MEDICATIONS ADMINISTRATION

RIGHTS, COMPUTATION, PREPERATION

10 RIGHTS OF MEDICATIONS ADMINISTRATION:

1. RIGHT PATIENT
 Make sure you are giving the right medication to the right person. If you are at home and giving
medication to a family member, make sure you check the bottle and giving the right prescription to the
right person.
 If you work in the medical field, always ask the patients name, check an ID band, and check the
medication bottles to compare before giving a medication.
2. RIGHT MEDICATION
 Check the name of the medication, brand names should be avoided.
 Check the expiry date.
 Check the prescription.
 Make sure medications, especially antibiotics, are reviewed regularly.
3. RIGHT DOSE
 Check the prescription.
 Confirm the appropriateness of the dose using the BNF or local guidelines.
 If necessary, calculate the dose and have another nurse calculate the dose as well.

4. RIGHT ROUTE
 Again, check the order and appropriateness of the route prescribed.
 Confirm that the patient can take or receive the medication by the order.

5. RIGHT TIME
 Check the frequency of the prescribed medication.
 Double-check that you are giving the prescribed at the correct time.
 Confirm when the last dose was given.

6. RIGHT PATIENT EDUCATION

 Check if the patient understands what the medication is for.
 Make them aware they should contact a healthcare professional if they experience side-effects or
reactions.

7. RIGHT DOCUMENTATION
 Ensure you have signed for the medication AFTER it has been administered.
 Ensure the medication is prescribed correctly with a start and end date if appropriate.

8. RIGHT TO REFUSE
 Ensure you have the patient consent to administer medications.
 Be aware that patients do have a right to refuse medication if they have the capacity to do so.

9. RIGHT ASSESSMENT
 Check your patient actually needs the medication.
 Check for contraindications.
 Baseline observations if required.

10. RIGHT EVALUATION

 Ensure the medication is working the way it should.
 Ensure medications are reviewed regularly.
 Ongoing observations if required.
DRUG DOSAGE CALCULATIONS:
Drug dosage calculations are required when the amount of medication ordered (or desired) is
different from what is available on hand for the nurse to administer.
FORMULA:

AMOUNT DESIRED_(D)_ X QUANTITY = Y (TABLETS REQUIRED)

AMOUNT ON HAND (H)

Note: When medication is given in tablets, the QUANTITY = 1 since the amount of medication
available is specified per (one) tablet.
Example 1: Toprol XL, 50 mg PO, is ordered. Toprol XL is available as 100 mg per tablets. How
many tablets would the nurse administer?
Step 1: Determine your givens. Amount desired (D) = 50 mg
Amount on hand (H) = 100 mg tablets
Quantity = 1
Step 2: Plug in what you know into the _50 mg_ x 1 = 0.5 mg tablet
formula and simplify. 100 mg

Therefore, the nurse would administer 0.5 of a tablet

Example 2: 1200 mg of Klor-Con is ordered. This medication is only available as 600 mg per
tablet. How many tablets should the nurse give?
Step 1: Determine your givens. Amount desired (D) = 1200 mg
Amount on hand (H) = 600 mg
Quantity = 1
Step 2: Plug in what you know into the 1200 mg x 1 = 2 tablets
formula and simplify. 600 mg

Therefore, the nurse should give 2 tablets.

The same formula can be used for dosage calculations where the medication is available as
amount per certain volume.
In these types of calculations, the volume available on hand is the QUANTITY.
Example 3: Dilantin-125 is available as 125 mg/5 mL. Dilantin-125, 0.3 g PO, is ordered. How
much should the nurse administer to the patient?
Step 1: Determine your givens. Amount desired (D) = 0.3 g
Amount on hand (H) = 125 mg
Quantity = 5 mL
Step 2: Convert 0.3 g to mg (since the ordered
dose is in grams but the drug is available on 0.3 g x 1,000 mg/g = 300 mg
hand in milligrams).
Step 3: Plug in what you know into the 300 mg x 5mL = 12 mL
formula and simplify. 125 mg

Therefore, the nurse would administer 12 mL.

