Medication “Rights” and Safety Checks

It is essential that HCAs are familiar with and always follow the “Rights” of Medication Management and complete the medication safety checks whenever assisting clients to take their medications or administering medications that have been delegated to them.

When managing medications it is important for the HCA to check the label for each medication three times; this is called the medication safety checks. The safety check should happen:

1. When obtaining the medication from its storage location
2. Just before measuring/counting out the medication
3. When medication container is returned to its storage location

With each medication safety check, the HCA must follow the six critical ‘rights’ of assisting or administering medications. Remember, there are 7 critical ‘rights’ for regulated care providers, but HCAs are not required to know the “right reason’ as this is out of their scope.

The “6 Critical Rights” for the Health Care Assistant

In some community settings, a HCA may be working with more than one client, as in Supportive Care/Assisted Living sites, groups homes, or when both the client and the spouse are receiving assistance in the same home. When situations like these occur, there is an increased risk that a client may be given someone else’s medications.  There are a number of ways to prevent this from occurring:

• When meeting a client for the first time, HCAs must always use two client identifiers such as name, address, or date of birth to ensure you have the correct person
• In some settings, a photograph may be used as a client identifier
• If there is any indication or uncertainty on the client’s part regarding their name, look for another way to confirm this, such as asking the client their date of birth, mail addressed to the client, photos in the client’s room, ask another care provider if available, etc.
• always give the medication to the client in the client’s room/suite – not in common areas such as a dining room – if the home support service plan directs you to provide medication assistance or administration in a common area, do not proceed, and report this to your Supervisor
• Always check the controlled dosage system label for the client name to ensure you are using the correct one – the client may have a spouse in the same home with a similar blister pack!
• If there is any chance that the client’s identity could be mistaken, do not proceed, and discuss this concern with your Supervisor or RN

Right Client

The right client is confirmed using two (2) client identifiers such as the client’s name and date of birth. In some settings, a photograph may be used as a client identifier.

Right Medication

Checking between the label on the medication or packaging and the care plan or medication record. Also, the client’s name on the medication label confirms the medication belongs to the client.

Right Time

Verifying the date and time medication is provided, identified on the controlled dosage system or medication label, which corresponds to the care plan or medication record. It is important to know how to read the medication label and dosage system, and to be aware that if a HCA is being asked to assist a client with medications from the dosage system, it must be accurately labelled. If there is any discrepancy that does not include the client’s name, name of dispensing pharmacy, and a correct date range, stop what you are doing and report this to your Supervisor or RN.

Right Dose (amount)

The correct number of tablets/capsules or amount of medication (e.g., number of drops) is checked against the medication label and care plan or medication record.

Right Route

The right route is the method the medication is taken into the body. The route is identified on the medication label and in the care plan or medication record. It may seem very unlikely that the route for medications could be mixed up when assisting a client but it is possible. While most pills are swallowed, some pills are placed under the tongue to be absorbed. Suppositories can be given vaginally as well as rectally and could, therefore, be confused.

When you think of the right route, you also need to think about the right place. For example, topical medications such as creams or ointments are usually applied to a specific area on the body. Transdermal patches are usually rotated from place to place, so getting the ‘right’ place is also very important. If medications have been delegated for administration, the Care Plan needs to be checked very carefully for information regarding the ‘right place’.

Right Documentation

Documentation of the medication assistance or administration is completed immediately after the medication care activity has been completed, in accordance with the processes in the care setting. Signing that you completed the task (medication assistance) or restricted activity (medication administration) is part of the being accountable. Forgetting to sign the documentation is considered a medication error. In a court of law, unless there is a documented note saying that the task or restricted activity was done, it is considered to not be completed. Always sign the appropriate agency documentation form after completing medication care activities.

Right to Refusal*

While not considered a “critical right”, the client has the right to refuse medications. If the client refuses medication, document the refusal and immediately notify the supervising regulated health care provider. Do not force the client to take the medication.

Right Reason*

Unregulated health care providers (ie: HCAs) are not required to know the “right reason” for the medication when providing medication assistance or administration. Regulated health care providers (ie: RNs) who regularly review the medication regimen in collaboration with the client and the health care team are responsible to ensure medication is taken for the “right reason.”