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Understanding the basics of medication administration

Nurses reach out to me regularly with questions concerning medication administration and preparation.

One reader asked about a nurse’s responsibilities when drawing up an injectible medication but not administering it, and specifically wanted to know about the documentation duties affiliated with the draw-up.

Proper preparation and medication administration

One of the first general principles in medication administration that a nurse must adhere to is to personally prepare any medications properly ordered for a patient and to personally administer those medications.

Although there may be instances in which more than one healthcare provider may be required to administer a single medication, such as in a code, it is not generally acceptable practice to prepare any type of medication for another person to administer. Nor is it acceptable practice to administer a medication that another has prepared.

The reasons for this strict rule are numerous. First and foremost, because preparation and administration are fraught with potential for error, relying on another nurse to prepare a medication that you administer is dangerous at best.

Did your nurse colleague correctly pull the right medication? Did your nurse colleague calculate the correct amount of an injectible drug for the patient? Did the nurse check the order and determine the medication was ordered for this patient?

If there is a patient injury or death because of an incorrect drug or an incorrect amount given, both you and your colleague will be named in a suit filed by that patient or the patient’s family. During the judicial process, the two of you most likely will be at odds with each other, as your colleague will steadfastly state he or she prepared the drug as ordered while you try to convince the jury otherwise.

In addition, since you administered a medication you did not personally prepare, you will need to overcome the testimony of a nurse expert that a general, cardinal rule in administering medications is that one never administers a drug not personally prepared.

Responsible and truthful documentation

A second reason this rule is important is the fact that along with personally preparing and administering a medication, the nurse doing so is also responsible for the proper, accurate and truthful documentation of the medication administered. This responsibility speaks to a nurse’s accountability when preparing, administering and documenting medications given.

Moreover, if you prepare a medication for someone else to administer, but you document the medication as given, you have just falsified that entry in the patient’s medical record. In contrast, if the nurse who administered the medication that you prepared documents the medication as given, your nurse colleague also has falsified the entry, since he or she did not prepare the medication.

Falsification of any record is a serious allegation that can result in an employee being fired or reported to the state board of nursing. And if a patient injury or death occurs because of the medication administered and its surrounding false documentation, a verdict against those involved in the professional negligence or wrongful death suit is very likely.

Following the basic rule coupled with the “8 rights of medication administration” — right patient, right dose, right medication, right route, right time, right reason, right response and right documentation — can help you avoid medication administration errors.

By | 2020-04-21T09:16:25-04:00 December 16th, 2015|Categories: Nursing careers and jobs|9 Comments

About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.

9 Comments

  1. Avatar
    Randy January 27, 2017 at 12:45 am - Reply

    Hello,

    I need help in finding documentation to show my home care patient. He is a quadriplegic who receives 24 hour nursing care from RNs and LPNs. He recently had his mother buy him some over-the-counter Melatonin to take at HS. He wants us to give it to him but we have no doctor’s order. I tried to explain to him that if it is not on the POC we can’t give it…unless there is new written and signed order by the doctor. He is asking me to show him documentation regarding this law. I googled it but can’t seem to find the right document. Can you direct me to one?

    Thanks!
    Randy, RN

    • Sallie Jimenez
      Sallie Jimenez February 6, 2017 at 3:22 pm - Reply

      Hello Randy,

      The best source for the information you need would be the home care organization with which you work. If their policies are based on legislation, they would probably have that information on record.

      Thank you for your question.

  2. Avatar
    Katherine Garza December 12, 2017 at 8:40 am - Reply

    Salutations

    My home health care company requires me to sign the MAR of a patient I do not give medication to. I don’t like the possibility for fraud by someone entering my initials on the MAR. What can I do? My DON say’s it is company policy.

  3. Avatar
    Vickie Keys June 4, 2018 at 11:06 am - Reply

    I work in a VA facility. They are asking that I pull medication from a pixis machine that will record it under my name and day shift will administer the medication. They ask night shift to pull medication for day shift. The pills are in a prepackaged bag and are scanned before given but how do I know those but pills were actually given? They are pulled under my name.

  4. Avatar
    Stan Anderson November 21, 2018 at 1:52 pm - Reply

    Hello and thank you for what you do. I understand in homecare environments certified medication technicians are able to administer medications to patients. Is there a federal or like law which states it is required for a nurse to administer a medication in a hospital setting, or are there alternate options such as a medication technician, an LPN, or other?

  5. Avatar
    Alfred B. Saye May 3, 2019 at 8:27 am - Reply

    A nurse is working in a public health clinic. A 15-years old with no known allergies is diagnosed with syphilis and prescribed 1 dose of 2 million units of procaine penicillin G intramuscularly (IM).
    1. Developmentally, why is this drug a good choice for this patient?
    2. The patient asks why he cannot get medication in a pill. How should the nurse respond?
    3. Describe the technique the nurse should use to administer this IM injection, including precautions to prevent administration complications.
    4. The patient has denied an allergy to penicillin. why does the nurse need to be cautious about possible allergy?
    5. What action/policies should the clinic have in place to prevent death from an anaphylatic reaction?

  6. Avatar
    Kris May 10, 2019 at 6:59 pm - Reply

    As the only private duty nurse for a complex and fragile client, the mother refuses to document in the MARs and TARs….she feels as the mother. she shouldn’t have to. I have requested this twice, stating I need to see the documentation, and as much information as possible to provide safe and appropriate care.
    The mother is overwhelmed with the care hours, and resents having to provide care. yet she does an outstanding job.
    What are my options and responsibilities to the client?
    I have educated her and she remains resistive, yet she is paid as a personal support worker by the State. Does anyone have advice? Thank you.

  7. Avatar
    Abdikadir hassan abdi October 31, 2019 at 6:05 pm - Reply

    I need to learn general pharmacology.I’m Somali Bantu man who is living in Kenya I’m a refugee. in Kenya turkana west I’m 23 yes old I have completed primary up to glass 8 , I’m very interest to learn this pharmacology, in side my email,because in Kenya I’m not able to learn because money,because we are refugee,I would like to learn general pharmacology in side email if it’s free in America,for this general pharmacology

  8. Avatar
    Mrs. Williams May 9, 2020 at 5:47 pm - Reply

    my mother has dementia, is considered an incapacited individual. Her doctors have prescribed two pills a day, one to be given two times a day on Sunday only. She is staying with my sister and is being given eight different pills. We do not know what the other pills are. Her legal Guardian which is a company will not make any changes or take her for a second opinion. What are my legal rights and what can be done.

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