Nurses are responsible for medication administration, and, as with many other nursing interventions, some risk is involved. If an error occurs, a patient may suffer harm or injury, which may lead to a permanent disability or a fatality. To ensure safe drug administration, nurses are encouraged to follow the five rights ('R's; patient, drug, route, time and dose) of medication administration to prevent errors in administration. The five 'R's do not consider all causes of drug errors; instead, they focus on medication administration at the bedside so they relate only to this stage of a drug prescription. A drug's journey is more than what happens at the bedside; therefore, the reduction of errors requires more than just the five 'R's. This article proposes a multi-professional, evidence-based approach to medicines management, which all clinicians can work towards, together. Clinicians can achieve this approach by considering the National Patients Safety Agency's definition of a medication error and the values set out by the National Prescribing Centre. The approach utilizes 10 'R's, which provide a benchmark for good practice. The 10 'Rs' advocate the need for the knowledge of the causes of drug errors, how to implement strategies to reduce drug errors, how to ensure safe practice throughout the medication journey, from chemical preparation, to monitoring outcomes, to response.

a b s t r a c tThe new standards of proficiency for Nurse and Midwife prescribers have been in place for 4 years and have provided a challenge for education providers and students alike. Many students find the pass mark of 100% for numeracy a frightening prospect, the way numeracy is assessed can vary across the higher education institutions adding to the complexity of the problem. Drug calculation remains a challenge for the nursing profession and the standards for numeracy assessment in nurse prescribing add more to the debate.

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The issue of drug errors in the NHS has been highlighted recently in the mainstream press, and has shown that mistakes can, and occasionally do, happen. Yet nurses are in a unique position to prevent drug errors, as they are at the forefront of medication management. To do this, nurses need to understand the issues related to the administration of a drug, e.g. the five or six rights. Nuses should also be aware of drug errors that can occur before and after administration, i.e. considering the full medication journey, as a drug error can occur from naming, labelling, prescribing, transcribing, dispensing, preparing, failing to undertake a medication review and failing to monitor outcomes. This article considers drug errors and their causes, and draws on current literature to discuss some of the strategies nurses can use to prevent such errors from occurring. These strategies are not without their own problems and issues; nevertheless, a lot of information has been accrued about drug errors and it is time to start putting these together and take action by applying them to everyday medication management practice in order to ensure patient safety at all times.

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