Medication Administration Fundamentals

Must-know rules

Three checks, two identifiers, zero shortcuts. Verify the med label when retrieving, preparing, and at the bedside. Confirm identity with name + DOB (or MRN) every time.
Right Assessment = the safety gate. Apical pulse before digoxin (hold <60). BP before beta-blockers and ACE inhibitors. RR before opioids (hold <12).
Hold → Notify → Document. If assessment contraindicates the med, do not give it. Notify the provider. Document your finding, the decision to hold, and the provider response.
Never crush SR/ER/XL/XR or enteric-coated formulations. Crushing destroys the controlled-release mechanism and delivers the entire dose at once: potential overdose.
Route precision matters. Ear drops: up-and-back (adults), down-and-back (children <3). Eye drops into the conjunctival sac with inner canthus pressure.
TB test: wheal must form. No wheal = too deep = repeat. Read at 48–72 hours. Measure induration, not redness.
Medication reconciliation at every transition. Admission, transfer, handoff, discharge.
Incident reports go to risk management: NEVER in the chart. Document the facts objectively in the medical record. File the incident report separately.

THE RIGHTS OF MEDICATION ADMINISTRATION

ADDITIONAL RIGHTS: THE EXPANDED FRAMEWORK

Right Reason. Does this drug match the client's diagnosis.
Right to Refuse. A competent adult can refuse any medication.
Right Assessment. Assess before giving: apical pulse before digoxin, BP before antihypertensives
Right Evaluation. Return and assess the drug's effect. Did the pain med work.

NCLEX TIP

The NCLEX loves the "right to refuse" scenario. A common question pattern: a client refuses a medication.

PRE-ADMINISTRATION ASSESSMENT

THE HOLD-AND-NOTIFY RULE

If your assessment contraindicates the medication, the correct sequence is: HOLD the dose → NOTIFY the provider → DOCUMENT your assessment finding, the decision to hold, and the provider notification.

ROUTES OF ADMINISTRATION

DOJO RULE

Ear drops: Up-and-back for adults, down-and-back for kids. The external auditory canal in children under 3 is straighter and more horizontal

MEDICATION RECONCILIATION & SAFETY SYSTEMS

MEDICATION RECONCILIATION: THE PROCESS

Obtain a complete medication list: at every transition of care: admission, transfer between units
Compare the list to current orders. Identify discrepancies: duplications, omissions, dose changes
Communicate the reconciled list: to the client, the next provider, and the medical record.

DOJO RULE

The incident report never goes in the chart. This is one of the NCLEX's most repeated legal/safety facts. The medical record documents what happened to the client (objective facts).

CLIENT EDUCATION ON MEDICATIONS

WHAT EVERY CLIENT NEEDS TO KNOW

Drug name: both generic and brand. Teach the client to recognize both names to avoid accidental...
Purpose. Why am I taking this.
Dose and timing. How much, how often, and when: with meals or on an empty stomach.
Expected side effects vs. reportable adverse effects. Teach the difference
Food, drug, and herbal interactions. Warfarin + vitamin K-rich foods (green leafy vegetables).
Storage and handling. Refrigeration requirements (insulin, some antibiotics).

HIGH-RISK EDUCATION SITUATIONS

Anticoagulants, insulin, opioids, and medications with narrow therapeutic indices: require the most thorough discharge education.

DOJO RULE

"Do you understand?" is not education: it's wishful thinking. The client who nods and says "yes" may not understand a single word you said.

FINAL DOJO RULE

Every medication you administer is a promise. A promise that you checked the right drug, verified the right client, assessed before giving, chose the right route

Memory hooks

Pulse, Pressure, Breath, Sugar, Clot Pulse Apical pulse before digoxin · Pressure BP and HR before · Breath RR before opioids · Sugar Glucose before insulin · Clot INR before warfarin

Rights of Med Admin Client Right client · Drug Right drug · Dose Right dose · Route Right route · Time Right time · Chart Right documentation · Reason Right reason and right · Refuse Right to refuse

Up for Adults, Down for Babies Adult Pull the pinna up · Under 3 Pull the pinna down