What Are The Three Checks Of Medication Administration

The Three Checks of Medication Administration: A Comprehensive Guide for Safe Practice

Medication administration is a critical process in healthcare, demanding meticulous attention to detail to ensure patient safety. Errors in medication administration can have severe consequences, ranging from minor adverse effects to life-threatening complications. To mitigate these risks, healthcare professionals rely on a fundamental procedure: the three checks of medication administration. This article provides a detailed explanation of each check, highlighting crucial aspects and emphasizing the importance of adhering to this vital safety protocol.

What are the Three Checks?

The three checks are a systematic process designed to verify the correct medication, dose, and patient before administering any medication. These checks are performed at three distinct points:

1. Before removing the medication from its storage location: This initial check verifies the medication label against the medication order.
2. After retrieving the medication, but before preparing it: This second check confirms the medication, dose, and route against the medication order and the patient's medical record.
3. Before administering the medication to the patient: This final check ensures the medication, dose, route, and patient match the medication order and patient identification.

While the three checks are a cornerstone of safe medication administration, it's crucial to understand that they are not a standalone safety net. They form part of a broader strategy that includes other essential safeguards, such as using a barcode scanner for medication verification, double-checking calculations, and employing the principles of "rights" of medication administration.

The First Check: Verification at the Point of Retrieval

This initial check is paramount. It sets the stage for the entire medication administration process. This check should be conducted before removing the medication from its storage location, be it a medication cart, automated dispensing cabinet (ADC), or other storage system. Here’s what you should verify:

1.1 Verify the Medication Name:

Carefully compare the medication name on the medication label with the medication name on the medication order. Pay close attention to spelling and any potential look-alike or sound-alike medications. Many medications have similar names, and even a minor discrepancy can have serious consequences. For example, confusing "lisinopril" with "lisinopril" might seem insignificant, but a quick glance at the label and the order is needed to prevent mix ups.

1.2 Check the Dosage Form:

The dosage form (e.g., tablet, capsule, liquid, injection) must precisely match the order. A tablet cannot be substituted for a capsule, even if both contain the same medication and dosage. Each dosage form has its unique properties, and administering the incorrect form can lead to ineffective treatment or adverse reactions. For instance, an oral liquid formulation is not interchangeable with the oral tablet form, even if the active pharmaceutical ingredient (API) is identical.

1.3 Review the Expiration Date:

Ensure the medication is within its expiration date. Administering expired medication can be ineffective and potentially harmful. Expired medications may not retain their potency, may contain harmful degradation products and must never be used. Always check the label for clear visibility of the expiration date, and if it is unclear, do not use the medication.

1.4 Assessing the Storage Condition:

Observe the medication's physical state and storage conditions. Is it properly sealed? Does it display any signs of degradation, such as discoloration or unusual texture? If there is any doubt about the medication's integrity, it should not be used. Any inconsistencies should be immediately reported to the supervising pharmacist or nurse.

The Second Check: Verification Before Preparation

After retrieving the medication from storage, but before preparing it for administration, the second check is performed. This is a crucial step that involves multiple verification points to reduce the chance of error.

2.1 Re-Verify Medication Name and Dosage Form:

This step reiterates the first check, offering a second opportunity to catch any errors made earlier. It is a powerful redundant step to enhance safety.

2.2 Confirm the Dosage and Route:

Carefully compare the dosage on the medication label with the dosage prescribed in the medication order. Pay particular attention to decimal points and units of measurement (e.g., mg, mL, mcg). Also, confirm that the route of administration (e.g., oral, intravenous, intramuscular, subcutaneous) on the medication label matches the prescribed route. For example, make sure an intramuscular injection is not mistaken for an intravenous one or vice versa. Using the incorrect route can drastically affect how the medication is absorbed and metabolized by the body.

2.3 Assess the Medication's Physical Characteristics:

Again, examine the medication's physical characteristics. Look for any signs of damage, discoloration, or other irregularities. This reinforces the observation made in the first check, giving an additional safeguard against potentially compromised medication.

2.4 Patient-Specific Considerations:

At this point, begin to consider the patient's specific needs. Review the patient's medication profile for any potential drug interactions or allergies. If there are any concerns, consult a pharmacist or physician before proceeding.

The Third Check: Verification Before Administration

This final check is the last opportunity to prevent a medication error before administering the medication to the patient. It involves a meticulous verification process focusing on the patient’s identity.

3.1 Patient Identification:

This is the most critical aspect of this final check. Utilize two patient identifiers, such as the patient's name and date of birth, to positively identify the patient. Comparing the patient’s information with the medication order is vital, ensuring that the correct medication is given to the intended recipient. Using electronic medication administration records (eMARs) with barcodes can help minimize errors in patient identification.

3.2 Final Verification of Medication:

Before administering the medication, once again confirm the five rights of medication administration: right patient, right medication, right dose, right route, and right time. This comprehensive check reiterates the previous verifications, ensuring that all parameters are accurate and aligned. If there are any doubts during this process, stop, and seek clarification from a more senior colleague.

3.3 Observe the Patient:

Before, during, and after medication administration, observe the patient for any signs of adverse reactions or unusual responses. This includes monitoring for allergic reactions, such as hives or difficulty breathing, and also observing for any other unexpected physical symptoms or reactions to the medication.

3.4 Documentation:

After administering the medication, accurately document the administration in the patient's medical record. This includes the medication name, dosage, route of administration, time of administration, and any observations made during or after administration. Thorough documentation is essential for tracking medication administration and providing a comprehensive record for future reference.

Beyond the Three Checks: Enhancing Medication Safety

While the three checks are a fundamental part of safe medication administration, they are not sufficient in isolation. Additional safety measures should always be implemented to enhance medication safety:

• Use of Technology: Barcode scanners, eMARs, and automated dispensing cabinets (ADCs) can significantly improve accuracy and reduce the risk of medication errors.

• Double-Checking Calculations: Always double-check any dosage calculations to ensure accuracy. Independent verification by another healthcare professional is recommended, especially for complex calculations.

• Policy and Procedure Adherence: Strict adherence to institutional policies and procedures is essential. These policies typically provide guidelines for handling high-alert medications and managing specific situations to reduce potential risks.

• Education and Training: Continuous education and training for healthcare professionals are crucial in maintaining and improving medication administration skills. Regular updates and competency assessments help ensure ongoing proficiency.

• Reporting Errors: A culture of open reporting of medication errors is crucial. Reporting allows for identifying patterns, implementing corrective actions, and ultimately preventing future incidents. Reporting of medication errors is a vital aspect of risk mitigation within a healthcare environment and should be a mandatory practice.

• Understanding Pharmacology: A thorough grasp of pharmacology and the medications being administered is critical for safe medication administration. This includes awareness of potential drug interactions, adverse effects, and contraindications.

Conclusion

The three checks of medication administration are a crucial safety net against medication errors. This systematic approach, coupled with other safety measures, significantly contributes to patient safety. By meticulously following these checks and embracing a culture of safety, healthcare professionals can reduce the risks associated with medication administration and improve patient outcomes. Remembering that patient safety is paramount, consistent vigilance and the application of best practices are essential in achieving the highest standards of care. Remember, the three checks are not just a protocol; they are a commitment to patient safety.