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Backbone of Medication


  • 5 Rights

  • Right patient

  • Right drug

  • Right dose

  • Right time

  • Right route

What is Medication Error

What is Medication Error
What is Medication Error

Medication Do’s and Don’t’s


1. Give medication on time 2.Use only labeled bottles

  • 3. Look at label 3 times

    • A. When you take it out

    • B. When you pour it

    • C. When you put it back

      • 4. Check order for accuracy

      • 5. Use quiet area to prepare meds

      • 6. Check I.D. and allergy band

      • 7. Know action of drugs

      • 8. Document immediately in MAR.

Initial and sign full name, title



Give earlier than 30 minutes and not later than 30 minutes (one hr. window)


Use unlabeled or blurred labeled



Forget to do 3 checks and check expiration dates


Assume anything


Talk or be distracted when preparing meds


Give med, if no I.D. or allergy band


Give wrong information to



Forget to sign immediately.

Signature has to be legible

Timely Administration of

Scheduled Medications

  • Scheduled medications include all maintenance doses administered according to a standard, repeated cycle of frequency (e.g., q4h, QID, TID, BID, daily, weekly, monthly, annually).

Scheduled Medications DO NOT


  • STAT and Now doses

  • First doses and loading doses

  • One-time doses

  • Specifically timed doses (e.g., antibiotic for surgical patient to be given a specified amount of time before incision, drug desensitization protocols)

  • On-call doses (e.g., pre-procedure sedation)

  • Time-sequenced or concomitant medications (e.g., chemotherapy and rescue agents, n-acetylcysteine and iodinated contrast media)

  • Drugs administered at specific times to ensure accurate peak/trough/serum drug levels

  • Investigational drugs in clinical trials

  • PRN medications.

Time critical scheduled Medications

  • Time-critical scheduled medications are those where



delayed administration of

maintenance doses of greater than 30 minutes before or after the scheduled dose may cause harm or result

in substantial sub-optimal therapy or pharmacological effect.

time-critical scheduled medications

  • 1. Identify a hospital-specific list

  • Medications with a dosing schedule more frequent than every 4 hours

  • Scheduled (not prn) opioids used for chronic pain or palliative care (fluctuations in the dosing interval may result in unnecessary break-through pain)

  • Immunosuppressive agents used for the prevention of solid-organ transplant rejection or to treat myasthenia gravis

Cont ..

  • Medications that must be administered apart from other medications (e.g., antacids and fluoroquinolones).

  • Certain medications that require administration within a specified period of time before, after, or with mealsfor example, rapid-, short-, or ultra-short- acting insulins, certain oral antidiabetic agents (e.g., acarbose, nateglinide, repaglinide, glimepiride), alendronate, and pancrelipase.

  • 2.Establish guidelines for time-critical medications

Non- time- critical scheduled


  • Non-time-critical scheduled medications are those where early or delayed administration within a specified range of either 1 or 2 hours should not cause harm or result in substantial sub-optimal therapy or pharmacological effect.

Non-Time-Critical Scheduled


  • 1. Establish guidelines for daily, weekly, or monthly medications

  • Administer these medications within 2 hours before or after the scheduled time.

  • Medications administered more frequently than daily but not more frequently than every 4 hours (e.g., BID, TID, q4h, q6h) Administer these medications within 1 hour before or after the scheduled time.


  • Sound Alike Medications: confused drug names

  • Verbal or telephone orders :

  • should have: date and time, the name of the

  • physician, the generic and brand name of the drug,

drug dosage, quantity , duration, route, frequency, age and weight of patient if known, known allergies of not yet determine, reason the drug is order for the patient,

name and level of licensure of the individual

Receiving and documenting the order , and must be

signed by the physician within 24 hours.


  • Verbal Order any order from the physician to the RN that is given during:

  • emergency ( code Blue ), surgical procedure,

endoscopy, bronchoscopy

  • Telephone orders: maybe prescribed in the following instances:

  • the prescribing physician has determined the need of the patient and he is physically unavailable.

  • V.O and T.O are not accepted for anti-neoplastic drugs and controlled / narcotic drugs



Any Questions ?
Any Questions ?
THANK YOU Keep learning! You are as young as your last bright idea.


Keep learning! You are as

young as your last bright