REVIEW OF TEN (10) R’s of DRUG ADMINISTRATION
(M E D D C A T E E N)
PRINCIPLE: SAFE and EFFECTIVE administration of the DRUG
1. Right MEDICATION / DRUG
Drug names:
a. Chemical and Structural name : contains the chemical composition and molecular structure of
the drug. Most meaningful to a chemist.
b. Official name: The name under which a drug is listed by Food and Drug Administration
c. Generic name: The name given to a drug before it becomes official. It usually contains the
active ingredient of the medication. Also known as non-proprietary name.
d. Brand name: Also known as trademark name, or proprietary name. This is the name that is
registered and that its use is restricted to the owner of the drug or manufacturer.
Example:
CN: 2-p-isobutylphenyl propionic acid Acetylsalicylic acid
GN: Ibuprofen Aspirin
BN: Motrin ® Aspilet
Three checks if the Right drug is being prepared:
First check: During verification of the doctor’s written prescription of the drug use
Second check: During preparation of the drug
Third check: Before returning the medication to its storage area (before administering it to the
client).
2. Right ENTRY / ROUTE
PARENTERAL : administration of medication that requires the use of a syringe and a needle, and
that requires a break in the continuity of the skin. It does not undergo the first-pass effect of the
liver.
Examples: IV, SQ, IM, intrathecal (subarachnoid space)
Intraosseous (bones), intraarticular (joints),
Intracavernosal (spongy part of penis), intravireal (eyes)
Intrapleural (lungs), intraperitoneal (peritoneum)
Intraarterial(arteries), intracardiac( heart)
ENTERAL : anything taken-in in the alimentary tract. Undergoes the first –pass effect of the liver.
Examples: Buccal (mucous membranes of the cheek)
Oral (tablets, capsules, syrup, suspensions, lozenges, effervescent, elixirs)
Sublingual (under the pocket of the tongue)
Suppository (rectal)
TOPICAL / PERCUTANEOUS : applied to the skin or mucous membranes for its absorption
Examples: Dermatologic preparations (lotions, creams, ointments, liniments)
Instillation and Irrigation(eyedrops/ointments, eardrops,nasal drops and
sprays)
Inhalations (nebulization, MDI, powdered-inhalers)
Patches (transdermal patch)
Suppositories ( vaginal)
3. Right DOSE
FORMULA:
Drug computation:
Doctor’s Order x Quantity =
Stock
Pediatric dose computation:
Clark’s Rule: (Wt of child in lbs / 150) x Ave Adult dose
Young’s Rule: [Age in years/(Age+12)] x Ave Adult dose
Fried Rule: (Age in months/ 150) x Ave Adult dose
BSA: (*BSA in m2 / 1.73 m2) x Ave Adult dose
* Identify the BSA (body surface area using the WEST Nomogram). Determine the child’s
height and weight. Using a straight edge (such as a ruler), align the straight edge so that it
intersects exactly at the child’s height and weight. Doing sowill create an intersection in the BSA
scale. The boxed in scale is only used if the child is of normal height and weight.
The Mosteller Formula
BSA (m2)= ([Height (cm)x Weight (kg)]/3600)1/2
BSA (m2)= ([Height (in) x Weight (lbs)]/3131)1/2
-use the formula:
Child’s Dose: BSA of a child (m2) x average adult
Ave. adult BSA (1.73 m2)
Per Body weight: *take instructions from doctor’s order / drug insert
Weight x pediatric dosage = amount (dose) to be administered.
4. Right DOCUMENTATION
Document the administration of the drug IMMEDIATELY after giving the medication. NOT before!
Document reasons for refusal, delays and patient’s behavior and tolerance
Proper documentation:
Countersign in the medication sheet the time you have given the medication with your initials
(not signature).
Note: Emphasize on the proper color –coding and counter-signing of medications.
5. Right CLIENT / PATIENT
To ensure the Right patient, identify at least two (2) verifiers:
Check on the identification band
Ask for the name of the patient (Let the patient state his/her name)
Verify identity from significant others
Chart of patient
6. Right ASSESSMENT and APPROACH
Assess for:
Drug Allergy – assess for allergies for medication, food, environmental allergens
Drug History – note for concomitant use of prescription and OTC drugs
Drug Interaction – know drug-drug ad drug-food interactions that may happen when taking-in
a drug
Vital signs – assess vital signs prior to administration of the medication
Heart rate in one full minute when giving cardiac glycoside, beta-blockers, CCBs
Respiratory rate when giving centrally-acting analgesics, anesthesia, MgSO4, muscle relaxants
BP for antihypertensive agents
Temperature for antipyretics
7. Right TIME
Types of Drug orders:
a. Standing orders: or scheduled medications. To be given with 30 minutes allowance before or
after the scheduled time of administration. The order is terminated only upon written order of a
physician.
b. Single order: to be given only once as instructed.
c. PRN or as necessary
d. STAT or NOW medications. Immediately after the written order, the medication should be given.
NOTE: Review on accepted abbreviations:
OD - Once a day a.c - Ante-cebum (before meals)
BID - Twice a day p.c - Post-cebum (after meals)
TID - Thrice a day HS - hora somni (hours of sleep)
QID - Four times a day PRN - pro re nata (as necessary)
q2, 4, 6, 12 – every nth hour STAT - now
8. Right EDUCATION
Educate the client on:
1. Purpose of the medication
2. Side effects to expect
3. Adverse reactions to report
Types of adverse drug reaction:
a. Pharmacologic - extensions of the drug’s effect. e.g. hypotension for anti-hypertensive
b. Idiosyncratic – not a result of a known pharmacologic property of a drug. A peculiar reaction to
the patient. E.g drug-induced hemolysis for patients with G6PD deficiency patients.
c. Hypersensitive – involves the patient’s immune system. E.g allergic reactions from iodine-based
medications, antibiotics
d. Drug interaction – two incompatible drugs interact and produce unwanted effect. e.g Warfarin
and valproic acid(anti-convulsant) – increased anticoagulant effect
e. Iatrogenic – unintentional adverse effects that occur during the treatment of a patient. E.g
NSAID-induced renal failure, aspirin-induced gastritis
9. Right EVALUATION
Evaluate and record patient’s response to the medication.
10. Right to say NO - to RESUSE
Prepared by:
OWEN MARI L. DOMONDON, RN
