Nurses Rx: Medication Administration

Friday, November 11, 2011

From George Indest's Nursing Law Manual

Nurses face a busy schedule often including a long list of patients and extensive work hours. As a result, they can become overworked and overtired, which may lead to mistakes when carrying out essential job duties like administering medication.

An Institute of Medicine (IOM) report titled
To Err is Human: Building a Safer Health System (IOM, Dec. 1999) states the deaths from medication errors that take place both in and out of hospitals, more than 7,000 annually, exceed those from workplace injuries. In a separate report, investigation by the Chicago-Tribune states that since 1995, at least 1,720 hospital patients have died and 9,548 others have been injured because of mistakes made by RN’s across the country (Associated Press, Sept. 10, 2000).

Because nurses are usually the front-line health care providers who are required to administer medications prescribed by physicians (and often the most potent medications to critically ill patients), they must be especially careful in their procedures and practices to avoid one of the many types of common medication errors.

The most common types of medication errors include:
1. similar sounding medication name;
2. administration without a prescription;
3. the wrong medication;
4. the wrong dosage;
5. negligent injection;
6. failure to note an order change;
7. failure to administer medication;
8. failure to discontinue medication;
9. use of an unsterile needle;
10. the wrong patient;
11. allergic reactions; and
12. failure to assure patient taking medications.

Nurses are required to handle and administer a vast variety of drugs that are prescribed by physicians and dispensed by an organization’s pharmacy. Medications may range from aspirin to esoteric drugs that are administered through intravenous solutions. These medications must be administered in the prescribed manner and dose to prevent serious harm to patients. There are a variety of ways to ensure that, as a nurse, you are helping to prevent medication errors within your facility.

Use this checklist from George Indest's Nursing Law Manual in order to maintain safe administration procedures. Nurses are exempted from the various pharmacy statutes when administering a medication on the oral or written order of a physician. However, the improper administration of medications can lead to malpractice suits.

A nurse should never administer prescription medications without a valid prescription or order from a physician. In effect, doing that constitutes practicing medicine without a medical license and is beyond the scope of a nurse's license. Administering medications without approval may give rise to legal liability and disciplinary action against the nurse.


The injection of the wrong medication into a patient can lead to civil liability or to a charge of substandard nursing care made to the Department of Health. A nurse who prepares medication for a physician is liable for the preparation of that medication. A physician can blame a nurse who fails to prepare the medication properly in order to escape liability.

In the case of Ambercrombie v. Roof, a solution was prepared by a nurse employee and injected into the patient by a physician, 28 N.E. 2d 772 (Ohio 1940). The physician made no examination of the fluid, and the patient suffered permanent injuries as a result of the infection. An action was brought against the physician for malpractice. The patient claimed that the fluid injected into her was alcohol and that the physician should have recognized its distinctive odor. The court, in finding for the physician, stated that the physician was not responsible for the misuse of drugs prepared by the hospital, unless the ordinarily prudent use of his faculties would have prevented injury to the patient.


A nurse is responsible for making an inquiry if there is uncertainty about the accuracy of a physician's medication order in a patient's record. A nurse who is in doubt about a physician's orders should contact that physician and seek clarification of their order.

The nurse in Fleming v Baptist General Convention, 742 P.2d 1087 (Okla. 1987), negligently injected the patient with a solution of Talwin and Atarax subcutaneously, rather than intramuscularly. The patient suffered tissue necrosis as a result of the improper injection. The suit against the hospital was successful. On appeal, the court held that the jury's verdict for the plaintiff found adequate support in the testimony of the plaintiff's expert witness on the issues of nursing negligence and causation.

A nurse's failure to review a patient's record before administering a medication, to ascertain whether an order has been modified, may render a nurse liable for negligence.

In Kallenberg v. Beth Israel Hospital, 357 N.Y. S.2d 508 (N.Y. App. Div. 1974), a patient died after her third cerebral hemorrhage because of the failure of the physicians and staff to administer necessary medications. When the patient was admitted to the hospital, her physician determined that she should be given a ceratin drug to reduce her blood pressure and make her condition operable. For some unexplained reason, the drug was not administered. The patient's blood pressure rose, and after a hemorrhage, she died.

The jury found the hospital and physicians negligent in failing to administer the drug and ruled that the negligence had caused the patient's death. The appellate court found that the jury had sufficient evidence to decide that the negligent treatment had been the cause of the patient's death.


