The 5 RightsMedication errors, or mistakes involving medications, are so common that in the medical profession we have the “5 Rights” to help us avoid them. The Five Rights are:
- The right dose
- The right medication
- The right patient
- The right route
- The right time
There should be one thing added to the list when giving medication in the home: the right storage.
This method has helped avoid a lot of accidents involving medicines in hospitals and other health care settings and can help you avoid accidents in your home as well. If you are in charge of giving medications to someone you are caring for, the “5 rights” is something you should be familiar with and start checking the moment you get the prescription from the physician.
Because there can be differences in the way medication orders are given and received in palliative care and hospice, I will try to include variations when appropriate.
Take Notes at the Doctor's Office or Nurse's Visit
When the doctor or nurse tells you to start giving a new medication, take notes. Write down the name of the medication, the dose you will be giving, and any instructions they give you on how to administer it. For example, when I am visiting a patient and inform them that they will be starting oral morphine solution at 5mg every 4 hours as needed, I instruct them to take their own notes in addition to the ones I will be writing down for them. I tell them how the medication is dosed; for example, a concentrated solution of 20mg of morphine for every milliliter of liquid. I will tell them that 5mg of morphine is equivalent to 0.25ml. I bring a sample of the bottle and medicine dropper with me that our pharmacy supplies. I show them the dropper and draw up a sample dose of medication. I may draw a diagram of the dropper that they can refer to later. I tell them what the medication is to be used for, how often to give it, and how to keep a record of what they gave. Hopefully their notes look something like this:
- Oral Morphine Solution
- 5mg or 0.25ml or ¼ of the dropper
- Give every 4 hours if needed for pain
- Write down date, time, and dose given
Take your own notes, even if the doctor or nurse writes down their own instructions for you. You will probably make better sense of instructions you wrote down versus those written by someone else. Taking notes also helps solidify the information in your memory.
Check the Prescription at the Pharmacy
Whether you pick up the medication at the pharmacy or it is delivered to your house, always check the medication before accepting delivery of it. Make sure it is the same medication and the same dose, or concentration, as the notes you took. Check that the patients name on the bottle is your patient. Also check that the instructions are the same as those you wrote down. If the instructions vary at all, contact your healthcare provider to clarify before giving any of the medication.
Store the Medication Properly
Some medications have specific storage requirements to preserve their effectiveness. Insulin, some liquid antibiotics, and several other medications need to be refrigerated. Any type of medication in the form of a suppository will need to be stored in a cool place to keep them from getting too soft. Nitroglycerin needs to be protected from sunlight. Always check with the pharmacist for specific storage instructions for your medications and be sure to follow them.
It is also very important to store all the medications in their original containers. Pill cases seem like they would be convenient, and probably are, but once you fill them up it can be confusing to tell the medications apart. It is just much safer, if a little less convenient, to keep all the medicines in their own bottles.