Key Takeaways
- Verify all medication rights: patient, medication, dose, route, time, documentation, reason, response, refusal
- Check medication labels against MAR three times before administration
- First action for medication error is to assess the patient for adverse effects
- High-alert medications (insulin, anticoagulants, opioids) require additional safety checks
- LPN/VN medication administration scope varies by state—know your state's regulations
Medication Administration Fundamentals
Safe medication administration is one of the most critical responsibilities of the LPN/VN. This section covers the rights of medication administration, legal considerations, and fundamental principles that ensure patient safety. This content area represents 10-16% of the NCLEX-PN exam.
The Rights of Medication Administration
The traditional "5 Rights" have expanded to include additional safety checks:
| Right | Verification |
|---|---|
| Right Patient | Check ID band, ask patient to state name and DOB |
| Right Medication | Compare label to MAR three times |
| Right Dose | Verify calculation, check if appropriate for patient |
| Right Route | Confirm route matches order and formulation |
| Right Time | Administer within designated window (usually ±30 min) |
| Right Documentation | Record immediately after administration |
| Right Reason | Know indication for the medication |
| Right Response | Evaluate for expected effect and adverse reactions |
| Right to Refuse | Patient has the right to refuse; document and report |
Medication Orders
Types of Orders:
| Order Type | Description | Example |
|---|---|---|
| Routine/Scheduled | Given regularly at specified times | Metformin 500 mg PO BID |
| PRN (As Needed) | Given when specific criteria are met | Ondansetron 4 mg IV PRN nausea |
| STAT | Given immediately, only once | Furosemide 40 mg IV STAT |
| Single/One-Time | Given once at specified time | Cefazolin 1 g IV on call to OR |
| Standing | Pre-approved for specific situations | Acetaminophen 650 mg PO q4h PRN temp > 101°F |
Required Components of a Valid Order:
- Patient name
- Date and time
- Medication name
- Dose
- Route
- Frequency
- Prescriber signature
LPN/VN Scope of Practice
LPN/VNs can administer medications within their scope of practice, which varies by state:
| Generally Permitted | May Require Additional Training | Generally Not Permitted |
|---|---|---|
| Oral medications | IV push medications | Investigational drugs |
| Subcutaneous injections | Blood/blood products | Titrating vasoactive drips |
| Intramuscular injections | Central line care | Chemotherapy (most states) |
| Topical medications | PCA pump management | Conscious sedation |
| Rectal/vaginal meds | PICC dressing changes | Initial IV push (some states) |
| Some IV fluids/meds | Epidural medications |
Medication Errors
Common Types of Medication Errors:
- Wrong patient, drug, dose, route, or time
- Omission errors (missed doses)
- Documentation errors
- Preparation errors
- Monitoring errors
When a Medication Error Occurs:
- Assess the patient immediately for adverse effects
- Notify the RN/supervisor and physician promptly
- Document what was given and patient's response
- Complete incident report per facility policy (does NOT go in patient chart)
- Implement interventions as ordered
- Never hide or attempt to cover up the error
High-Alert Medications
High-alert medications have increased risk of causing significant patient harm:
| Category | Examples | Safety Measures |
|---|---|---|
| Anticoagulants | Heparin, warfarin, enoxaparin | Verify dose, check labs (PT/INR, aPTT) |
| Insulins | All forms | Another nurse must verify, never abbreviate "U" |
| Opioids | Morphine, fentanyl, hydromorphone | Double-check dose, count narcotics |
| Concentrated Electrolytes | Potassium chloride, hypertonic saline | Never give IV push, must be diluted |
| Chemotherapy | All antineoplastic agents | Specialized training required |
| Neuromuscular Blockers | Succinylcholine, vecuronium | Causes paralysis; ventilator required |
Sound-Alike/Look-Alike Medications
Be especially careful with medications that have similar names or appearances:
| Confused Pair | Potential Consequence |
|---|---|
| Celebrex / Celexa | Anti-inflammatory vs. antidepressant |
| Hydroxyzine / Hydralazine | Antihistamine vs. antihypertensive |
| Prednisone / Prednisolone | Different potencies |
| Humalog / Humulin | Rapid vs. intermediate insulin |
| Metformin / Metronidazole | Diabetes vs. antibiotic |
Prevention Strategies:
- Use both brand and generic names
- Include indication on order
- Use tall man lettering (hydrOXYzine vs. hydrALAzine)
- Keep look-alike drugs in separate locations
- Read labels carefully, don't rely on location or appearance
An LPN/VN is preparing to administer a medication. How many times should the medication label be checked against the MAR?
A medication error has occurred. What is the FIRST action the LPN/VN should take?
Which medication requires double verification by two nurses before administration?