This article has been written by Hemant Bohra, a law student at Lovely Professional University, Punjab. This article discusses in detail the different rights of medication administration that a medical professional should consider and their importance in reducing medication administration errors. It also provides other solutions to lessen the chances of errors during the medication process.
It has been published by Rachit Garg.
When someone is admitted to the hospital, they have the right to be treated for their medical problem and to get high-quality nursing care. In the same way, nurses also have various rights in their medical practice to make their work more convenient and avoid suffering risks. The complicated procedure of medication administration is often guided by a standard set of tests/rights that are used in nursing schools and hospitals to help students and faculty. The nurse is expected to implement those rights since there are legal obligations for the activities that are in compliance with the Standard Operational Procedure (SOP) and only then would the nurse be able to minimize errors in delivering medication.
However, all registered nurses are academically qualified, ethically accountable, and held professionally responsible for carrying out their tasks in a safe manner. Therefore, nurses have the ability to administer, identify, and report medication mistakes if there are any. But before we know about the rights of medication administration, let’s first discuss what exactly a medical administration is.
Medication administration may be defined as the process of overseeing and managing each and every element of the administrative side of providing healthcare services. In order to guarantee the success of the healthcare provider or system, medication administration is required to perform all the non-clinical functions involved in running a healthcare institution, from daily operations like personnel to budgeting and finance. Healthcare delivery must be planned, supervised, and coordinated by medical administrators.
Medication administration may include the control and management of:
- Hospitals, medical clinics, medical stores, healthcare agencies, medical camps, etc.
- Particular divisions or sections, such as cardiac care units, critical care units, and emergency rooms.
- Particular sectors, including personnel, facilities management, admissions, and financing.
The healthcare system is one of the most complicated and dynamic industries as a whole, so it requires highly qualified management personnel to keep things operating smoothly. It includes medical billers, transcriptionists, nurses, hospital executives, assistants, HR, etc. Depending on the tasks or responsibilities assigned to them, medical administrators may also be referred to as hospital administrators or health care managers.
Responsibilities of a nurse as a medication administrator
As medication administrators, the nurses must verify the medication order before administering it, and they must also use their critical thinking skills to consider the ordered medication in light of the client’s status and condition, as well as any relevant lab results, vital signs, or other relevant information. They must also consider the client’s allergies and any potential drug interactions.
Because giving the patient the wrong drug can be fatal, the nursing duties associated with dispensing medications are quite extensive. To prevent medication mistakes, numerous checks and balances are in place. A nurse is required to be educated about adverse effects and drug interactions, validate the prescription and the patient, deliver medications as directed, obtain clarification when necessary, and record medication delivery in medication records.
According to the research conducted by the faculty of Tehran University of Medical Sciences, Tehran, nurses play a critical role in assuring the safety of the drug delivery process and are accountable for 64.55% of medication mistakes in hospitalized patients. Before a drug is provided, the nurse is the final person to verify that it was prescribed and dispensed accurately. The administration of medications is likely the riskiest duty a nurse may conduct, hence several regulations and standards have been developed to assist reduce the likelihood of medication mistakes.
Rights of medication administration
As administering medications involves the life of a human body, it is seen to be the duty with the highest level of risk that a medical administrator can undertake. As a result, several regulations have been established to protect human life from unseen danger and to minimize potential risks. That is where the rights of medication administration come into the picture.
Originally, there were five rights of medication administration, which includes:
The first step in administering medication is to make sure that the patient is the appropriate one. When a patient receives medication meant for someone else, it frequently results in medication mistakes. It is practically hard to recall the names and faces of every patient. The nurse must examine the patient’s medicine administration record, including identification accepted at the institution and identification band, in order to correctly identify a patient.
However, not all patients, particularly those in nursing homes or with mental illnesses, wear identifying bands. Extra caution may be required in these circumstances since some patients may be disoriented or unable to self-identify. Prior to giving medication, it is crucial to constantly abide by the facility’s identification policy.
