April 2024

In this VETgirl online veterinary continuing education blog, Bridget MacDonald, CVT, VTS (ECC) reviews “The 5 Rights” of medication administration and why it is important to maintain a patient safety mindset and promote a culture of safety within your practice. Have you asked yourself all of the right questions before medicating your patient?

By Bridget MacDonald, CVT, VTS (ECC)

5 Rights of Medication Administration: Essentials for the Emerging Veterinary Technician

As a veterinary professional entering the work field, embarking on a career as a Veterinary Technician is equally exciting and challenging. From clinical externship experience to becoming a primary nursing caregiver, the knowledge obtained during schooling is translated to hands-on application as one works toward becoming credentialed. During this process, what is often overlooked is the critical importance of maintaining a patient safety mindset and promoting a culture of safety within the practice.

Recognizing the significance of patient safety in human medicine, the World Health Organization emphasizes that “Unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world.” Medication-related errors are also common in veterinary medicine. As emerging veterinary technicians and the core of the patient care team, we play a vital role in creating a culture of safety within our hospitals. One way in which we can help reduce preventable injury and harm to our patients is by utilizing safe practices to help mitigate medication administration errors.

Referred to as “The 5 Rights”, these principles serve as the cornerstone for medication administration, guiding our every step to ensure patient safety. There are a few additional points of consideration that extend beyond the top 5 rights of medication administration that should not be overlooked and are an essential part of your nursing care plan. Here, we will review the top 5 rights, walk you through the thought process steps before administering any medication, and examine additional considerations.

1. The Right Patient
Confirm the patient’s identity. Similar-looking or same-named patients should be separated by where they are placed for holding and secured with proper identification. Utilize identification tools such as neck bands, cage cards, and cage alerts or signage.
Ask: Did I accurately identify and confirm the patient’s identity in conjunction with the prescribing orders?

2. The Right Medication
Avoid a medication mix-up. This is most likely to occur with drugs that sound alike or labels that look alike. (i.e., Cerenia® vs. Convenia®). Evaluate the hospital’s layout and consider relocating medications to improve preventable harm and patient safety.
Ask: Do I have the right medication, and did I double-check the container/label compared to written orders?

3. The Right Dose
Verify the correct and appropriate dosage for the patient’s weight. Reporting weights accurately can prevent patient harm. Confirm consistency in units (pounds or kilograms) used in the hospital and watch for verbal versus written order discrepancies.
Ask: Do I have the right dose/amount and can a friend cross-check my medical math?

4. The Right Route
Assess the appropriateness of the administration route based on the medication. Check for special considerations, such as NPO status or potential interactions with other medications that are currently being administered (i.e., concurrent intravenous fluid therapy with additional medication additives).
Ask: Is this the right route to administer this type of medication, and did I properly confirm lumen patency if it must be given intravenously or via tube?

5. The Right Time
Ensure that the medication frequency aligns with the prescribed orders and whether there are any other potential drug interactions to avoid by administering at the same scheduled time. Documenting in the patient records/nursing notes the last administration time, whether performed by the owner at home or in the hospital, can help prevent medication errors and patient harm.
Ask: Is this the right time to administer this medication and do I know when it was last delivered?

Additional nursing considerations:
The Right Documentation:
Accurately document all components of medication administration in detail. Documentation is key to maintaining continuity of care and ensuring patient safety from one veterinary technician to the next when passing off care of the patient.
Ask: Did I document in my treatment sheet/patient record detailed information about the medication such as what, when, how, dose written and my initials?

The Right Reason:
Always seek clarity with the prescribing clinician on a medication if uncertain. Positively embrace an opportunity to learn about drugs that you are less familiar with before following through with administration. Keep in mind that it is not only acceptable but also responsible to acknowledge when you do not know something and actively seek out resources for additional information.
Ask: Do I understand the disease process and why I am administering the medication and, if not, do I have access to a learning resource to help me learn?

The Right Response:
Assessing your patient’s response to a medication is imperative when making decisions about their ongoing care plan. Use your abilities to think critically and respond accordingly if the patient’s reaction is not your anticipated expectation.
Ask: Did my patient respond according to what the medication was intended for, and have I reassessed my patient’s vital status until the desired response was reached?

We are all human, mistakes are inevitable. However, as an emerging Veterinary Technician, the key to cultivating a patient safety culture is how we proactively respond to these mistakes by developing safer practices to prevent future harm.

World Health Organization
U.S. Food & Drug Administration
Institute for Safe Medication Practices
Veterinary Medical Association
Patient Safety Network

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2. Grissinger M. The Five Rights: A Destination Without a Map. P T. 2010 Oct;35(10):542. PMCID:PMC2957754.
3. Institute of Medicine (US) Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System.
Kohn LT, Corrigan JM, Donaldson MS, editors. Washington (DC): National Academies Press (US); 2000. PMID: 25077248.
4. Lahue BJ, Pyenson B, Iwasaki K, et al. National burden of preventable adverse drug events associated with inpatient injectable medications: healthcare and medical professional liability costs. Am Health Drug Benefits. 2012 Nov;5(7):1-10. PMID: 24991335; PMCID: PMC4031698.

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