Patient safety: examining the adequacy of the 5 rights of medication administration

The purpose of this article was to examine the adequacy of the 5 rights (5 R's) for nurses and for including patients in medication administration while considering patient safety. Patient safety related to medication adverse events will be discussed; the 5 R's will be examined and critiqued and the importance of patient-centered care and patient participation in care will be presented. A path forward is offered based on the expressive-collaborative model. Suggestions for introduction of the model are outlined, and implications for practice, research, and education are discussed.

Nurses have been guided by the 5 R's of medication administration in both education and practice for many decades. Many have found the 5 R's to be lacking and proceeded to propose the addition of a variety of rights from right indication to the rights of nurses to have legible orders and timely access to information. Patients are no longer passive recipients of care and are choosing to play increasingly greater roles in the process of care.

In a collaborative patient-centered environment, an expressive-collaborative model of approaching systems of care is needed. In this model, individuals negotiate with one another to find out what people need to know and to strategize on the means to acquiring the necessary information. Providers are no longer expected to be all knowing.

Medication administration is no longer simply the 5 R's. Medication administration is a process with many interconnected players including patients. We need to collaboratively restructure medication use in this era in which all involved in the process share the responsibility for a safe medication use system.