The 6 Rights of medication administration

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The 6 basic principle's of medication administration, known as the '6 rights of medication administration' should be followed where an individual is providing medication support to another person. 

1) The Right Service User

Identifying the right individual is a key aspect to ensuring the safe management of medications. Within community settings such as an individuals own home, this can be something that can be 'assumed' and often checks are not carried out which can increase the likelihood of harm. 

At Luna Care Services we carry out the following check to confirm we have the right service user prior to medication administration:

• Where possible, we check with the service user their name, date of birth and address. 
• We check the individuals name on the Electronic Medication Administration Record (EMAR).
• We check the pharmacy label on the medication.
• We address the service user by name to confirm their identity.

2) The Right Medication 

Checking each time that the medication to be administered is correct is an important stage in the process. Checks should be completed prior to medication being administered to verify that the name, form and strength of the medication are correct. This can also be verified against the service users Electronic Medication Administration Record (EMAR). 

Checks should be completed prior to verify that the medication date has been checked and it has not expired. Some medications such as eye drops have specific instructions such as 'once opened use within 30 days' which also need to be considered and the open and expiry date checked before use. 

At Luna Care Services we carry out the following checks to confirm the right medication:

• We check the name of the medication against the prescription label and also the Electronic Medication Administration Records (EMAR).
• We check the form of medication supplied
• We checked the strength of the medication 
• We check the date the medication was dispensed by the pharmacist and the date the medication is due to expire
• We consider any specific expiry dates such as eye drops which are clearly labelled with an opened and expiry date. 

3) The Right Route

Each medication should be checked and administered in its prescribed form. Some of the  prescribed medication forms are common in community settings and others are less common. The list includes both and some of the different forms include: 

• Liquid medication
• Tablets
• Capsules 
• Topical medicines - creams, lotions or ointments
• Eye, ear or nose drops 
• Inhalers
• Injections (subcutaneous - under the skin) 
• Injections (Intramuscular - into muscle) or (intravenous - into a vein) will most likely be done by a Doctor or Nurse.
• Transdermal patches
• Buccal tablets or liquids - held in the cheek of the mouth and absorbed in the mouth lining.
• Sublingual - placed underneath the tongue.

At Luna Care Services each staff member will check the prescription label and Electronic Medication Administration Record (EMAR) to verify that the correct route has been identified for the medications prescribed form. 

4) Right Dose

The medication dose to be administered must be checked in accordance with the prescriber's instructions. References must be made between the Electronic Medication Administration Records (EMAR) and the pharmacy label to ensure the correct dose is administered. Where the dose is unclear or is ambiguous it should be escalated immediately for further clarification prior to the administration of medication. If there is a discrepancy between the prescription label and the information held on the Electronic Medication Administration Record, this should be escalated immediately prior to the administration of the medication. 

At Luna Care Services we carry out a double check between the prescription label and the Electronic Medication Administration Record (EMAR) to verify that the dose to be administered is correct. If there is a discrepancy this is escalated to the Senior Management Team and the GP to seek clarification prior to the administration of the medication. 

5) Right Time

Checks should be completed prior to the administration of any medications to ensure that any medication to be administered is done at the right time. Some medications are time specific such as medications prescribed to manage Parkinson's disease which can have implications for the individual if the medication is not administered at the right time.

Considerations should be made to ensure that medication is not administered too early as some medications can cause toxicities and lead to a drug overdose which can have serious implications on an individuals health. 

Staff at Luna Care Services check the Electronic Medication Administration Record (EMAR) to verify that medication is being administered at the right time. Where support is required with medication, this is carefully considered and included in the service user's plan of care and within their visit activities. Considerations are made when arranging the package of care in relation to medication times to ensure any medication administration is done at the right time. 

6) Right to Refuse

Each individual has a right to refuse to take their medication and a right to provide consent to having their medication administered. 

Where an individual refuses medication it should not be forced on them. 

If an individual has capacity and understands the consequences of doing so, they are making an informed decision. Where possible it is a good idea to find out why the individual has refused the medication, their believes, understanding of what the medication is for and what the consequences of not taking the medication are.

Clear documentation should be maintained, including any reasons (if provided) as to why the individual is refusing to take their medication.

Where there is a refusal to take medication it may be beneficial to involve the individuals GP to review the medication or perhaps to try an alternative medication which the individual may accept. 

Where the individual does not have capacity a best interest decision may be considered which will be carried out in line with the Mental Capacity Act (2005).