Julie-Anne Martyn

701 – What nurses know about medication safety that the 5-rights framework can’t tell?

This presentation will have you thinking differently about the ‘5-rights framework for safe medication administration’. The purpose of this presentation is to share what we learned about medication administration practices of registered nurses in a regional Australian hospital. The 5-rights framework is highlighted as inadequate for making meaning of any nurse’s complexly contextualised medication management practices. We propose a more contemporary approach to person-centred medication management.

The globally accepted framework for safe medication administration is known as the 5-rights – it has been apparent in health literature since the 1960’s. The framework is reflected in healthcare policy, education and practice. However, for modern healthcare, this framework may not have kept pace with contemporary practice, moreover, it underplays the critical thinking and tacit knowledge in nursing practice.

The results of 136 observation hours of registered nurses (N=20) practice, that included medication administration episodes (N=192) in public inpatient medical/surgical units (N=4) in a regional hospital in Queensland, found that medication administration was not routine and rarely directly reflected the rights framework. The data collection tool included the rights framework as a checklist, and the data were thematically analysed by cross-referencing the field notes about practice contexts and participant behaviours within the framework. These participants implemented some unconventional strategies to enable safe and timely medication administration.

Medication administration is more complex than the simplistic process suggested by the rights framework. Critically thinking registered nurses develop person-centred strategies to deal with complex clinical contexts and enact patient safety principles.

Key words: 5-rights; medication administration; person-centred; nursing practice; critical thinking.