Accurate checking of medications

Having the ability to check medications safely, effectively and within the requirements of the law, is central to the ability of the nurse to fulfil the requirements of their role.  Medication checking involves more than simply checking the name of the medication and giving it to the person, there are a multitude of other factors which need to be considered.

The ability to check medicines correctly and in a timely manner is a core skill for nurses, who are required by the Nursing and Midwifery Council (NMC, 2018) to be able to 'Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence'.

Nurses play a key role in ensuring the safe use of medications in any setting, which involves having a sound knowledge of both medications and medications processes (Rohde and Domm, 2018).  As well as considering their own practice, nurses are in a

Before a nurse undertakes the administration of a medication, they need to ensure that  they know what the medication is for as well as any potential issues related to its use. This may mean:

• Assessing if they have administered that medication or similar medication before and understanding:
  • Medication type
  • Route of administration
  • The effects and side-effects of the medication
• Knowing the effect the medication should have and over what period
• Being aware of any interactions which may occur with other medication the patient may be taking
• Understanding the local policies which govern the administration of medication
• Being aware of their role in relation to the Code
• Understanding the fundamentals of safe prescribing
• Understanding what should be present on the medication label supplied with the medication:
  • The name of the medication and the active ingredients it contains
  • The strength supplied
  • The quantity dispensed in the packet or bottle
  • The name of the person

To check a medication before administration, the nurse may need access and be able to use:

• The British National Formulary or an alternative, such as the Monthly Index of Medical Specialties
• A local formulary
• The patient's medication administration record 

The nurse may also need a calculator or other means of undertaking the calculation involved in medication administration.

Checking of medications is subject to local policies and procedures. Local policies may dictate how many nurses must check a medication before administration; this may be different for certain classes of medications, such chemotherapy (Schwappach et al, 2016), intravenous medications and controlled drugs. The nurse should refer to The Royal Pharmaceutical Society guidance on the administration of medicines in healthcare settings for advice (Royal Pharmaceutical Society, 2023).

The nurse who is responsible for checking the medication must be certain that it is given to the person who has been prescribed it. Medication checking is not an isolated activity, as it is part of a wider process of patient care. Checking medication prior to administration requires the nurse to check that the medication administration record contains the correct information, including:

• Patient information, to ensure medication goes to the right patient safely including:
  • First name and surname, where known
  • Date of birth
  • Weight

Nurses should not administer medications when they:

• Do not know what the medication is or what it does
• Have not received the training and demonstrated the competence required to administer the medication via the prescribed route
• Are concerned about the prescription in any way (eg the dose appears wrong)
• The medication appears to be out of date or stored incorrectly

Failure to check medication properly can have a various consequences, including:

• Denying the patient the medication they need
• Denying the patient relief from symptoms
• Giving the wrong medication to the patient
• Worsening the condition of the patient
• Causing irreversible life-changing damage to the patient
• Causing the patient to die
• Subjecting the nurse to a fitness to practice hearing
• Subjecting the nurse to prosecution for negligence

Where the nurse does not know the medication that they are being asked to administer, they should:

• Look it up on a reliable pharmaceutical reference

Nurses who can administer medication are educated and deemed competent to do so, and should update their training according to local policy, which may mean attending annual updates. Nurses should constantly update their medication knowledge according to the requirements for revalidation, in order to ensure not only that they know about new medications, but also that they are aware of any safety concerns.

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 2: Procedures for the planning, provision and management of person-centred nursing care

11.2 recognise the various procedural routes under which medicines can be prescribed, supplied, dispensed and administered; and the laws, policies, regulations and guidance that underpin them

11.5 undertake accurate checks, including transcription and titration, of any direction to supply or administer a medicinal product

11.6 exercise professional accountability in ensuring the safe administration of medicines to those receiving care

Coyne E, Needham J, Rands H.  Enhancing student nurses' medication calculation knowledge; integrating theoretical knowledge into practice. Nurse Education Today.  2013;33(9):1014-1019. https://doi.org/10.1016/j.nedt.2012.04.006

Koyama AK, Maddox CS, Li L, et al. Effectiveness of double checking to reduce medication administration errors: a systematic review. BMJ Quality & Safety.  2020;29:595-603.  http://dx.doi.org/10.1136/bmjqs-2019-009552

Nursing and Midwifery Council. The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. 2018.  https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf.  (accessed 19 August 2021)

Nursing and Midwifery Council.  Useful information for prescribers. 2023. https://www.nmc.org.uk/standards/standards-for-post-registration/standards-for-prescribers/useful-information-for-prescribers/ (accessed 16 October 2023)

Rohde E, Domm E. Nurses’ clinical reasoning practices that support safe medication administration: An integrative review of the literature. J Clin Nurs. 2018;27(3-4): e402– e411. https://doi.org/10.1111/jocn.14077

Royal Pharmaceutical Society. Professional guidance on the administration of medicines in healthcare settings. 2023. https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/SSHM%20and%20Admin/Admin%20of%20Meds%20prof%20guidance.pdf (accessed 16 October 2023)

Schwappach DLB, Pfeiffer Y, Taxis K.  Medication double-checking procedures in clinical practice: a cross-sectional survey of oncology nurses' experiences.  BMJ Open. 2016;6:e011394.