A health care organization will be held liable if a nurse continues to inject a solution into a patient after noticing its ill effects. Once something is observed to be wrong with the administration of the medication, the nurse has a duty to discontinue its use.


The blood donor in Brown v. Shannon West Texas Memorial Hospital, 222 S.W. 2d 248 (Tex. 1949), sought to recover from a serious injury allegedly caused by the use of a nonsterile needle. The court held that the burden of proof was on the plaintiff to show, by competent evidence, that the needle was contaminated when used and that it was the proximate cause of the alleged injury. The mere proof, said the court, that infection followed the use of the needle or that the infection possible could be attributed to the use of an unsterile needle was insufficient. If the plaintiff had been able to prove the needle was not sterile, then the plaintiff would have recovered damages.

It is of utmost importance to check each patient's name bracelet before administering any medication. To ensure that the patient's identity corresponds to the name on the patient's bracelet, the nurse should address the patient by name when approaching the patient's bedside to administer any medication. Especially in nursing homes and hospitals where there may be more than one patient in a room, this is exceptionally important. Should the nurse unwittingly administer one patient's medication to a different patient, the attending physician should be notified and appropriate documentation placed on the patient's chart.

Any adverse reactions to a medication should be charted on the patient's medical record. The attending physician and the facility's pharmacy should be advised as to the patient's allergic reaction.

A nurse normally has a duty to monitor and ensure that a patient is taking their medications. A failure to perform this act can lead to nursing negligence on the part of the nurse.


There is a checklist every nurse should learn called the "Seven Rights of Medication." If this checklist is memorized and followed in every case, medication errors would be significantly reduced or eliminated altogether. Every nurse and nursing student should memorize this list and go through it in her mind every time a patient is administered a medication by the nurse. Always check for and confirm:

1. The right medication;
2. The right patient;
3. The right dose;
4. The right time;
5. The right route;
6. The right reason; and
7. The right documentation;

The nurse may be the last wall of defense to protect a patient from a medication error. The nurse should avoid at all costs, being rushed, tired, inattentive, sloppy, or lazy. Guard at every turn against medication errors. For more information about nursing law, or to read more from the Nursing Law Manual, visit


Response to: Nurses Rx: Medication Administration
Thursday, November 22, 2012
Susan Abruzzi says:

How long can a nurse administer a long term medication from a RX in a Day treatment facility? For example Depakote is ordered at 12noon(although it is TID) the 12 noon is for day program The RX states give at 12noon. Family sends in 90 tablets, Rx written 11/ 20/12 with 1 refill.Is the order good for a year during the course of the day program? Or must we ask the family to get another RX by 1/20/12 even though the Dr is aware the med will be administered through out the year and the family sends in the medication as needed? Any changes in dosage or medication would be sent in by family.

Response to: Nurses Rx: Medication Administration
Friday, January 22, 2016
Debra Blocker says:

I'm just disgusted with health care providers right now. I was recently in Roanoke Carillon Memorial Hospital and was given phenergan by injection, AFTER TELLING THEM AND DIRECTING THEM TO READ MY NOTES IN THE COMPUTER, that I can't have it injected due to my anxiety and it raising my heart rate. I was ALREADY mostly sedated off of other meds they'd given, so I didn't notice until the panic began. Long story short, I jumped up in a panic. They tried grabbing me and I hit someone unintended. I was afraid. They called cops and had me charged as if I were just VIOLENT. Is that right?

Response to: Nurses Rx: Medication Administration
Monday, February 15, 2016
candance says:

Can a change an admin tome to 7am 2pm and 8pm if the doctor writes on the script take med every 8hour?

Response to: Nurses Rx: Medication Administration
Saturday, June 25, 2016
Brandy Dauphine says:

I have a question. I have a patient who had orders for 4 separate prn pain meds. (Apap, oxycodone, neurontin, and flexeril). A nurse at my facility is administering them all at once. Is this legal??

Response to: Nurses Rx: Medication Administration
Tuesday, May 8, 2018
Mary Crook says:

Is it negligent when a PCP tells patient he will escribe medication in and a nurse is responsible to fax it over to pharmacy but doesn't and patient having withdrawal with nenzo. Is nurse negligent for not following through?

Response to: Nurses Rx: Medication Administration
Wednesday, August 29, 2018
Jonathan says:

I need to know what the law says about who can lawfully administer controlled meds in a privately owned residential care facility. I work at a Rescue Mission in Missouri and the meds are currently administered by a resident, not an employee or a certified med tech.

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