Example 4: Furosemide is available as 40 mg in 1 mL. 10 mg is ordered to be administered
through an IV. What amount of furosemide should the nurse administer?
Step 1: Determine your givens. Amount desired (D) = 10 mg
Amount on hand (H) = 40 mg
Quantity = 1 mL
Step 2: Plug in what you know into the formula 10mg x 1mL = 0.4 mL
and simplify. 40mg

Therefore, the nurse should administer 0.4 mL of furosemide.

Dosage Calculations based on Body Weight.
Dosage calculations based on body weight are required when the dosage ordered and
administered is dependent on the weight of the patient. For example, many pediatric drugs
are ordered and given per weight (usually in kg). Dosage calculations based on body weight
are calculated in two main stages.
Stage 1: Using the formula below, calculate the total required dosage based on given the
body weight.

Weight (kg) x Dosage Ordered (per kg) = Y (Required Dosage)

Stage 2: Apply the D/H x Q formula to calculate the actual amount of medication to be
administered.
Example 1: Medrol 4 mg/kg is ordered for a child weighing 64.8 lb. Medrol is available as 500
mg/4mL. How many milliliters of medication must the nurse administer?
Step 1: Determine your givens Weight: 64.8 lb
Dosage ordered: 4mg/kg
Available on hand: 500 mg/4mL
Step 2: Convert 64.5 lb to kg since 64.8 lb ÷ 2.2 lb/kg = 29.45 kg
the infant’s weight is given in Therefore, the infant’s weight is 29.45 kg.
pounds (lb) but the dosage
ordered is in mg per kilogram
Step 3: Calculate the required Weight (kg) x Dosage Ordered (per kg) =
dosage (mg) of medication based Y (Required dosage)
on the child’s weight.
29.45 kg x 4 mg/kg = 117.8 mg

Step 4: Calculate the volume of Amount Desired x Quantity = Y

medication (mL) to be Amount on Hand
administered based on what’s 117.8 mg x 4ml = 0.942 ml
available on hand 500 mg

Therefore, the nurse must administer 0.942 mL of medication.

Example 2: A doctor prescribes 250 mg of Ceftin to be taken by a 20.5 lb infant every 8 hours.
The medication label indicates that 75-150 mg/kg per day is the desired dosage range. Is this
doctor's order within the desired range?
Step 1: Determine your givens. Weight: 20.5 lb
Dosage ordered: 250 mg
Desired dosage range: 75-150 mg/kg
Step 2: Convert 20.5 lb to kg 0.5 lb ÷ 2.2 lb+/kg = 9.32 kg
since the infant’s weight is given
in pounds (lb) but the medication
label is in mg per kilogram.
Step 3: Calculate the minimum Weight (kg) x Dosage Ordered (per kg) = Y
and maximum dosage for a 9.32 Minimum dosage: 9.32 kg x 75 mg/kg = 699 mg
kg infant. Maximum dosage: 9.32 kg x 150 mg/kg = 1398 mg
Step 4: Calculate the amount of 24 hr ÷ 8 hr = 3
medication the doctor has The doctor has ordered the medication to be given 3
ordered for one day or 24 hours.
Step 5: Compare the total
amount of medication ordered
for one day to the dosage range
listed on the medication label.
times per day.
Every dose is 250 mg.
250 mg x 3 = 750 mg
Therefore, the doctor has ordered 750 mg of medication
per day.
750 mg is within the desired range of 699-1398 mg since
699 < 750 < 1398
Therefore, the doctor has ordered a dosage within the
desired range.

PREPARATION:
STEPS ADDITIONAL INFORMATION
1. Check MAR against doctor’s orders. Check that MAR and doctor’s orders are
consistent.

Compare physician orders and MAR

Compare MAR with patient wristband.

Night staff usually complete and verify this check

as well.

2. Perform the TEN RIGHTS x 3 (this must be The right patient: check that you have the correct
done with each individual medication): patient using two patient identifiers (e.g., name
and date of birth).
 The right patient
 The right medication (drug)
 The right dose
 The right route
 The right time
 The right patient education Compare MAR with patient
 The right documentation wristband

The right medication (drug): check that you have

 The right to refuse the correct medication and that it is appropriate for
the patient in the current context.
 Right Assessment
The right dose: check that the dose makes sense for
 Right Evaluation the age, size, and condition of the patient. Different
dosages may be indicated for different conditions.

