Medicines Management in Nursing
Safe medicines management is a core nursing responsibility. Errors in medication administration can cause serious harm to patients. Understanding the principles of safe prescribing, dispensing, and administration is essential.
The 5 Rights of Medication Administration
- Right patient — Check patient identity using two identifiers (name, date of birth, NHS number)
- Right drug — Check the medication label against the prescription
- Right dose — Calculate and verify the dose is appropriate
- Right route — Ensure the medication is given via the correct route
- Right time — Administer at the prescribed time
Many nurses now use additional rights: right documentation, right reason, right response, and right to refuse.
Medication Routes
- Oral — Tablets, capsules, liquids (slowest onset)
- Sublingual — Under the tongue (rapid absorption)
- Intravenous (IV) — Directly into the bloodstream (fastest onset)
- Intramuscular (IM) — Into muscle tissue
- Subcutaneous (SC) — Under the skin
- Topical — Applied to skin or mucous membranes
- Inhalation — Breathed into the lungs
- Rectal — Inserted into the rectum
Controlled Drugs
Controlled drugs require special precautions. They must be stored in a locked controlled-drug cupboard. Two registered nurses must check and sign for controlled drug administration. Records must be kept in the controlled drug register.
Common Prescription Abbreviations
- BD (bis die) — Twice daily
- TDS (ter die sumendum) — Three times daily
- QDS (quater die sumendum) — Four times daily
- PRN (pro re nata) — As required
- STAT — Immediately
- OD (omni die) — Once daily
- PO (per os) — By mouth
- IV — Intravenous
- IM — Intramuscular
- SC — Subcutaneous
Medication Errors
If a medication error occurs: assess the patient, inform the prescriber immediately, complete an incident report, and document what happened. Be open and honest with the patient (duty of candour).
Adverse Drug Reactions
An adverse drug reaction is an unwanted or harmful response to a medication. Report suspected ADRs using the Yellow Card Scheme. Common ADRs include allergic reactions, side effects, and drug interactions.