Medication Safety and Medication Administration
Framing the domain
Questions test the rights of administration, high-risk medicines, calculations, and what to do when something is wrong. Know the rights: right person, right medicine, right dose, right route, right time, right documentation, right reason, and right to refuse. Understand the additional safeguards for high-risk medicines (insulin, anticoagulants, opioids, chemotherapy, concentrated electrolytes), the meaning of Tall Man lettering, look-alike/sound-alike names, and the requirement for independent double checks where policy specifies.
Concepts to know
Prescription requirements and what makes a prescription legal and complete; verbal and telephone orders and their documentation limits; allergy and adverse drug reaction documentation; therapeutic drug monitoring; PRN decision-making and evaluation of effect; medication reconciliation at transitions; reporting and open disclosure of medication errors; and the role of the person in confirming identity and medicines.
Common traps
- Relying on a bed number or room rather than two approved identifiers.
- Accepting an incomplete or illegible order instead of clarifying with the prescriber.
- Double-checking with the same person who prepared the medicine and calling it independent.
- Failing to evaluate and document the effect of a PRN medicine.
- Hiding an error; the correct action is assessment, escalation, disclosure, and incident reporting.
Rule of thumb and worked example
Rule of thumb: if any right cannot be confirmed, stop and clarify - the safe answer is almost never "give it anyway".
Worked example: An order reads "insulin sliding scale" with no target range and the patient is drowsy. The correct action is to withhold until clarified, check blood glucose immediately, assess for hypoglycaemia, contact the prescriber for a complete order, and document the omission and the conversation. If harm occurred, follow open disclosure and complete an incident report.