The Rights of Medication Administration

The core rights — right patient (two identifiers), right drug, right dose, right route, right time, plus right documentation, right reason, and right to refuse — must be verified before every administration, not just at the bedside once. Compare the MAR against the original order at least three times: when pulling from storage, before preparing, and immediately before giving. If any right cannot be confirmed, do not administer the medication until it's resolved. Barcode scanning supports but does not replace critical thinking verification.

Route-Specific Technique and Priorities

IM injections use the ventrogluteal site preferentially for adults due to fewer major nerves and vessels; Z-track technique prevents medication tracking into subcutaneous tissue and staining. Subcutaneous injections (like insulin and heparin) use a 90-degree angle in normal-weight patients and should not be massaged, especially heparin, to prevent hematoma. For IV push medications, always verify compatibility and correct push rate, since pushing too fast can cause cardiac arrest with drugs like potassium or digoxin. Enteral tube medications must be given one at a time with water flushes between to prevent clogging and interactions.

Error Prevention and Professional Responsibility

If a medication error occurs, the priority is always to assess the patient first, then notify the provider and complete an incident report — incident reports are not part of the medical record and should never be documented as having been filed within the chart. If an order seems unsafe, illegible, or clinically inappropriate, the nurse has a professional and legal obligation to clarify with the prescriber before administering; 'I was just following orders' is not a defense. Patients also have the right to refuse medication after being informed of the risks of refusal.