Medication Administration & Safety

01Rights of medication administration

Every dose is checked against the right patient, right medication, right dose, right route, right time, and right documentation. Documentation happens immediately after giving the medication, never before.

02High-alert medications

Insulin, anticoagulants (heparin, warfarin, DOACs), opioids, and concentrated electrolytes are ISMP-designated high-alert medications because an error with them is more likely to cause serious patient harm, so they get extra verification steps.

03Insulin basics

Regular insulin is the only insulin type given IV (important in DKA management). NPH is intermediate-acting and cloudy in appearance. When mixing regular and NPH in one syringe, draw up the clear (regular) insulin before the cloudy (NPH) insulin.

04Anticoagulant antidotes

Protamine sulfate reverses unfractionated heparin. Vitamin K reverses warfarin. Confusing the two antidotes is a common and dangerous error.

05Insulin dosing safety

Insulin must be drawn up and administered using a syringe calibrated in units, not a standard mL syringe, to prevent tenfold dosing errors — one reason it's treated as high-alert.

06IV potassium safety

Potassium chloride is a concentrated electrolyte that must always be diluted and given as a controlled infusion — never as an IV push — because a rapid bolus can cause a fatal cardiac arrhythmia.