharmacies offer a computerized MAR chart administration system; otherwise, clear recording in black pen, using an agreed coding system, is key.

You will then be able to demonstrate to the relevant authorities such as your local commissioners and to CQC that you understand medication administration and you are getting it right.

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Medication errors

People do make mistakes, and sometimes a medication error may happen. It’s important that your staff feel able to admit when they’ve made a mistake.

Your policy should cover what happens in the event of an error. The staff should contact either the person’s GP or NHS 111. This is to ensure there will not be an issue if a dose is missed or given incorrectly.

The person responsible should record this advice in the person’s notes.

In instances of incorrectly completed documentation, re-training is often crucial. It ensures that your staff not only gets it right in the future but also comprehends the importance of accurate documentation.

What Next? Accessing the right training for safe medication

Training is important in the safe administration of medication.

Well-trained workers know how important it is to give the right medication. They will write down everything correctly and help each other take time to give the medication safely.

Our Safe Administration of Medicines course can be taught as an open course, or brought to your care setting. 

In addition if your clients use peg feeding, we would recommend them partaking in that course. We will discuss and practice the specifics around enteral tube feeding.

Taught by registered nurses, staff will learn about their

1. responsibilities,
2. about medication errors,
3. infection control and risk assessment,
4. how to administer medication, and
5. ensure correct documentation and disposal of medication.

For more information, or to arrange a course for your staff, contact us on 01782 563333 or email office@caringforcare.co.uk.

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