Medication Administration Part 1: Universal Rights

Now that I am officially a med tech (a caregiver who prepares and administers medications) in the long term care facility in which I work, I thought I would outline some basic rights that we all have (except for some very extenuating circumstances) when receiving medication in a healthcare setting. This is the first of a three part series in medication administration. One of the first things a med tech learns at the company in which I work, are the seven rights of administering medications. They are:

1. Right person- the right person gets their prescribed medication
2. Right dose- the correct dose is given
3. Right medication- the correct medication is given
4. Right reason- the medication aligns with the correct reason the mediation was prescribed (for example, you wouldn’t give an enema for a fever, or pain medicine for vomiting, etc)
5. Right route- the route is the way by which the medication is given (by mouth, sublingual, inhaled, rectally, vaginally, etc.)
6. Right time- the medication is given within the time parameters determined by the prescriber
7. Right documentation- you are documenting required items such as the reason for giving the medication, and/or the corresponding vital signs needed to give the medication

There are other rights, and these rights are changing constantly. These particular rights are changing year by year, and there are many other rights that are out there that I haven’t listed. The most important one, which I do not understand why it is not listed in our company policy, is the right to refuse medication. 

That’s right. Even if your brain has turned into mush from dementia, mental illness, drug and alcohol abuse, or for any other reason, except for very extenuating circumstances, all patients/residents (this includes you too!) have the right to refuse treatment, care, and most importantly, medication. If you, for example, are in the hospital, and a doctor says “Let’s get you some medication for X,” and you do not want that medication, you have the right to refuse. You can also refuse any treatment. If a doctor wants to place a catheter, and you don’t necessarily feel like having a rubber tube inserted in your urethra, you have the right to refuse. The hospital or long term care staff assume that you are fully capable of making your own decisions about your body, and they are legally obligated to respect your wishes. 

As a med tech, I am legally obligated to inform everyone I give medication to that the person is, in fact, about to take medication. This includes when the medication is crushed and mixed into food such as ice cream, applesauce, or pudding. It can be as simple as stating “this is your medication.” However, if the person asks me what kind of mediation it is or what it is for, again, I am legally obligated to tell them. This is a tactic to get people to take medication, too. A person may be skeptical of taking a handful of random pills. However, once a person knows that they are taking a combination of pain medicine, antipsychotics, heart medicine, or the like, they may be more likely to take the pills. If someone is taking a variety of medications at once, they may refuse some and not others, as is their right.  

There are, however, very extenuating circumstances in which you will receive medication without your knowledge or consent. This happens most frequently in long term psychiatric care facilities. In these facilities, the residents may have delusions about medications, and may become violent or sick to a point of needing to be hospitalized if they do not take their medications. In these cases, a doctor will issue a “crush and hide order.” It is exactly what it sounds like. The medication is crushed and mixed with food or drink, and given to the resident without telling them that their medication is in the food. The resident then takes the medication and receives the benefits of that medication(s) without knowing that they are even taking anything. These orders are generally very difficult to obtain, and sometimes even require the support of a judge and/or lawyer. 

Another right is the right to be free from physical and chemical restraints. This means that long term care facilities are not allowed to use physical restraints, such as seat belts for wheelchairs, or bedrails (bedrails in particular are actually really dangerous). We are also not allowed to sedate people using medications. This means that if someone is just being annoying, and not showing signs of physical or mental anguish, we cannot just “give them something” to make them compliant, quiet, or less physically active. This goes along with “right reason” and “right documentation.” Medication must be given for the correct reason (pain medication for pain, anxiety medication for anxiety, etc), and must also be documented properly. We will be going over proper documentation in the next part of the series. 

Okay! That was the first part of the three-part series. The next part will be about non-medication interventions, and will be released next week. Thanks for reading!