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.

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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.