Giving medication safely

The rights, and the three checks

Right client, right drug, right dose, right route, right time, and right documentation — plus the client's right to refuse, and the right reason for giving it at all.

The label is read three times: taking it from storage, preparing it, and returning or discarding the container. Three readings catch what one does not, and the error found at the third reading is one that had already survived two.

Assessments that come before the dose

• Digoxin: apical pulse for a full minute, and the most recent potassium. Withhold and report below 60 in an adult.
• Beta blockers: heart rate and blood pressure.
• Antihypertensives: blood pressure, and whether the client has just stood up.
• Opioids: respiratory rate and sedation level; sedation deepens before the saturation falls.
• Anticoagulants: the relevant clotting result, and any sign of bleeding.
• Insulin: the current glucose, and whether the client is about to eat.
• Aminoglycosides and vancomycin: renal function and the trough level.

Working out a dose

Every dose calculation is the same shape: the dose wanted, over the dose held, multiplied by the volume it is held in.

1. Put both figures into the same unit before dividing anything. Grams to milligrams, milligrams to micrograms.
2. Divide what you want by what you have.
3. Multiply by the volume that holds it.
4. Ask whether the answer is a volume a syringe can measure. An impossible answer means a conversion was missed, not that it should be rounded.

For an infusion by pump, the rate in milliliters an hour is the volume divided by the hours. For a drip counted by drops, it is the total drops — volume times the drop factor — divided by the total minutes.