Name: ________________________________________
Date: _________________________________________
Procedure 54-1:
Administering Medication Safely
Objective: Demonstrate understanding of the safety protocol (the “three befores” and “10 rights”)
that must be followed when administering medication.
Equipment and Supplies: List of patient medications; corresponding correct medications;
incorrect medications with similar names, dosages, or routes to correct medications
Affective Behaviors: Affective behaviors provide a professional approach to a skill that enhances
the patient encounter. These behaviors may also display sensitivity to a patient’s rights and
enhance communication. Pay close attention to these skills, which will be in bold, italicized font.
Skills Assessment Requirements
Read and familiarize yourself with the procedure. Complete each procedure within a reasonable
amount of time, with a minimum of 85% accuracy.
Documentation
Use the area below for any documentation needed to complete the procedure.
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Name: ________________________________________
Date: _________________________________________
POINT VALUE
= 3–6 points
= 7–9 points
GRADED
TRIAL
# 1
GRADED
TRIAL
# 2
NOTES
1. Review the physician’s patient
medication orders.
2. Ensure that you are selecting the
correct medication according
to the physician’s orders, and
properly putting it back in storage
after use, by adhering to the
“three befores.” [Recite to your
instructor the “three befores” that
are required for checking and
selecting the correct medication.]
3. Ensure that have observed the
“six rights” before you administer
a medication. [Recite to your
instructor the “six rights” of
medication administration that
must be confirmed before
administering medication to a
patient.]
4. Ensure that you observe the
additional “four rights” in the
course of administering a
medication. [Recite to your
instructor the additional “four
rights” that must be considered
when administering a medication
to a patient.]
GRADING
Points Earned
Points Possible 33 33
Percent Grade (Points Earned/
Points Possible)
PASS: YES
NO
N/A
YES
NO
N/A
Instructor Sign-O
Instructor: ______________________________________________ Date: _________________________
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