The nine rights of medication administration: an overview P atient safety and quality of care are essential aspects of clinical nursing practice. When people are admitted to hospital, they expect to have their illness or disease treated, and to receive quality nursing care. They do not expect to be harmed. The primary goal of nursing care is to maximize health and wellbeing, and so optimize the quality of people’s lives (Wilson, 2009). However, hospitals can carry a risk to patients. In the UK as many as 10% of hospitalized patients may experience an adverse event, and some may experience multiple events (Vincent et al, 2001, Sari et al, 2007). Studies from other countries suggest that up to 30% of patients will experience an adverse event, and these come at a very high cost (Ehsani et al, 2006; Fowler et al, 2008; Griffin and Classen, 2008). The cost of adverse events Vincent et al (2001) reported that patients experiencing an adverse event in British hospitals are admitted for an extra 8.6 days, with additional costs of £290 268 to the trusts concerned. In 1999, it was estimated that the total annual cost of preventable adverse events in North America was between £10 billion and £17 billion (Thomas et al, 1999). Today, these costs may be even higher. Research in Australia Malcolm Elliott, Yisi Liu and New Zealand cited costs ranging from £3179 to £4616 per adverse event (Ehsani et al, 2006; 2007). One of these studies examined adverse events in acute admissions for cardiac disease. The sum total cost of adverse events for each diagnostic category was £23.6 million, representing 21.6% of total expenditure on cardiac surgery, and adding 27.5% to the cardiac surgery budget (Ehsani et al, 2007). A more significant cost of adverse events is the human one: the cost to the patient. Patients experiencing an adverse event are 4—7 times more likely to die than those who do not (Ehsani et al, 2006; 2007).Vincent et al (2001) found that 19% of adverse events result in moderate physical impairment, 6% in permanent impairment and 8% in death. One of the reasons adverse events are so common is that clinicians are human, and thus prone to error. The seminal study by Wilson et al (1999) found that human error was a significant factor. The majority (81%) of adverse events in their study were associated with one or more human factors, such as lack of knowledge, care or attention. Of the events that were considered highly preventable, less than 1% were not associated with human error.Vincent et al (2001) labelled 48% of adverse events as preventable, while Neale et al (2001) found that 53% of preventable events occurred in general ward care. Other studies have also found human error to be a key factor contributing to adverse events (Regenbogen et al, 2007; McQuillan et al, 1998; Rex et al, 2000). The nurse’s role Nurses have an important role in patient surveillance and error prevention (Rothschild et al, 2006). One of the most common types of adverse event is medication error, which is the most frequent cause of morbidity and preventable death in hospitals (Adams and Koch, 2010). Gurwitz et al (2003) reported that 38% of medication errors are serious or fatal, and 42% of those are preventable. A recent study in the UK found that 26% of medication errors were potentially grave (Dean et al, 2002), with fatal events including aspiration pneumonia and intracranial haemorrhage (Gurwitz et al, 2005). Medication errors can take many forms, and may occur at different phases of the medication administration process (from prescription by the medical officer, to dispensing by the pharmacist, or administration by the nurse). Examples of factors contributing to these errors are: Poor medication labelling Miscommunication among clinicians Lack of verification A disorganized medication trolley An incomplete medication prescription n n n n n 300 British Journal of Nursing, 2010,Vol 19, No 5 Malcolm Elliott is Lecturer, School of Nursing, Australian Catholic University, Melbourne, Australia. Yisi Liu is Lecturer, School of Nursing, Capital Medical University, Beijing, China Abstract Nurses are responsible for ensuring safety and quality of patient care at all times. Many nursing tasks involve a degree of risk, and medication administration arguably carries the greatest risk. Unfortunately, patients are frequently harmed or injured by medication errors. Some suffer permanent disability and for others the errors are fatal. Nurses have traditionally followed the five rights of medication administration (patient, drug, route, time, dose) to help prevent errors, and more recently, the seven rights (including documentation and reason). This article identifies nine rights of medication administration. Key words: Medication administration n Patient safety n Quality of care