Medication Administration Safety
Apply the rights of medication administration, calculate dosages correctly, and understand what to do when something goes wrong.
By the end of this lesson you can
- Apply the rights of medication administration
- Perform basic dosage calculations
- Select injection sites and describe correct technique
- Respond appropriately to a medication error
Lesson Notes
Read through the key concepts before you try the challenge.
The rights are a checklist, not a slogan
You administer an immunization at Lakeside Medical Associates, where this is within your delegated scope.
Two patients with similar surnames are in adjacent rooms. You carry a prepared syringe into the room, confirm the patient's name against the chart, and realize you are in the wrong room. The check caught it. Without it, a patient would have received a vaccine intended for someone else.
Your task: Perform every check every time, including the ones that feel unnecessary.
| Right | Verify |
|---|---|
| Patient | Two identifiers — name and date of birth. Never room number |
| Drug | The label against the order, read at least twice |
| Dose | Calculated and verified; double-checked for high-alert drugs |
| Route | As ordered — never substitute a route |
| Time | As ordered, within the permitted window |
| Documentation | Immediately after administration, never before |
| Reason | You understand why this patient is receiving this drug |
| Response | Observe for the expected effect and for adverse reactions |
Dosage calculation uses one reliable formula: desired dose divided by dose on hand, multiplied by the quantity that dose comes in. If an order is for 500 mg and the vial contains 250 mg per 5 mL, then 500 divided by 250, times 5 mL, gives 10 mL.
| Route | Site | Angle | Typical volume |
|---|---|---|---|
| Intramuscular | Deltoid | 90 degrees | Up to 1 mL |
| Intramuscular | Vastus lateralis | 90 degrees | Up to 3 mL adult |
| Intramuscular | Ventrogluteal | 90 degrees | Up to 3 mL |
| Subcutaneous | Upper outer arm, abdomen, thigh | 45-90 degrees | Up to 1 mL |
| Intradermal | Inner forearm | 5-15 degrees, bevel up | 0.1 mL |
Responding to a medication error
You realize you have administered the wrong dose of a medication.
- 1
Stay with the patient and assess them first.
Patient safety comes before everything else, including reporting. Observe for adverse effects and do not leave them alone. Everything else can wait a few minutes; a deteriorating patient cannot.
- 2
Notify the provider immediately.
They need to know now so they can evaluate the patient and decide whether intervention is required. Delay to work out how to phrase it is the worst possible choice — the clinical window matters more than your discomfort.
- 3
Document factually what was given, when, and what you observed.
Record the facts without speculation or self-justification. The documentation is for the patient's care and for the incident review, and an accurate record helps both.
- 4
Complete an incident report through the practice's process.
Incident reports exist to identify system problems, not to assign blame. Two similar surnames in adjacent rooms is a system condition, and reporting is how it gets fixed before it catches someone else.
- 5
Do not alter or backdate anything.
Amending the record to obscure an error converts a reportable mistake into falsification, which is far more serious and, in every case, discovered. The error is survivable; the cover-up is not.
Result: The patient is assessed and monitored, the provider can intervene, and the system condition is documented.
Patient first, provider immediately, document factually, report through the process, alter nothing.
A colleague has drawn up an injection and asks you to administer it because they are called away. What should you do?
Challenge
Apply what you've learned in this lesson.
Medication administration is a delegated clinical skill requiring hands-on competency assessment. Calculation, however, you can and should practice now.
- Calculate each: order 250 mg, on hand 125 mg/5 mL. Order 0.5 g, on hand 250 mg/mL. Order 40 mg, on hand 10 mg/mL. Show your work.
- Write the rights of medication administration from memory, then check.
- Research the correct landmarking for a deltoid intramuscular injection and describe it in three sentences.
- Find out whether MAs may administer injections in your state, under what supervision, and what training is required.
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