You are correct that "right" response may be subjective but so might be "right route." Many parents in our pediatric clinical setting choose to have their child treated for "strep throat" with a shot of Bicillin regardless of the child's choice. We believe that the "right" response to the medication is a matter of dual intent between what the ordering practitioner has stated as the treatment plan, and the patient's understanding of the intended purpose of said medication (we fully realize there are multiple variations on that theme). We agree with your assessment that multiple variables interact depending on the patient's status; thus, it is even more important for nurses to assess what the "right" response for that patient should be depending on those variables. In our opinion, this latter statement is what makes critical thinking an important aspect of medication administration for each individual patient. We still assert that we must use all methods available to prevent medication errors until there is sufficient evidence (as in evidence-based practice) to support or abandon practices such as the use of the 5 Rights (plus one!!).

We agree that patients have the right to refuse medications; we tell that to our students and tell them to inform the patient of the intended purpose of the medication so the patient will know if that purpose is not achieved. The patient's right to refuse a medication being administered is really in a context other than the 6th Right we hoped to promote. Our intended purpose is to make nursing students aware of the "process" of medication administration as being fairly complex, rather than a simple task. We think we all seek to minimize medication errors and make our patients comfortable and safely deliver care.

David Wilson, MS, RNC

Adjunct Faculty, [email protected]

Pam DiVito-Thomas, PhD, RN

Site Coordinator, Langston University, School of Nursing, Tulsa, Okla