The right route: check that the route is appropriate

for the patient’s current condition.

The right time: adhere to the prescribed dose and

schedule.

Check the right patient,

medication, dose, route, time, reason,
documentation

The right reason: check that the patient is receiving

the medication for the appropriate reason.

The right documentation: always verify any

unclear or inaccurate documentation prior to
administering medications.

NEVER document that you have given a

medication until you have actually administered it.

3. The label on the medication must be checked

for name, dose, and route, and compared with
the MAR at three different times:

1. 1.When the medication is taken out of the drawer

2. 2. When the medication is being poured
3. 3. When the medication is being put away/or at Perform 10 checks three
bedside times before administering medication

These checks are done before administering the

medication to your patient.

If taking the drug to the bedside (e.g., eye

drops), do a third check at the bedside.
 4. Circle medication when poured Pour medication. Circle MAR to show that
medication has been poured.

Circle medication once it

has been poured
5. Positioning: This ensures patient safety and comfort.

 Position patient appropriately for medication

administration.
 Ensure proper body mechanics for health care
provider.
 Position patient safely and appropriately once
medication is administered.
Position patient
appropriately for medication administration

6. Post-medication safety check: This ensures patient safety.

 Complete post assessment and/or vital signs (if This step prevents the transfer of microorganisms.
applicable).
 Sign MAR; place in the appropriate chart.
 Perform hand hygiene.

Hand hygiene with soap

and water.

DRUGS COMMONLY USED IN NEWBORN:

 OPTHALMIC OINTMENT – APPLIED ON BOTH EYES

 HEPATITIS B VACCINE – 0.5 ML IM AT RIGHT VASTUS LATERALIS OR RIGHT LATERAL
THIGH MUSCLE.
 VITAMIN K 1 MG/0.1 ML IM AT LEFT VASTUS LATERALIS OR LEFT LATERAL THIGH
MUSCLE.
 AMPICILLIN 50MG/KG/DOSE FOR EVERY 12 HRS.
 CEFOTAXIME 50MG/KG/DOSE FOR EVERY 12 HRS.
DRUGS COMMONLY USED IN LABOR AND DELIVERY:
1. Oxytocin - is a uterine stimulant, prescribed for the initiation of uterine
contractions and induction of labor in women as well as stimulation of
contractions in cases where the uterus does not contract enough during labor.
Controls bleeding. AFTER DELIVERY.
2. Methergine – Injection is used for the prevention and control of post-delivery
bleeding. It may also be used for the active management of the third stage of
labor, to facilitate the delivery of the placenta. It is given intravenously (into a
vein) or intramuscularly (into the muscle) by a doctor or healthcare provider in a
hospital or clinic. “UTERINE ATONY”.
3. Buscopan (HNBB HYOSCINE-N-BUTYL BROMIDE) - an antispasmodic drug
that may be used to treat prolonged labor and used for pain relief.
4. Magnesium sulfate- is indicated for immediate control of life-threatening
convulsions in the treatment of severe toxemias (pre-eclampsia and eclampsia) of
pregnancy.
5. Cefuroxime – is a strong antibiotics to treat bacterial infections. It helps reduce
the growth of bacteria and does not work for viral infections.

THERE ARE SEVERAL WAYS IN GIVING MEDICATION:

1. Oral administration: This is the most common method and is the most convenient and
safest way to give medicine. Administration is in the form of tablet, capsule, emulsion,
mixture or as a gel.
2. Inhalation: For people who have difficulty with respiratory issues, they will often inhale
medication.
3. Instillation: Instillation is in the form of liquid and enters the body via the eyes, nose or
ears.
4. Injection: IM, SC, IV DRIP, IV PUSH, (SKIN TEST)
5. Transdermal Administration: given through a patch placed on the skin
6. Rectal Administration: inserted into the rectum ex. Rectal suppository
7. Vaginal Administration: inserted into the vagina ex. Vaginal suppository