Research has shown that the most common medication error involves giving and prescribing the wrong medicine to the patient. It is the utmost responsibility of medical professionals to make sure that the medicine name specified matches the medication being delivered. Due to prefixes, suffixes, or names beginning with the same initial letter, certain brand names or generic names may have extremely similar spellings or sounds. Given that the two pharmaceuticals at issue might have radically different modes of action or reasons for prescription, it is crucial to distinguish between medications with similar names.
Patients purchase the wrong medications as a result of poor handwriting and sometimes abbreviations in prescriptions, which ultimately results in causing severe injury to them. To confirm the prescription, the physician should be called if their handwriting is illegible. Utilizing Computerized Prescriber Order Entry (CPOE), which has been shown to lower prescription mistakes, is one way to address this problem.
In the case of Krushna Pad Mandal v. State of Odisha (2020), in order to get his ill wife treated, Krushna Mandal, the accused in the Narcotic Drugs and Psychotropic Substances (NDPS) Act, 1985 case, requested an interim bail. However, the Court discovered that a doctor’s prescription was written in illegible handwriting while reviewing accused’s wife’s medical records. The Court while granting bail to the accused observed that in order to prevent drug errors, doctors must make a conscious effort to write prescriptions legibly, preferably in capital letters. In addition, the Court pointed out that unclear handwriting on prescriptions confuses not only harms patients but also pharmacists, prosecutors, and judges who might have to read such documents during a hearing.
In a similar case, in February 1997, a 4-year-old boy named Harry Donnelly of Somers passed away following routine, low-risk outpatient operation to remove his adenoids and insert small tubes to drain fluid from his ear holes at Hudson Valley Hospital Center in Peekskill. After investigation, it was found that the cause of the death was an adverse reaction to the use of the false or non-prescription anesthetic phenylephrine by the medical professional.
Nurses’ daily responsibilities include calculating and verifying medicine dosages, verifying the frequency recommended and accurately filling out the medication chart. To prevent giving patients the incorrect dose, nurses should check the label on the dose, challenge prescriptions for medications and doses that are illegible or seem risky, or employ bar-code technology if it is functioning. Medical organizations (hospitals, clinics) believe that these procedure guidelines are sufficient to confirm the appropriate dosage. Usually, nurses do not actually prescribe the dose; they just provide it as directed by the medical authority.
Additionally, mistakes might happen if the prescriber employs inaccurate or deceptive units. Misuse of decimal points and acronyms might result in incorrect prescriptions. Similar to this, the right units of measurement must be used when the nurse determines the amount of medication to dispense.
In the case of M/S. Spring Meadows Hospital & Anr v. Harjol Ahluwalia (1998), a child with typhoid was admitted as a patient in the hospital of the accused. The child passed out soon after receiving the injection from the nurse and later died. Before the National Commission, the minor child’s parents filed a complaint. The panel came to the conclusion that the child’s brain had been harmed by a significant delay in steps to revive the heart and that the infant had cardiac arrest as a result of intravenous administration of an excessive quantity of the injection.
The biggest difficulty and top concern for a doctor is timely medication administration. In order to sustain a beneficial effect, various medications frequently have predetermined intervals or window periods during which another dose should be administered. This right time is based on the guiding premise that drugs should be prescribed as nearly as feasible to the time, and that nurses should not stray from this time by more than 30 minutes to prevent negative effects like changing bioavailability or other chemical processes.
Preparing the drug at the proper moment is another aspect of administering medication when it is needed. Unless the manufacturer specifically advises it, medications shouldn’t be prepared more than a few hours (or even an hour) before administration. How soon after the scheduled time a drug should be provided may be a question for medical students. The basic idea is that drugs should be taken as close as possible to the time that has been recommended.
Choosing the proper route of administration has grown increasingly difficult. Because each route has related technology or equipment that must be mastered, nurses today need to be far more informed than they were in the past. There are various ways to provide medicine to patients, and each has a different impact on how quickly the chemical is absorbed, how quickly the medication takes action, and if there are any potential adverse effects. Oral, through the eyes, intravenously, topical, or subcutaneous injections are a few popular methods.
