三讀五對對藥師和護理師來說，都是必備的專業知識，不過，你知道五對的英文該怎麼說嗎？
The “Five Rights” of Drug Administration
right patient, right drug, right dose, right time, and right route.
RIGHT PATIENT
The right patient means that the healthcare provider gives the drug to the right
patient. Each time a drug is administered, the healthcare provider must verify
who the patient is by the patient’s identification bracelet. This is the preferred
method as opposed to identifying a patient by asking his or her name. Some
patients will answer “yes” to any name and two patients can have similar-
sounding names or the same name. Some patients are not mentally alert and do
not remember their name. Again, check the patient’s identification every time
medication is administered.
RIGHT DRUG
Healthcare providers must be sure that the drug is the correct medication for the
patient. This too leads to errors. Healthcare providers ask: Was this the drug pre-
scribed on the medication order? Is the medication order legible and complete?
Why is the patient receiving this medication? Is the medication consistent with
the patient’s condition? Does the patient have any food or drug allergies?
Providers check the expiration date and return the medication to the phar-
macy if it has expired. If the medication is used past the expiration date, the
effect on the patient can be unpredictable.
Healthcare providers check the medication label three times before adminis-
tering the drug. First, when they take the medication from the shelf or drawer.
Next, the label should be checked before pouring the drug, and third it is
checked after pouring the drug before throwing away the drug packaging.
RIGHT DOSE
The dose on the medication order must be within recommended guidelines. The
healthcare provider should have a general idea of the dose before performing
any drug calculations. If the calculated dose varies too much from this estimated
dose, check with a pharmacist or another appropriate healthcare provider. Some
drug calculations should always be checked by two individuals if the calculation
is complicated or the drug has the potential to be harmful if the dose is too large
or too small. Medications that are wrapped and labeled or pre-filled for the exact
dose are preferred and can reduce errors.
Healthcare providers should also make sure they use the proper system of
measurement when calculating a dose (see Chapter 4 Principles of Medication
Administration).
RIGHT TIME
Is it the correct time to administer the drug? The time is specified in the drug
order and may be given a half hour before or after the stated time depending on
the policy of the hospital or healthcare facility. How often a drug is given is
dependent on the half life of the drug. Adrug’s half life is the amount of time for
1⁄2 of the drug to be eliminated from the body. Adrug with a short half life must
be administered more frequently than a drug with a long half-life in order to
maintain a therapeutic level of the drug in plasma.
The use of military time can avoid A.M. andP.M. errors.
Check if the patient is scheduled for diagnostic or other procedures that might
interfere with administration of medications. Check if the patient should receive
the medication even if they are scheduled to be NPO (nothing by mouth).
Healthcare providers should also make sure that medication is given in coor-
dination with meals. Some drugs must be given with meals while other drugs are
given a specific period before or after a meal.
Where possible, the medication schedule is adjusted to conform to the patient’s
lifestyle, which may differ from the normal schedule. For example, Digoxin
might be scheduled for 10 A.M.to conform to hospital policy, but the patient can
take Digoxin any time in the morning. This becomes important once the patient
is discharged and takes medication at home.
RIGHT ROUTE
The healthcare provider determines the proper routine to administer the drug so
the patient’s body properly absorbs it. Here are the common routes:
• Oral (by mouth): liquid, elixir, suspension, pill, tablet, and capsule
• Sublingual (under tongue): pill, tablet, and capsule
• Buccal (between gum and cheek): pill, tablet, and capsule
• Topical (applied to skin): cream, ointment, and patch
• Inhalation (aerosol sprays): liquid
• Instillation (nose, eye, ear): liquid, cream, and ointment
• Insertion (rectal, vaginal): suppository
• Intradermal (beneath skin): injection
• Subcutaneous (beneath skin): injection
• Intramuscular (in muscle): injection
• Intravenous (in vein): injection
• Nasogastric and gastronomy tubes: liquid
• Transdermal: patches
Make sure that the patient can swallow if the route of the medication is by
mouth and stay with the patient until the medication is swallowed. Enteric
coated or time-release drugs should not crushed or mixed. Caution should be
used when administering intravenous medications because the body quickly
absorbs these drugs. Therefore, healthcare providers need to know expected side
effects, effects that occur when the drug is first given, effects the drug has dur-
ing its therapeutic peak, and duration of the drug’s action. Caution should be
used when administering any medication via this route.
Self-administration of medication (SAM) is the normal practice for patients
in the home and workplace. This method is also used in some acute and long-
term care institutional settings. In these settings the nurse gives the patient a
packet of medications with instructions that are kept at the bedside. The
patient takes the medication according to the instructions and advises the nurse
when he or she has done so. This practice help patients learn how to manage
the medications and prepares them for discharge and use of these medications
in the home. This method is often used with oncology (cancer) patients and
maternity patients.
Patient controlled analgesia (PCA) is a common method of administering
intravenous pain medication for many patients.
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