Medication Administration: Beyond the 6 rights

Medication errors are a critical concern within the healthcare system, with potential consequences that can be life-altering. When examining medical records in the context of legal cases, legal nurse consultants and legal professionals often start by assessing adherence to the “6 Rights” of medication administration. These rights are the cornerstone of safe medication practices, but it’s essential to recognize that there is more to medication safety than meets the eye.

The 6 rights

The 6 Rights of medication administration include:

Right Patient: Ensuring the medication is intended for the correct individual.

Right Drug: Confirming the medication’s accuracy and appropriateness for the patient’s condition.

Right Dose: Administering the precise amount of medication as prescribed.

Right Route: Delivering the medication through the appropriate route (oral, intravenous, etc.).

Right Time: Administering the medication at the ordered time, considering the medication’s indication.

Right Documentation: Thoroughly recording all administration details for comprehensive patient records.

Examination of potential issues

These principles seem straightforward, but the intricacies of medication administration can leave room for error. To shed light on the complexities involved, consider the following points:

Scope of Practice: Some medications can only be administered in specific healthcare settings by registered nurses (RNs). For example, paralytic medications and other emergency medications require specialized training to administer due to the increased risk associated with them. Deviating from these guidelines may lead to adverse outcomes due to inappropriate monitoring and treatment of complications.

Pharmacy Oversight: Certain medications, such as heparin, require pharmacy oversight for dose adjustments, even in intensive care units (ICUs). Failure to adhere to these guidelines can have dire consequences.

Critical Care Medications: Most titratable medications, those adjusted based on a patient’s condition, are reserved for critical care areas like the emergency room (ER), ICU, operating room (OR), and labor and delivery (L&D).

Insulin Management: The administration of insulin drips necessitates dosage adjustments based on regularly monitored blood sugar levels. This process demands hourly blood sugar checks and adjustment of the insulin rate as often as every hour, requiring two nurses double-checking the dose during the programming of the pump.

Patient Assessment: Some medications have specific parameters based on the patient’s condition, which RNs must be familiar with to ensure safe administration.

Areas of Liability

In real-life healthcare scenarios and case reviews, the following issues have been observed:

Scope of Practice Violations: Medications administered by RNs via routes beyond their scope of practice can lead to catastrophic outcomes when complications arise, and appropriate monitoring and intervention are lacking.

Disregarding Pharmacy Parameters: Failure to follow pharmacy-set parameters for medication administration can result in administering medications when they are contraindicated, leading to rapid deterioration or even life-threatening situations.

Weight-Based Medication Errors: Weight-based medications require precise calculations and programming into infusion pumps based on the patient’s weight in kilograms. Errors in entering the weight can result in overdosing or underdosing, even if the actual medication dose is correct.

What’s striking is that many of these errors often go undocumented in medical records. The only way to identify these issues is for the reviewer to be acutely aware of the intricacies of medication administration. This is where a legal nurse consultant can play a pivotal role in your case.

In conclusion, while the 6 Rights of medication administration serve as a fundamental guide for healthcare professionals, it’s crucial to recognize the intricate details within this guideline. Medication errors can have far-reaching consequences. A thorough assessment of medical records with the expertise of a legal nurse consultant can make a significant difference in identifying and rectifying such errors, ultimately promoting patient safety and ensuring accountability within the healthcare system.

Valerie Creel

Valerie Creel

Valerie Creel is the owner of Bridge Point Legal Nurse Consulting. Valerie has been an RN since 2013 and has extensive experience with Critical Care, having been in ICU for the entirety of her Nursing career. Valerie has worked with Trauma, Neuro, and Medical ICU patients including providing care through the Covid-19 pandemic. In addition to her nursing experience, she worked providing prehospital care in the 911 system of San Mateo County from 2007-2014. She had the opportunity to work with complex trauma and multi-casualty incidents including the Asiana Airline Crash at SFO in 2013. Valerie holds her board certification in Critical Care and earned her Bachelors Degree from Grand Canyon University. She has been working in the legal nursing field since 2021 and has completed her coursework to specialize in Strangulation. She will also complete her Forensic Nurse Certification by the beginning of 2023. In her spare time, she loves spending time with her family and two young daughters and husband. She also enjoys being outdoors, fitness, and cooking.