The nurse has to be aware of how various routes differ from one another, such as in terms of rate of absorption or time before effect. However, the notes surrounding the way that medications should be administered are important to keep communication clear as nurse shifts change or others administer medication.
There is scarcely any evidence of a reduction in errors that can be seen even after implementing these five conventional rights in medical practice. The rights of medication administration needed to be improved as the work becomes more complicated due to the multiplication of diseases and becomes more dangerous, which is why certain new rights have been implemented in the medical industry to encourage administrators to exercise greater caution in their job.
Other rights of medication administration
Right to refuse
Both the nurse and the patient may be offered the option to decline treatment when necessary under various conditions. The patient may find it difficult to take the medication or they may not understand the necessity for it, which leads to refusal. In a similar manner, the nurses have the right to decline to deliver a prescribed medicine if they have any questions about the validity of the prescription or believe it to have been written erroneously.
The right to refuse is also mentioned under Article 21 of the Constitution of India, in which the patient has a legal right to refuse treatment except in an emergency situation. However, if a patient persists in refusing the prescription, it is the obligation of the medication administrator to note this in the patient’s file and let the healthcare practitioner know.
In the case of A.S.Mittal v. State of U.P. (1989), the Court observed that when a patient consults a doctor, the doctor has certain obligations to the patient. These obligations include a duty of care in determining whether to take on the case and what treatment to administer. Any of the aforementioned obligations that have been violated may give rise to a claim of negligence, and the patient may then sue his doctor for damages.
Right to documentation
The individual dispensing the drug is accountable for accurately documenting that delivery. The nurse should sign the patient’s medical chart and indicate any medicine administrations in the patient’s medical file. This shows that the patient has received the drug, according to the proof. The patient may refuse their medicine or, in certain situations, forget to take it. Thus, signing the medication record before the drug has been given carries a risk.
Similar to not signing when a drug has been provided, doing so increases the possibility that another nurse may repeat the dose. The medication’s generic name, dosage, timing, route, reason for administration, and result should all be documented. Communication between medical providers may break down in the absence of sufficient documentation.
Right to information/ knowledge
All facets of the drugs that they are taking (patients) or giving (medical administrator) should be explained to patients and nurses, depending on each individual’s responsibilities. Information regarding the purpose of the medicine, any potential side effects, and the proper disposal of unwanted and expired medications should be provided frequently to nurses. The proper and safe way for the patient to self-administer drugs should be explained to them.
Some nurses may also need to get additional instructions on how to administer tube feedings, prepare insulin, give themselves an intramuscular injection, use an inhaler properly, or take insulin. In a similar way, nurses have a responsibility to ask pharmacists about the medications they are to provide to their patients. Apart from that, nurses should be taught how to prepare and store medications in accordance with local regulations and educated on proper monitoring prior to medication administration.
In the case of Poonam Verma v. Ashwin Patel and Ors. (1996), while distinguishing between negligence, carelessness, and recklessness, the Supreme Court held that anybody who practices medicine while being ignorant of a specific medical system would be considered to have committed medical negligence.
Right to policies and action
The framework required for nurses to safely dispense medicine must be provided by the health care administration. The Board of Regulation in Nursing regulates nursing practice, but nursing rules within a healthcare organization are what direct nursing practice. In many cases, policies shield the nurse from legal action if something goes wrong. In contrast, failing to adhere to the policy or administering medication without one puts the nurse in danger of legal action as well as the suspension or loss of their license.
A nurse giving medication must make sure it is administered for the right result. It might be dangerous to provide a stimulant to a patient who already seems to be asleep. When a nurse is giving a patient medication, they should explain to them what the medicine does and why it was ordered.
In the case of Sishir Rajan Saha v. The State of Tripura and Ors. (2002), the Court held that If a doctor or specialist neglects to treat a patient who has been hospitalized in an emergency situation or who is under his care and the patient dies or suffers effects that could have been prevented with the doctor’s proper care, the doctor may be held accountable for medical malpractice.
