Safe Medication Administration: The Six Rights and Why the Seventh Matters
Medication errors are the most preventable patient safety events in healthcare. The NCLEX-PN consistently tests whether the future LPN applies a systematic verification process before every medication administration. The Six Rights are the baseline. The Seventh Right — the right to refuse — reflects the patient's autonomy and appears in questions about patient education and informed consent.
| Right | What to Verify | Common NCLEX Trap |
|---|---|---|
| 1. Right Patient | Two identifiers (name + DOB or MRN) | Verbal confirmation alone is NOT sufficient |
| 2. Right Drug | Generic and brand name match; allergies cleared | Similar drug names (hydromorphone vs morphine) |
| 3. Right Dose | Calculated dose matches order; safe range confirmed | Pediatric weight-based calculations |
| 4. Right Route | Ordered route is appropriate for patient status | NPO patient receiving oral medication = error |
| 5. Right Time | Correct timing; before or after meals as required | Insulin timing relative to meals |
| 6. Right Documentation | Document immediately after administration — not before | Documenting before giving = falsification |
| 7. Right to Refuse | Patient may refuse any medication; document refusal; notify provider | Do not give the medication despite patient refusal |
Never Document Before Giving: Pre-documenting medication administration is a legal and ethical violation. Document only after the medication has been administered. If interrupted, return, verify, give, and then document.
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