Medication administration is arguably the most frequent and highest-risk task performed by nurses in most clinical settings. With hundreds of thousands of patients hospitalized annually due to medical errors, medication administration demands unwavering focus. As a nursing student, you will learn about the Six Rights of Medication Administration before you ever touch a patient. Implementing these steps is crucial to minimizing errors and upholding patient safety.
In this article:
- The Six Rights of Medication Administration
- New Additions To The Six Rights
- From Checklist to Safe Practice
- References
The Six Rights of Medication Administration
The six steps to safe medication administration include the:
Any deviation from this process can result in a medication error. Many facilities implement technological safeguards to prevent errors, but it’s imperative not to rely solely on them. Over time, the six rights will become less of a checklist and a normal part of your everyday routine.
Right Patient
The first step in the process is to identify the right patient using two unique identifiers. This is most often the patient’s name and date of birth. The patient’s medical record number is another acceptable identifier. It is best practice to read the patient’s wristband as they are telling you their name and date of birth. Next, you will compare this information with the Medication Administration Record (MAR).
Student Tips for Patient Identification
- Never use the patient’s room number as an identifier, as this can change. Also, don’t state the patient’s name for them. Patients may be confused or share the same name as other patients in busy settings. Always have the patient verbalize their name and date of birth.
- Many settings utilize barcode scanning to link the patient to the MAR. Treat this safeguard as an additional check, not a replacement for human verification.
Right Medication
Administering the correct medication is paramount. There are often several opportunities to ensure you are administering the correct medication:
- When you retrieve the medication
- When you prepare the medication
- Just before administering the medication
Retrieving the Medication
In hospital settings, most medications are stored in a Pyxis, which is an automated medication dispensing system. If a specific medication is not ordered for the patient, it will not be retrievable, unless you override the machine. Again, utilize this safeguard, but do not rely on it for final confirmation.
Preparing the Medication
If the medication has to be crushed, drawn up from a vial, or mixed, pause to ensure it is the right medication.
Nursing Pearl: Every effort should be taken to prepare a medication at the patient’s bedside to limit errors. If this is not possible, such as drawing up insulin from a refrigerated vial, the syringe or container should be labeled with the medication name, dose, the patient’s name, and your initials to prevent mix-ups.
Administering the Medication
Once you are at the patient’s bedside, perform a final check against the MAR to ensure you are administering the correct medication and dose to the patient before discarding the vial or packaging.
Student Tip: Look-Alike-Sound-Alike Drugs
As a student nurse, it is imperative to familiarize yourself with common medications and drug classes. You will encounter drugs with very similar names known as Look-Alike Sound-Alike drugs. Most medications will have both the brand and generic names on the label, and some will use “tall man lettering” to grab your attention and prevent errors.
Right Dose
Ensuring the right dose may require critical thinking. It isn’t always as simple as confirming the prescription order. This is an opportunity to ensure the dose is safe for your patient based on their age, weight, and current health status. There are times when a physician enters an order incorrectly, the pharmacy fills it, and the nurse is the final catch before administering a dose that could cause patient harm.
Medication Calculations
Performing medication calculations is a common task for nurses. For example, the physician orders 1 mg of hydromorphone for a patient, but the vial is 2 mg/mL. The nurse will only administer 0.5 mL and will waste the rest with a witness.
In critical care settings, medication calculations will be more complex, such as titrating sedatives or vasopressors.
High-Alert Medications
When administering high-alert medications like insulin or heparin, you will be required to have a second nurse double-check the order/calculation/lab result to ensure the correct dose is administered.
Student Tip: Memorize unit conversions, such as milligrams (mg) to micrograms (mcg) or pounds (lbs) to kilograms (kg), as these are frequently encountered in calculating medication dosages.
Right Route
Ensure the route (PO, IV, subQ, IM, rectal, topical, etc.) matches the order and drug formulation. Never substitute or alter routes. For example, an enteric-coated tablet should not be crushed, as this can alter the absorption.
If a patient states they cannot take a medication a certain way (e.g., pills are difficult to swallow), the nurse can request an order for another formulation, such as a liquid, if available.
Student Tip: You may not be studying to be a pharmacist, but understanding the pharmacokinetics of a drug (how it is absorbed, distributed, metabolized, and excreted) will help you understand how routes determine a medication’s speed and efficacy.
Right Time
It can be difficult in busy hospital settings to administer medications on time. Most facilities allow a one-hour window before and after the medication is due. Many medications are scheduled for specific times to achieve an optimal therapeutic effect.
For instance, antibiotics must be administered at precisely scheduled intervals to maintain therapeutic drug levels and prevent bacterial resistance. Other medications, like short-acting insulin, are scheduled before meals.
Student Tip: Make every effort to stick to the MAR schedule, but understand that factors like meal times, patient refusal, blown IV lines, surgeries, diagnostic tests, and more will frequently cause delays.
Right Documentation
Documentation is the final piece of medication administration. Document immediately following the administration, never before. If using barcode scanning, the MAR will automatically update. If administering an IM or subQ injection, don’t forget to note the location so subsequent injection sites can be rotated. If administering a PRN medication, include the reason (such as the patient’s pain level or temperature if administering an antipyretic).
Student Tip: Commit this quote to memory: “If it wasn’t documented, it wasn’t done.” Accurate documentation protects the patient and serves as a legal record to protect the nurse.
New Additions To The Six Rights
There are several extended “rights” that further round out safe medication administration:
- Right Reason: You must understand the rationale for every medication you administer. What is the medication indicated for? Refer to the patient’s current diagnosis or history to ensure the medication is appropriate. When in doubt, collaborate with the provider.
- Right Response: It’s important to evaluate the response to certain medications. For example, did the antihypertensive reduce the patient’s blood pressure? Did the antiemetic relieve their vomiting? It’s also important to monitor for any adverse effects or allergic reactions.
- Right Education: In some cases, it may be necessary to provide education about a medication’s intended effects, side effects, or administration instructions.
- Right to Refuse: Patients may refuse any medication for any reason. Document the refusal, educate the patient on potential consequences, and notify the provider.
From Checklist to Safe Practice
The six (and extended) rights are an evidence-based framework to support safe medication administration. As a student nurse, commit to adhering to each step of this process and avoid shortcuts. It can be easy to become complacent after years of practice, but remaining vigilant is key to preventing errors and keeping your patients safe.
References
- Angela Hanson; Lisa M. Haddad. Nursing Rights of Medication Administration. Accessed November 2025. https://www.ncbi.nlm.nih.gov/books/NBK560654/
- Institute for Safe Medication Practices (ISMP). High-Alert Medications in Acute Care Settings. Accessed November 2025. https://home.ecri.org/blogs/ismp-resources/high-alert-medications-in-acute-care-settings
- Paul MacDowell; Ann Cabri; Michaela Davis. Medication Administration Errors. Accessed November 2025. https://psnet.ahrq.gov/primer/medication-administration-errors
- The Joint Commission. Two Patient Identifiers – Understanding the Requirements. Accessed November 2025. https://www.jointcommission.org/en-us/knowledge-library/support-center/standards-interpretation/standards-faqs/000001545
- U.S. Food and Drug Administration. FDA Name Differentiation Project. Accessed November 2025. https://www.fda.gov/drugs/medication-errors-related-cder-regulated-drug-products/fda-name-differentiation-project