Right to response
The nurse should keep an eye on the patient to make sure it is having the appropriate impact after giving the medicine to the patient. This right to medication delivery entails a determination of whether the medicine is working as intended, which is critical for several high-risk treatments, including insulin, blood thinners, etc. Providing medication monitoring to determine the medication’s ongoing effects is another aspect of the appropriate approach.
The medical administrator benefits as well from keeping track of which medications are effective and which are not. It is important for nurses to remember that their role and duty in ensuring drug safety does not end once the proper medication has been given.
In the case of Bombay Hospital & Medical Research Centre v. Asha Jaiswal & Ors., (2010), the patient was not examined or assessed by any doctor in the hospital and because of this the patient’s pulse dropped. Furthermore, it was claimed that despite his serious state, the patient was compelled to wait in line for the Digital Subtraction Angiography (DSA) machine for many hours before finding out that it was broken and having to wait again for several hours before an angiography could be done. Then, the legal heirs of the deceased filed a complaint with the Commission, accusing the institution.
Significance of rights of medication administration
Medical administrators frequently feel as though there is not enough time due to the number and complexity of patients in today’s healthcare system. Nurses can use a variety of tactics to lessen the likelihood of adverse medication events. Going back to the fundamentals of giving patients their medication rights involves the core premise. High-risk or high-alert drugs, as determined by the Institute for Safe Medication Practices (ISMP), require more time. In fact, many hospitals demand that high alert medicines be double-checked before being administered by a second nurse. The safety and wellness of those you serve to depend on your understanding of medication administration rights and how to use them.
The easiest approach for a medication administrator to avoid medication errors is to always follow the rules while helping someone administer their medications. The rights of medicine administration exist to safeguard the patient and the nurse giving it as well as to lessen the harm brought on by medication errors. In order to guarantee a firm base of knowledge throughout their careers, nurses should continue learning about various drugs and their rights and policies because drug responses vary from person to person. Therefore, poor medicine delivery might result in dangerous mistakes and reduce the effectiveness of the senior patient’s treatment.
To further grasp the idea and use of medical administration rights, let’s now discuss potential errors in medication administration.
Errors in medication administration
Medication administration errors continue to be common despite huge efforts to reduce them by deploying new technology and simplifying procedures. This is a truth that errors cannot be avoided because nurses, patients, and medical professionals are all human beings that are prone to errors. Because of their interdisciplinary character, they are obligated to uphold their specific duties to guarantee the security of medication administration and respect the aforementioned rights.
Medication errors would be any avoidable incident that may result in or contribute to improper medicine usage or patient damage when the medication is within the control of the medication administrators or even the patient. Most common medication errors include wrong prescriptions and screening errors such as forgetting to record an allergy or failing to consider the possibility of a medication interaction. Medication errors also include errors in compliance, such as failing to adhere to protocol or regulations set forth for the distribution of medicines.
Cases of negligence in medication administration
Dr. T.T. Thomas v. Smt. Elisa And Ors. (1986)
In the above case, the husband of the plaintiff was hospitalized after experiencing extreme stomach discomfort. It was determined that the patient had acute appendicitis, which required rapid surgery to preserve his or her life. However, the surgeon backed out of the emergency procedure, and the patient passed away. According to the Kerala High Court, the defendant was responsible for the patient’s death since the doctor failed to execute the procedure in an emergency.
Juggankhan v. State Of Madhya Pradesh (1964)
In the recent case, the defendant, a licensed homeopath, gave the guinea worm patient 24 drops of stramonium and a leaf of dhatura. The accused did so and was held accountable even though he was unaware of the consequences of administering such a chemical. In this case, the Supreme court observed that if a doctor administers a medication that is known to or used in a specific branch of the medical profession, he implicitly proclaims that he has an understanding of that area of science, and if he does not actually possess that understanding, he is acting rashly or negligently.
