Administering medications

Chapter 34 discussed the basics of pharmacology, and Chapter 35 discussed pharmacology-related math problems. You will use these skills when administering medications. This chapter discusses administration safety techniques, along with medication forms and routes. The techniques of preparing and administering medications will be the primary focus.

The nine rights of medication administration

Throughout this chapter, administration procedures for various routes will be given. Before learning how to give medications, it is important to understand medication safety rights. Over the years, the guidelines have grown to include additional steps to address patient education and the right to refuse medication.

Each time you prepare and give medication, it is important that you follow the nine rights of medication administration. These rights are designed to help you look at the details and avoid making errors during the procedure.

Right medication

An order or a prescription from a provider is required before a medication can be given. As discussed in a prior chapter, orders can be written or verbal. For all verbal orders, make sure to write down the order and read it back to the provider. This helps to ensure the accuracy of the order. The order requires several elements, including the medication’s name and form.

With the order in hand, the medical assistant must prepare the medication. This requires finding the correct medication. Use drug reference information if you are not familiar with the medication listed on the order. Sometimes the provider will give a brand name, but the stock medication will indicate only a generic name. Make sure you have the correct medication, which includes the correct form (e.g., tablet, suppository, suspension).

You will need to check the medication order against the label three times during the preparation process to ensure that you have the correct name and form of medication. You check the label in the following situations:

• When you get the medication from the storage area (e.g., cabinet, freezer, or refrigerator)
• Before preparing the medication
• Before you return the medication to the storage area

It is important that you do an activity between each check. For instance, after you do the first check, assemble the supplies you need to prepare the medication. Then do the second check. As you clean up your area, you do the third check. Too often, we reach for something based on the color, size, or location of the object. We may look at the label and think we see what we want to see. Checking the label three times, with activities between, helps to ensure that you have the right medication.

Right dose

The dose of medication is on the order. The provider may have written the order in two different ways, even though the amount is the same. For example, both of these orders give the patient 1000 mg:

• Acetaminophen 500 mg, 2 tabs po × 1 dose
• Acetaminophen 1000 mg po × 1 dose

The first order shows the tablet strength (e.g., 500 mg) and the number of tablets (e.g., 2) to give. If the stock medication comes in 500-mg tablets, the medical assistant has no calculations to do. The second order just shows the number of milligrams to give (e.g., 1000 mg). The medical assistant would need to calculate how many tablets to give.

Right route

Besides checking the label for the name and form of the mediation, it is also important to check the route. The route is the means by which a drug enters the body. The route of the medication must match the provider’s order. The route should be checked along with the name and form, three times before the medication is given.

Right time

Medications need to be given at the right time. For most medication orders, the time is part of the order. Some orders are STAT, whereas others are every month. Vaccines are a little different, and this will be described later in the chapter.

Right patient

Before you administer the medication, it is important to correctly identify the patient. Ask patients or parents/guardians to state their full name and date of birth. Some agencies require patients to spell their last names. Verify the information against the order and the patient’s health record. All three must match. Any differences must be resolved before the medication is given.

In some agencies, patients are given identification bracelets that are scanned before medication is given. The medication is also scanned. An automatic entry is made in the electronic health record (EHR). This is a common practice in hospitals and is starting to be used in ambulatory care facilities. The identification process with bracelets still requires asking the patient’s name and date of birth. The information is checked against the bracelet and the order.

Right education

Before administering the medication to the patient, the medical assistant must do the following:

{`1. Give the patient the name of the medication and who ordered it. For example, “Dr. Martin ordered acetaminophen for your fever.”


2. Explain the desired effect or action of the medication. For example, “The acetaminophen will bring down your fever.”


3. Describe common side effects of the medication. For example, “The acetaminophen may cause nausea, rash, and a headache.”


4. Verify the patient’s allergies.
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If the patient is receiving certain vaccines, a Vaccine Information Statement (VIS) must be given to the patient. VIS will be discussed later in this chapter.

Right to refuse

The patient or the person legally responsible for the patient (e.g., parent, guardian) has a right to refuse any medication. If a patient refuses the medication, the medical assistant should respect the patient’s wishes. Do not pressure the patient. Notify the provider that the ordered medication was refused and specify the reason if it was shared. Document the refusal of the medication and identify the provider who was informed. The provider will talk with the patient regarding other options.

Right technique

When administering the medication, the medical assistant must give it in the right way. This may include an assessment before the medication is administered. Examples of the right technique include the following:

• Obtain vital signs before giving a specific medication. For instance, digoxin must be withheld if an adult’s pulse is under 60.
• Obtain information about the patient’s pain level before giving an analgesic medication. The medical assistant can ask the patient to rate the pain using a 0 to 10 scale. Zero is no pain, and 10 is the worst pain ever. Another pain assessment tool is the Wong-Baker FACES Pain Rating Scale, which is discussed in Chapter 28. The medical assistant should explain the scale to patients. Then patients can indicate how they feel. This scale works well for children.
• Some medications must be taken with food and others with a full glass of water. Medications that need to be taken on an empty stomach need to be taken 1 hour before meals or 2 hours after meals.

Information regarding the techniques to use when administering the medication can be found in the drug reference information.

Right documentation

After giving a medication, the medical assistant must document it in the patient’s health record. If the medication is not documented, it will appear to others as though it were not given. The documentation will vary based on what the patient received. Some documentation is done in narrative form, whereas vaccines are documented on paper or electronic vaccination forms. Elements that should be in the documentation include the following:

• Provider ordering the medication
• Assessment done (e.g., vital signs or pain level)
• Allergies
• Coaching/instructions given to patient (includes the edition date of the VIS for vaccine teaching)
• Name of medication (e.g., acetaminophen)
• Dose given (e.g., 650 mg)
• Route given (e.g., po)
• Lot number, expiration date, and manufacturer (usually only required for vaccines and controlled substances)
• How the patient tolerated the medication
• Additional information as needed (e.g., patient is resting on exam table)
• Signature if the note is handwritten (an EHR uses automatic signatures for documentation entries)