The current five ‘R’s fail to consider the
intricacies associated with administering
medications in more complex settings; for
example, when a patient refuses to take a
prescribed medication. The patient may
have a difficulty in taking the medicine
(such as trouble with swallowing) or
they may not perceive the need for the
medication. A sixth right is implied: the
right of the patient to refuse a drug.
The right to refuse can also
incorporate the right of a nurse to refuse
to administer a prescribed drug, as nurses
should not thoughtlessly obey ‘orders’.
If the prescription has been incorrectly
written, the prescription is ambiguous,
or the nurse doubts the legitimacy of the
prescription, the nurse has a right not to
give or administer the drug to the patient.
However, problems can arise here—if
a nurse omits or fails to administer a
drug or does not give it at the correct
time, these incidences can constitute a
medication error, and the nurse is placed
in a difficult position. If nurses refuse to
administer a drug on the grounds that the
prescription is inappropriately written,
or if an inappropriate preparation is
to be given, this may also constitute
a drug error.
According to the NMC (2015),
medicine administration should be
evidence-based, so nurses can refuse or
omit a drug, referring to sound evidencebased
practice, yet can still be accused of
a drug error. For example, the refusal of
potassium supplements on the grounds
that the patient’s potassium level is too
high (by checking daily blood results)
or the refusal of digoxin, if the apex
and redial pulses are below 60 beats
per minute. These issues question the
policies and procedures, which may fail
to represent the nurses as autonomous
and knowledgeable practitioners, who are
able to use their own clinical judgement
in such situations without the fear of
being accused of a drug error. With the
increase in independent prescribing by
disciplines other than in the medical
profession, nurses may find themselves
administering drugs prescribed by
non-medical prescribers (pharmacists,
physiotherapists and other nurses, for
example), which may add to the complex
nature of patient management and the
right to refuse.
The current five ‘R’s fail to consider theintricacies associated with administeringmedications in more complex settings; forexample, when a patient refuses to take aprescribed medication. The patient mayhave a difficulty in taking the medicine(such as trouble with swallowing) orthey may not perceive the need for themedication. A sixth right is implied: theright of the patient to refuse a drug.The right to refuse can alsoincorporate the right of a nurse to refuseto administer a prescribed drug, as nursesshould not thoughtlessly obey ‘orders’.If the prescription has been incorrectlywritten, the prescription is ambiguous,or the nurse doubts the legitimacy of theprescription, the nurse has a right not togive or administer the drug to the patient.However, problems can arise here—ifa nurse omits or fails to administer adrug or does not give it at the correcttime, these incidences can constitute amedication error, and the nurse is placedin a difficult position. If nurses refuse toadminister a drug on the grounds that theprescription is inappropriately written,or if an inappropriate preparation isto be given, this may also constitutea drug error.According to the NMC (2015),medicine administration should beevidence-based, so nurses can refuse oromit a drug, referring to sound evidencebasedpractice, yet can still be accused ofa drug error. For example, the refusal ofpotassium supplements on the groundsthat the patient’s potassium level is toohigh (by checking daily blood results)or the refusal of digoxin, if the apexand redial pulses are below 60 beatsper minute. These issues question thepolicies and procedures, which may failto represent the nurses as autonomousand knowledgeable practitioners, who areable to use their own clinical judgementin such situations without the fear ofbeing accused of a drug error. With theincrease in independent prescribing bydisciplines other than in the medicalprofession, nurses may find themselvesadministering drugs prescribed bynon-medical prescribers (pharmacists,physiotherapists and other nurses, forexample), which may add to the complexnature of patient management and theright to refuse.
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