Pooja Sharma & Ors. v. Maharaja Agrasen Hospital & Ors.
In the aforementioned case, a newborn became completely blind as a result of Retinopathy of Prematurity (ROP), a medical condition connected to premature birth, going untreated until it reached the irreversible Stage 5 stage. Because the parents of the baby were not informed or given instructions on the possibility of ROP in a premature newborn, the hospital and its workers were held accountable for medical negligence. The hospital and the ophthalmologist did not evaluate the infant as per the standard procedure.
Solutions to reduce medication administration errors
Simply adopting the rights of medication administration will not significantly minimize or eliminate medication errors. Therefore, the healthcare administration needs to apply other possible and effective methods to reduce the chances of errors. Some of them are as follows:
Use of barcodes
In a system with extensive barcoding technology, a research conducted by the faculty of the School of medicine, Johns Hopkins University on medication errors indicated a 41% reduction in errors and a 51% decrease in possible adverse drug events. So, by marking patients, drugs, and medical data with barcodes, it is possible to electronically link the correct dose of the right medication to the right patient at the right time, which helps eliminate errors in the healthcare system.
Proper storage of medicine
To retain effectiveness, medicines that need to be kept refrigerated must be kept refrigerated, and vice versa for prescriptions that need to be stored at room temperature. The majority of biologicals need to be refrigerated, and if a multidose vial is used, it has to be labeled so that its expiration date from the time it was opened is not exceeded.
Double checking process
Double checking is a process that calls for two authorized medical practitioners to examine the drug before giving it to the patient. Based on the subjective hypothesis that other people’s compensating behaviour might minimize human errors, it is an effective function. Double checking is a preventative measure that can identify issues before they endanger the patient and, as a result, frequently stops the reporting of errors in medication administration.
Communication and counselling
Interacting with the patient and confirming their understanding of the dose, drug allergies, and discussing any additional drugs they may be taking can help prevent medication errors. At a certain point, counselling a patient helps to decrease errors because if the patient begins to feel better, he or she may believe that the medication is no longer necessary, or if they start to feel worse, they could stop their therapy to prevent adverse effects. So, it is important to guide the patient throughout the medication process.
As we all know, administering medication is considered to be one of the most complex professions which requires due attention at every stage of it, and thus nurses are provided with various rights to reduce that complexity and make the medication process safe and secure. To assist nurses in avoiding prescription mistakes that might have negative or even fatal effects on patients, nurse education programmes should cover all of the preventative techniques described above and more.
By effectively enforcing their rights, medication administrators must strive to deliver quality treatment. In any clinical circumstance, the well-being of the patient and the standard of care must come first. However, nurses are not the only ones responsible for upholding rights; the entire healthcare system must be effective.
Frequently Asked Questions (FAQs)
What is a Standard Operating Procedure (SOP)?
A collection of written instructions known as a ‘standard operating procedure’ (SOP) outlines the precise steps that must be taken to carry out common medical procedures. To ensure that the company maintains consistency and complies with industry norms and business standards, standard operating procedures (SOPs) should be adhered to consistently.
How can patient-centered strategies for medication management reduce errors and enhance outcomes?
According to a study conducted by the faculty of the Department of Medicine, Indiana University, USA, patient involvement in the medication process or taking an active part in sharing their expertise and concerns can increase the efficacy of medication safety. Therefore, assessing what is important to patients is crucial.
Is pursuing a career in medication administration rewarding?
One of the industries with the highest employment growth worldwide, healthcare administration has a high median pay and a wide range of career opportunities. Financial manager, healthcare financial consultant, administrative medical assistant, hospital administrator, etc. are just a few of the many career options available in the complex field of healthcare administration.
Can nurses give patients medication on their own without a doctor’s prescription?
No, nurses are not allowed to administer without a professional doctor’s approval. Although, under certain advanced nursing practices, nurses have the power to prescribe medicines as well as the kinds of drugs and dosages that further vary from state to state.
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