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Doctor Says Nurses’ “5 Rights” Don’t Avoid Hospital Medication Errors

David W. Hodges
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Partner at Kennedy Hodges LLP practicing pharmacy error, medical malpractice and personal injury law
Posted on Aug 31, 2012

The method that nurses learn to prevent drug errors may not be effective in reducing the number of medication-related injuries, according to the associate dean for research at the University of Utah College of Nursing.

Dr. Ginette Pepper said nursing students are usually taught the "5 rights" of safe medication delivery. These steps are: right patient, right drug, right dose, right route, and right time. While it may be an easy mnemonic to memorize, it’s not necessarily effective in ensuring patient safety.

According to Pepper, there are several problems with the 5 rights:

  • They are goals, not procedures. The 5 rights focus on the individual who is performing them rather than system factors. As long as a nurse believes she has the right drug, she will often move on to the next “right” to complete the task, rather than evaluate the order.
  • They ignore the big picture. Telling nurses they can avoid errors by following the 5 rights, Pepper explained, is like telling airline pilots they can avoid crashes by making sure they have the right plane, the right passenger, the right airport for departure, the right destination, and the right take-off time.
  • They overlook other potential areas of error. Since the 5 rights do not include several steps in the overall medication use process, such as documenting and transcribing, errors that occur during those steps are likely to be overlooked.

Nurses have a hefty duty in caring for their patients and are most responsible for protecting them against errors. While nurses are often held accountable for drug mistakes, in reality they intercept an estimated 58 percent of all medication errors before the drugs are administered.

Pepper suggested that nurses have two specific roles when it comes to avoiding medication errors: They need to verify that other individuals have not made errors leading up to the point of medication administration, and they need to make sure that they do not make an error themselves.

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