Medicines - administration

The safe, accurate, timely and effective administration of medications is a fundamental nursing skill. The knowledge and skills involved in medicines administration are crucial to the provision of safe, holistic and person-centred nursing care.

Medication plays an important role in the management of disease, illness and symptoms. It is important that nurses are clear about what is required of them when administering medication.

Most medications that nurses administer must be prescribed by a registered prescriber, although in some instances medication which is available over the counter may be administered as identified in a local homely remedies policy (National Institute for Health and Care Excellence, 2014) or via a patient group direction (NHS England, 2024).

Prior to administering any medication, the nurse needs a comprehensive understanding of the:

• indications for prescribing
• actions on the body (pharmacokinetics and pharmacodynamics)
• dosing
• routes of administration
• side effects and adverse effects
• interactions with other medications
• cautions related to the use of the medication
• absorption, distribution, metabolism and excretion of the drugs

Nurses must also know and understand what constitutes:

• a safe medical administration record and/or prescription
• safe medication storage
• legal labelling

Medication administration is patient facing and therefore nurses must be aware of the various checks and behaviours needed to undertake safe administration. Prior to administration, the nurse should know the patient, or know how to identify the patient for whom the medication is prescribed (Royal Pharmaceutical Society, 2024). The nurse should understand how to assess the patient’s status before giving, or withholding, a medication, including for example:

• any pulse rate requirements and results (eg for digoxin)
• any blood

To check a medication before administration the nurse may need access to some or all of the following:

• an up-to-date British National Formulary or another drug reference resources (eg Monthly Index of Medical Specialties)
• a local formulary
• a patient medication administration record or prescription chart
• equipment for administering the medication for instance:
  • tablet/ liquid medication pots
  • a syringe
  • a giving set
  • nebuliser pots
  • personal protective equipment
• a red 'Drug Round in Progress Do not Disturb' tabard (Scott et al, 2010)
• if a calculation is involved, the nurse may need a calculator
• if the prescription is on paper, then a black pen for recording administration is needed

The processes involved in checking a prescription and a medication are detailed in Accurate checking of medication.

There is little consensus as to how many ‘rights’, in regard to checks, there are relating to medication administration or what these are (Smeulers et al, 2015). There are at least five rights of medication administration, although many commentators suggest various other rights (Elliot and Liu, 2010). The five rights which are widely cited (Elliot and Liu, 2010; Smeulers et al, 2015) are:

Right person

All medication as prescribed must be given to the correct person. The identity of the person may be ascertained by:

• asking the patient
• reading a name band which identifies the person
• using a photograph on the medication administration record or prescription; this is especially useful in children or people living with, for example:
  • acquired brain injury
  • dementia
  • learning disability

Right drug

Providing the right drug should involve reading the

Nurses must not administer medications when they:

• cannot ascertain the identity of the recipient
• do not know what the medication is or what it does or when there is some confusion about the name
• are concerned about the prescription in some way, eg the dose appears wrong
• cannot ascertain the timing for the medication dose or the dose has been missed
• do not have the training or competencies required for the route of administration prescribed
• do not have the formulation required in the prescription
• do not have the patient’s permission, ie the patient has refused the medication and has the capacity to do so

Failing to follow any of the rights of medication administration may lay the nurse open to claims relating to their professional capabilities. Any harm arising from a medication error may lead to the nurse having to attend a fitness to practice panel or other workplace review.

Nurses need to maintain their competence in the administration of medications if this is part of their role in order to meet role requirements and revalidation. In many organisations, nurses need to undertake refresher training each year. Nurses must be familiar with local policies which guide medication administration.

Nurses can subscribe to ‘drug safety updates’ from the Medicines and Healthcare products Regulatory Agency, which will help stay up to date on clinical advice pertaining to the safety of medication (HM Government, 2024).

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. Procedural competencies required for best practice, evidence-based medicines administration and optimisation

11.4 undertake accurate drug calculations for a range of medications

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

Dirik HF, Samur M, Seren Intepeler S, Hewison A. Nurses’ identification and reporting of medication errors. J Clin Nurs. 2018;28(5-6):931– 938. https://doi.org/10.1111/jocn.14716

Furnish C, Wagner S, Dangler A, et al. Evaluation of medication administration timing—are we meeting our goals? J Pharmacy Practice. 2020. https://doi.org/10.1177/0897190020905456

HM Government. Recent drug-name confusion. 2014. https://www.gov.uk/drug-safety-update/recent-drug-name-confusion (accessed 29 January 2024)

HM Government. MHRA email alerts. 2024. https://www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency/email-signup (accessed 29 January 2024)

Lau ETL, Steadman KJ, Cichero JAY, Nissen LM. Dosage form modification and oral drug delivery in older people. Adv Drug Deliv Rev. 2018;135:75-84. https://doi.org/10.1016/j.addr.2018.04.012

NHS England. Patient Group Directions (PGDs). 2024. https://www.england.nhs.uk/south/info-professional/pgd/ (accessed 29 January 2024)

National Institute for Health and Care Excellence.  Managing medicines in care Homes: social care guideline. 2014. https://www.nice.org.uk/guidance/sc1/resources/managing-medicines-in-care-homes-pdf-61677133765 (accessed 29 January 2024)

Phillips NM, Endacott R. Medication administration via enteral tubes: a survey of nurses’ practices. J Adv Nurs. 2011;67(12):2586-2592. https://doi.org/10.1111/j.1365-2648.2011.05688.x

Royal Pharmaceutical Society. Professional guidance on the administration of medicines in healthcare settings. 2024.