Are you tired of hearing about the 5 Rights? 7 Rights? 9 Rights?
By: Kristina Walker, Director of Client Care
Anyone associated with medications in a Long Term Care setting has heard about the 5 Rights ad nauseam. We have even started to add on more Rights, such as Right Documentation and Right to Refuse. With the hectic nature of our jobs it is easy to take these Rights for granted, yet they are the single most important thing to follow in order to keep our residents safe.
Medication errors are among the most common medical errors, causing harm to more than 1.5 million people a year and attributing to more than 7,000 deaths. Why so many? The sheer number of drugs residents are taking is the top reason. These errors also have a price tag of 3.5 billion dollars. Most medication errors occur during a transition from one care setting to another. Medications are not properly reconciled and/or transcribed. The medications that contribute to the most adverse drug events and require close attention to detail are opioids, anticoagulants and diabetic medications.
In 2011, The American Geriatric Society performed a study where they observed 83 med passes for 301 residents totaling 4,957 medications at eleven Assisted Living facilities. The error rate among nurses and non-licensed caregivers was a staggering 42 percent1. Anything above 5 percent is non-compliant. During the medication passes, 38% of med passers do not compare the name on the drug package to the medication administration record (MAR) and 48% did not verify the dose on the packaging with the MAR1.
Overview of the 5 Rights, plus a few more:
1. Right Resident- Residents should be identified two different ways. To ensure you are giving medications to the correct resident you can:
Check ID bracelet.
Ask them their name. It is best to ask “Please tell me your name,” instead of “Are you Mrs. Jones?” especially if they have dementia.
Check their picture. Make sure it is up to date.
Ask another person to verify the resident’s identity. This is especially helpful for non-verbal residents.
Take a look at the following pictures. What would you do if asked you to give medications to Mrs. Smith, the woman with curly grey hair and glasses?
2. Right Drug- Many medications look and sound the same so it is important to triple check the spelling. Mixing up one of the drugs listed below could mean the difference between treating anxiety, blood pressure, cholesterol or hypothyroidism.
Lovostatin • Lovenox • Losartan • Lisinopril • Lipitor • Latuda • Levothyroxine • Lexapro
Lasix • Levamir • Levaquin • Lantus • Lorazepam • Lunesta • Lyrica • Lithium • Linzess • Lortab
Loratadine • Latanoprost • Lansoprazole
3. Right Dose- It is important to remember that the strength on the packaging and order may not match, but that is okay. You are looking for the total strength. Sometimes orders are written for strengths that do not exist or are hard to obtain. The pharmacy may have to send a different number of tablets to fill the order.
Example: Metoprolol 50mg ER: Take one tab by mouth daily
May have to be rewritten to: Metoprolol 25mg ER: Take two tabs (50mg) by mouth daily
4. Right Route- Most errors occur with sublingual medications.
5. Right Time- There is a window of time to give most medications, which may range from an hour before or after the prescribed time. This is not true of all medications.
Some exceptions include Insulin, Fosamax, Carb/Levo, any medication that has to be given with or without food.
Look for ways to combine med passes. Ask a pharmacist to review the physician orders for recommendations on timing.
***If you own or work in an AFH, please reference WAC 388-76-10470***
6. Right Documentation- If you don’t document it, it didn’t happen. All medication records are legal documents and could be used in the Court of Law. You have to be able to account for every pill given and not given. Page through the paper MAR after each major med pass, not just at the end of your shift. If you have electronic MAR, use their features to verify that every medication was documented.
Documentation is just as critical for OTCs. If you fail to sign for a potassium chloride or cranberry supplement and the resident has a fall, you could be liable.
7. Right to Refuse- You need to investigate the reason for the refusal. Document each refusal and notify the appropriate person(s).
Is it because:
• Unpleasant taste • Unpleasant side effect
• Lack of understanding • Denial of need for medication
Many refusals come from residents with cognitive impairments. To help reduce the number of refusals, look at the med pass process from their perspective.
Scenario: You are at home and a stranger knocks on your door. They smile and say “hello,” but you are unable to place them. They extend a cup full of strange and colorful pills stating “Here, take these.” If this happened to you in your own home, you would probably consider calling the police.
Establish a relationship of trust first. It doesn’t have to take long. Make sure you introduce yourself each time and address the resident by their name. Ask to be invited into their home. Bringing along the medication packages is extremely helpful, as it allows the resident to identify their name on the packaging and clearly discern one pill from the next. Also, being able to see where the medications are coming from provides the resident a greater sense of security and assuredness.
Following these 7 Rights will help to ensure safety and compliance for your residents. For more information on this article or to schedule a training in your community (DSHS Certified for CEUs) please contact Kristina Walker at firstname.lastname@example.org. If you are in an AFH, Kristina can speak on this topic through a WSRCC chapter meeting.