After reading "The Sixth Right of Medication Administration," by David Wilson and Pam DiVito-Thomas, (Nurse Educator, 2004:29(4):131-132), I also wished to express my concern about the rising number of medication errors, and medical errors in general, occurring in hospitals and healthcare centers. Taking careful admission histories, including food and medication allergies; identifying if the patient is taking herbals and other over-the-counter preparations; enlisting the participation of the patient, his or her family, caregiver, and significant others; and documenting the nurse's findings legibly and comprehensively in the patient record can help reduce many types of errors.

You suggest the 6th right is the correct response. Nurses have been taught to assess the patient's response to any and all interventions, including medications administered, and to document that response, regardless of the type of agent. However, I wonder how we know what constitutes the "right" response to a particular medication? The physician may have a particular outcome in mind; certain medications may produce pain relief, increased urinary output, bruising, fluid retention, alterations in blood cell counts, etc. To me, "right" is rather subjective, and may be clinical-setting dependent, relative to a particular diagnosis, patient status, body build, age, gender, or other factors.

At my hospital, the 6th "right" of medication administration is the right to refuse, and we have included such an item in our medication exam given to new employees. In an increasingly consumer-driven society, patient rights in healthcare settings are demonstrated through the advance directive, general and specific consents (including the concept of "informed" consent), and through patient and staff education initiatives. Empowered healthcare consumers who learn to take charge (and assume responsibility) for themselves are in the position to make informed choices, not the least of which is the "right" to refuse. Although it may not be the choice that you or I would make, we have the obligation to respect a refusal to submit to a particular treatment made by a competent adult.

Sally J. Ness, MSN, RN

Educator, Tempe St. Luke's Hospital, Tempe, Az, [email protected]