Medication errors are common but completely avoidable if you use the right tools and are sure to check your work thoroughly.¹ While there are different versions, you will find that most versions include 7 or 8 “Rights” of medication administration. They all include the same familiar five rights, with an added 2-3 more from medical experts.²

1)    Right Patient

Confirm you have the right patient and verify your patient against the order you have received. Always use two identifiers, such as name and date of birth, and ask the patient to identify themselves verbally.² Sometimes, patients will have a medical record number you can use, or you may scan their wristband, if applicable.²

2)    Right Medication

Check the medication label and compare it to the order.² Some brands sound alike, and some medications can have almost identical packaging. For example, Depo-Provera and Depo-Medrol sound similar but are used for very different reasons and could cause serious harm if mixed up.³ Also, double-check with a provider if an order is written and needs to be clarified. Finally, always confirm a medication order if you are unsure or it needs clarification; never guess.

3)    Right Dose

Verify the dose against the order.² If the dose seems unusual, you can confirm the appropriate dose with a coworker or drug reference. Still, you must always verify it with the provider before administration to stay within the scope of practice.⁴

4)    Right Route

Check the appropriateness of the route on the medication order.² For example, if the patient is an infant, and the order is for acetaminophen tablets, you would want to verify it with the provider as an infant cannot swallow pills.

5)    Right Time

Make sure you give the medication at the correct time according to the frequency at which the medication is ordered.² You also need to confirm that the last dose was given (and when), if there is one.²  

6)    Right Documentation

Always document administration after the medication is given.² Document the time, route, and any other necessary information. This could include the injection site, medication name, expiration date, and if there was any medication wasted. Also, include vaccine information statement (VIS) information for vaccines. 

7)    Right Reason

Confirm the diagnosis or reason for the medication.² Make sure to revisit this for long-term medication use. This is mostly for nurses but makes the difference between a good and a great Medical professional.

8)    Right Response

Did the medication have the desired effect, or is it having an unintended one?2 Again, this is mostly for nurses but can also be helpful for Medical professionals. Varifying the “desired effect” may be tricky. However, if, for example, you gave a patient an analgesic, did it lower their pain level? Or, is it having an unintended effect, i.e., is the patient exhibiting signs and symptoms of an allergic reaction?

You may be wondering, “how is this relevant to a Phlebotomist?” Let’s review a scenario that involves a Phlebotomist:

A 10-year-old patient named Lily is scheduled to have her blood drawn in the lab. She is scared and anxious due to her fear of needles and pain. To help ease her anxiety and reduce potential pain, the phlebotomist, Sarah, offers to apply a topical numbing cream before the blood draw with the provider's approval. Sarah meticulously follows the seven to eight rights of medication administration.

**Right Patient** Sarah greets Lily and confirms her identity by asking for her full name and date of birth. She verifies this information against Lily's medical record, ensuring the correct patient is being treated.

**Right Medication** Sarah collects the topical numbing cream and reads the label carefully. She checks it 3 times, making sure that it is the numbing cream intended for use before blood draws and that it is appropriate for pediatric patients, matching the order from Lily's provider.

**Right Dose** Sarah checks the recommended amount of the cream to use, referring to the manufacturer’s instructions and the provider's order. She notes that a small amount is sufficient for a topical application and prepares that exact amount.

**Right Route** Sarah confirms again that the cream is suitable for topical use. She explains to Lily that the cream will be applied to her skin where the blood draw will happen.

**Right Time** Sarah ensures she applies the numbing cream about 30 minutes before the scheduled blood draw to allow it enough time to take effect. She checks the clock to confirm that there is enough time for the cream to work before proceeding with the blood collection.

**Right Documentation** After applying the cream, Sarah documents the application in Lily’s medical record, noting the time it was administered, the specific cream used, and the area where it was applied. She also makes a note of Lily’s reaction to the cream.

**Right Reason** Sarah confirmed that due to the patient’s anxiety and fear (the reason or diagnosis), the provider ordered topical numbing cream to help alleviate some of the anxiety and pain that may come from having her blood drawn.

**Right Response** Once the cream has been applied, Sarah monitors Lily for a few minutes to ensure there are no adverse reactions, such as itching or redness. After the required time has elapsed, she checks with Lily to see if she feels numb in the area where the cream was applied, confirming that it has had the desired effect before proceeding with the blood draw.

By following these steps, Sarah prioritizes Lily's safety and comfort, demonstrating careful and thoughtful medication administration practices as a phlebotomist. It is important to employ your critical thinking skills when administering medication and to ask questions whenever necessary.⁵

Interested in learning more? PhlebCE.com covers this and other topics that are both engaging and medically relevant topics for practicing Phlebotomists needing to expand their knowledge for continued education certification renewal.     

References:

1.     Hanson, A. (2023, September 4). Nursing rights of medication administration. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK560654/
2. 8 Rights of medication administration. (n.d.). LNC. https://www.nursingcenter.com/ncblog/may-2011/8-rights-of-medication-administration
3. Authority, P. P. S. (n.d.). Medication errors linked to drug name confusion | Advisory. Pennsylvania Patient Safety Authority. https://patientsafety.pa.gov/ADVISORIES/Pages/200412_07.aspx
4. AAMA - State Scope of Practice Laws. (n.d.-b). https://www.aama-ntl.org/employers/state-scope-of-practice-laws
5. Bourbonnais, F. F., & Caswell, W. (2014). Teaching successful medication administration today: More than just knowing your ‘rights.’ Nurse Education in Practice, 14(4), 391–395. https://doi.org/10.1016/j.nepr.2014.03.003