Safety

• Keep medication storage areas locked when unattended.
• Use of an automated medication dispensing system may reduce the incidence of medication errors.
• Use of bar codes improves the accuracy of patient identification, reduces the incidence of medication errors, and improves medical record keeping. Always compare the medication provided to the medication administration record (MAR), the prescriber's order, or both because no medication dispensing system is foolproof.
• Prepare medications for one patient at a time.
• Minimize distractions and interruptions while preparing medication, including questions from staff and family, equipment alarms, and personal conversations. Never share your automated medication dispensing unit security code or password.

• Remember to sign out of the automated medication dispensing system when finished.

Equipment

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Medication unit-dose cart

Medication administration record (MAR)

Delegation

The skill of using medication dispensing systems may not be delegated to nursing assistive personnel (NAP).

Preparation

• If possible, prepare medications in an area designed for that purpose or at a unit-dose cart.
• Perform hand hygiene. Ensure that medication preparation surfaces are clean.
• Minimize distractions and interruptions during medication preparation, close the door of the medication room, and do not try to perform other tasks while preparing a medication.
• Double check all calculations and other high-risk medication administration processes (e.g., patient controlled analgesia) and verify with another nurse.
• Review any preadministration assessments (e.g., vital signs, review of laboratory results).

• Keep tablets and capsules in their wrappers and open them at the patient’s bedside. This allows you to review each medication with the patient. If a patient refuses medication, there will be no question which one was withheld.

Follow-up

• Log out of the medication dispensing system properly, and keep medication storage areas locked when unattended.
• Stay alert for medication errors, drug incompatibilities, and medication allergies.

• Verify all medications dispensed for the correct dose and route. Report any discrepancy between what the physician ordered or what was requested from the dispensing system and what was supplied.

Documentation

• Record the name of the medication, the actual time of administration, the dose, and the route on the MAR immediately after administration. Include your initials or signature. Do not chart medication administration until after the drug is given to the patient. (For details, see "Documenting Medication Administration.")
• It is not necessary to document use of a medication dispensing system separately.
• Document any medication dispensing discrepancy according to facility policy. It is not necessary to record the discrepancy in the patient's medical record if the medication was not administered.