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The Five Rights of Medication


Administering the correct medication can often be challenging for patients and family members in the home care setting. There are many people who are overwhelmed and unsure about the various dosage forms, application methods and instructions for taking medication. Meanwhile, pharmaceutical care in hospitals is also an important process that requires the highest level of accuracy. Our five R rules simplify the handling of medications in terms of quality healthcare and patient safety.

Use this article to learn everything you need to know about the basic rules for providing medications.

Why is it vital to take medication properly?

Incorrect handling of medications, whether in terms of dosage, documentation, intake or administration, can have significant consequences. According to a Swiss study from 2018, up to 15% of all patients in hospitals are affected by incorrect medication. Therefore, it is extremely important to ensure that medicines are taken correctly.

The five rights of medication provide an important guideline and include various people who are involved in pharmaceutical management. These include physicians, who prescribe the medication and draw up the medication plan, pharmacists, or hospital chemists and nurses, who administer the medication.

In technical jargon, the process of administering medications is called “application”. The application method represents the procedure of administering the drug. A suitable application form must be selected for this purpose.

What are the five rights of medication administration?

The five rights of medication are meant to be a guide to avoid incorrect medication. As already mentioned, the preparation of medications requires a high precision. To ensure patient safety, it is important to follow hygiene regulations and correctly store medications.
Regardless of whether it is a hospital professional or a family member at home, the 5 R rule is a fundamental pillar for monitoring pharmaceuticals, with the “R” standing for “right”.

The 5 R rules at a glance:

1: The right person

Before the nurse administers the medication to the patient, he/she must ensure that he/she is serving the correct patient. There are various ways of checking this, for example by addressing the patient directly (“Good afternoon, Mr./Mrs. X”), in the hospital the name can be checked at the patient's bedside or on the name bracelet.

2. The right medication

To prevent that the wrong medication accidentally gets given to a patient, we recommend the four-eyes-principle. However, until now, the requirement to have two people preparing medications has not been mandatory for hospitals, senior care facilities and outpatient care services. Nevertheless, such an arrangement can be imposed by the respective institution as part of a work procedure.

Should the nursing staff make a medication error, the supervisor must be informed immediately. In extreme cases, the emergency physician must be called.

3. The right dose

To prepare the medicine for the patient, attention is obviously required to ensure that the correct dose is used. Here it helps to take a look at the doctor's prescription or the patient's medication chart. This provides a better overview and prevents possible medication errors. A medication plan also helps to improve the information flow when nursing staff frequently change. Should an incorrect dosage of medication occur, the supervisor must be informed in the same way.

4. The right route of administration

The nurse must pay attention to where and how the correct medication is administered. The absorption speed of the drug is also important.
These are the most important application forms, with examples of the most suitable dosage methods:

  • local/topical: applied locally to a particular body part (ointments, eye drops)
  • intestinal: “via the intestines”, which includes
    • oral: taken by mouth and swallowed (like most tablets)
    • orally: the medication is placed under the tongue without swallowing (e.g., nitro spray)
    • rectal: through the anus into the intestine (suppositories)
  • parenteral: “passing the intestine
    • injections: the drug is either injected subcutaneously (under the skin), intravenously (into the vein), or intramuscularly (into the muscle) (such as insulin or many types of vaccines)
    • intravenous infusions: The drug slowly runs into the vein (such as parental nutrition)
    • Transdermal administration: through the skin (such as a band-aid)

5. The right time

The last R of the five rights of medication covers the correct timing of drug administration. The timing is critical because many medications require a constant level of the active ingredient to be effective. This means that the administration of medication must stick to a predetermined time.

For example, if drugs are taken on an empty stomach, they work much faster. For some drugs, it is important that the patient has eaten something beforehand to avoid damaging the gastric mucosa.
In other words, this is what is meant by the right time to administer the medication:

  • Before the meal: Approximately 30 – 60 minutes before a meal.
  • With food: After the first bite, the medicine is taken during the rest of the meal.
  • After a meal: most medicines specify when the medicine may be taken after a meal.
  • On an empty stomach: 2 hours after a meal or 30–60 minutes before.
  • Regardless of eating: it is not relevant whether the patient has eaten something or not

Why do people like to talk about the 6 R or even 10 R rule lately?

The 6 R rule has also been mentioned recently. In addition to the five rights of medication, this rule includes the correct duration of the medication. The duration of the medication is critical for a successful treatment. Pharmaceuticals must be taken according to the doctor's prescription and should not be stopped earlier or later.

A broader variant of the 5 R or 6 R rules is the 10 R rule of medication administration.

The correct storage is added to the six rules. For example, the medicines should not be exposed to direct sunlight or heat. Neither should they be stored in the bathroom, because of the humidity.

Another “R” in the 10 R rule is proper risk management, which should prevent medication errors.

The next step is proper documentation for administering medications.

In fact, especially for medications covered by the Controlled Substances Act, it is mandatory to have proper documentation.

The final “R” of the 10 R rule covers the proper disposal of medications that have either expired or are no longer needed. Under no circumstances should these medications be disposed in normal household garbage, but should best be returned to the pharmacy.

Conclusion – Professional use of medicine using the 5 R rules

Use this article to learn everything you need to know about proper medication administration. The five rights of medication or 6/10 R rules prevent mistakes when administering medication to patients. Especially in hospitals, where nurses change frequently, a seamless and error-free supply of medicines is the foundation of hospital management.

For this reason, pneumatic tube systems are now standard equipment in hospitals with more than 200 beds. The pneumatic tube system transmits vital medicines and other items, quickly, safely and gently.

The pneumatic tube systems of Air-Log International GmbH increase the economic and staff management of hospitals. They ensure a return on investment (ROI) with a payback period of between one and three years. These provide a great deal of relief to the medical staff. Instead of running time-consuming errands, they can concentrate fully on their actual task: taking care of patients.

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