Medication administration is an essential skill for EMS providers but it is also one of the riskier procedures because of potential adverse effects due to errors. One of the best ways to avoid mistakes is by using the "six rights" of medication administration. The six rights are easy to remember.
- Right Patient. Make sure you verify the patient's identity. Confirm the patient's name verbally and with family members if possible.[Native Advertisement]
- Right Medication. Double-check your protocol, standing orders or medical control instructions to be certain of the name and concentration of the medication you're administering. Carefully read the medication label both on the outside box and the vial or ampule to confirm you have it right.
- Right Dose. Most drugs are supplied in unit-dose forms, so there's usually very little calculation to be done. Make certain that you understand how to administer the medication to ensure you're not giving more or less than the amount that's required. Medications given by IV infusion after being mixed into a solution require more focus to get the dosage correct. If you feel the dosage you're about to give is higher or lower than the "usual" amount, double-check to make sure you have it right - you can't take it back once you give it!
- Right Time. Though most medications given in emergency situations are administered immediately, some medications are titrated over a period of time or given over a series of smaller dosages in specific time increments. Make sure you know when and how much to give the patient. You also need to ensure the medication isn't expired.
- Right Route. Since most medications can be administered by several routes, it's critical to make sure the proper route is used. Medications given by direct IV access will have a more immediate effect on the patient than that same medication given by the intramuscular route, and the dosages may vary depending on the route used.
- Right Documentation. As the saying goes, if it isn't documented, it didn't happen. There have been cases where the patient care report (PCR) didn't indicate that a medication had been given yet the paramedics testified in court that it was given and they just didn't document it. No one is likely to believe you if it wasn't documented with the PCR for that incident.
Ask and document whether the patient has any known allergies to the medication being given. This should be followed by documenting the name of the medication given, the time it was given, the dose, the method or route of administration, the speed in which the medication was given and its effect on the patient's condition. The provider should add anything else that s/he thinks that should be documented on the patient report about the administration of the medication.
When an ALS provider has a BLS partner the EMT/BLS provider can read the vial of medication to ensure it is correct. They don’t have to know all about it, but as long as they can read they can ensure that it is the proper medication.
It's critical to document patient condition both before and after medication administration. This "before and after" assessment should include full sets of vital signs, an assessment of the patient's level of consciousness and whether the pain or other patient difficulty changed after medication administration.
Finally, the PCR documentation must be explicitly clear regarding the name and credentials of the health care provider who administered the medication. Following these steps every time medications are administered will avoid harm to the patient.
A training power point was prepared by one of the Tidewater EMS Southide agencies. They were gracious to provide it for the purposes of regional training.
The following are cases that could happen to all of us:
Human error can never be eliminated but it can be significantly reduced. Device labeling and simple re-engineering medication separation can eliminate most of these avoidable errors.
The true answer to error reduction is adopting a culture of safety in an organization where instead of punishing providers for errors we instead learn from them and implement processes to eliminate them by targeting one of the three methods of error prevention. This is part of our performance improvement process.