Medications, Pharmacology: What Are the Three Checks of Drug Administration?

October 11, 2025 •

5 min read

According to the National Institutes of Health, medication errors are a significant cause of harm in the United States, with some estimates suggesting up to 9,000 deaths annually. A key strategy for mitigating these risks and ensuring patient safety is the systematic use of the three checks of drug administration.

Quick Summary

A guide to the three critical checks performed during medication administration to prevent errors. It details the process of comparing the medication against the order at multiple points for patient safety.

Key Points

The First Check: Compare the medication label to the medication order (MAR) when retrieving the drug from storage.
The Second Check: Perform a second comparison of the medication label to the MAR during the preparation of the medication.
The Third Check: Conduct the final check at the patient's bedside by comparing the label to the MAR and verifying the patient's identity.
Purpose: The three checks act as multiple safety barriers to significantly reduce the risk of medication errors.
Integration with the 'Rights': Each check is used to confirm the 'rights' of medication administration, such as the right patient, drug, dose, route, and time.
Technological Enhancement: Electronic systems (eMAR) with barcode scanning can automate and reinforce the three-check process, improving efficiency and accuracy.
Accountability: Following this standardized protocol enhances accountability for all healthcare professionals involved in medication administration.

The Foundation of Safe Medication Administration

For healthcare professionals, particularly nurses, the administration of medication is a routine yet critical task. It requires meticulous attention to detail to ensure patient safety and prevent potentially fatal medication errors. The three checks of drug administration serve as a fundamental safety net, a multi-layered verification process that reinforces accuracy and helps catch discrepancies before a drug is administered to a patient. These checks are inextricably linked with the 'rights' of medication administration, which act as the core data points to be verified at each step of the process.

The Three Checks Explained

The three checks are performed at specific, deliberate points throughout the medication administration process. This systematic approach ensures that multiple opportunities exist to confirm the medication's accuracy before it reaches the patient.

The First Check: When Retrieving the Medication This check occurs when the healthcare provider first takes the medication from the dispensing system, such as a medication cart, drawer, or automated dispensing cabinet. The provider compares the medication label against the Medication Administration Record (MAR), electronic or paper, for the first time. During this initial comparison, the provider must verify all applicable medication 'rights,' including:

Right Patient: Is this the correct patient's medication?
Right Drug: Is this the medication that was ordered?
Right Dose: Does the dose on the label match the dose ordered?
Right Time: Is the medication scheduled to be given now?
Right Route: Is the medication intended for the route ordered (e.g., oral, IV, subcutaneous)?

The Second Check: During Medication Preparation This is the mid-point check and is performed just before the medication is prepared or opened. For example, a nurse would perform this check while drawing up an injectable medication or placing a pill in a medication cup. This second verification involves re-reading the medication label and re-comparing it to the MAR to ensure consistency and to catch any details that might have been missed during the first check. For complex preparations or high-risk medications, some protocols may even require a second nurse to perform an independent verification at this stage.

The Third Check: At the Patient's Bedside This final, and arguably most crucial, check takes place immediately before administering the medication to the patient. It is the last opportunity to prevent a medication error. The provider confirms the patient's identity using at least two identifiers (e.g., name and date of birth) and compares the medication label to the MAR one final time. This bedside verification is particularly important for double-checking the right patient and confirming all other 'rights' before the drug is administered. If the medication is a unit-dose package, the final check is done by confirming the label before opening the package.

Integrating the Three Checks with the 'Rights' of Medication Administration

While the number of recognized 'rights' varies by institution, the core concept remains the same: a comprehensive framework for safe practice. By performing the three checks, healthcare providers systematically and repeatedly confirm each of these critical elements. The following table compares how the three checks apply to the primary rights.


Right of Medication	First Check (Retrieval)	Second Check (Preparation)	Third Check (Bedside)
Right Patient	Verify name and room number on MAR	N/A (unless preparing a specific dose for a specific patient)	Verify patient's identity with two identifiers
Right Drug	Compare drug label to MAR order	Re-compare drug label to MAR during prep	Re-compare drug label to MAR before administration
Right Dose	Confirm dose on label matches MAR	Re-check dose during measurement or preparation	Final confirmation of dose before administration
Right Route	Confirm route on label matches MAR	Re-check route against MAR	Verify route one last time before administration
Right Time	Check if current time aligns with scheduled time on MAR	Re-confirm time on MAR	Final verification of administration time

The Importance and Benefits of the Three-Check System

The primary goal of the three checks is to create multiple safety barriers, making it highly unlikely for a medication error to occur. The repetitive nature of the process helps to combat human factors that can lead to mistakes, such as distraction, fatigue, and memory lapses. By standardizing this protocol, healthcare facilities establish a uniform level of care that prioritizes patient safety above all else. This robust system helps to:

Prevent Errors: The most direct benefit is the reduction of medication errors, which can range from minor dosage inaccuracies to catastrophic events.
Enhance Patient Safety: A systematic approach ensures that patients receive the correct medication, dose, and route at the right time, minimizing the risk of adverse drug events.
Improve Accountability: Proper execution of the checks provides a clear, documented process for medication administration, increasing accountability for all staff involved.
Increase Confidence: Following a clear procedure builds confidence in both the healthcare provider and the patient, assuring the best possible care is being delivered.
Support Regulatory Compliance: Healthcare regulatory bodies, such as the Joint Commission, advocate for these and similar safety checks as a standard practice.

Overcoming Challenges and Looking to the Future

While the three checks are a vital safeguard, challenges can arise. A busy clinical environment can lead to distractions, and rushing can cause checks to be skipped. This is where technology plays a crucial role. Electronic Medication Administration Records (eMARs) with barcode scanning capabilities can significantly streamline and enhance the three-check process by automatically verifying the medication and patient information.


eMAR vs. Manual Checks	Feature	Manual Three Checks	eMAR with Barcode Scanning
Verification Method	Visual comparison of labels and MAR	Automated scanning and system verification
Error Reduction	Relies heavily on human vigilance	Significantly reduces human error via automation
Speed	Can be time-consuming, especially with many medications	Speeds up the process, especially during busy periods
Documentation	Paper-based, prone to legibility or omission issues	Automated, real-time documentation, time-stamped
Workflow	Can be interrupted by distractions	System provides guided workflow, minimizing interruptions

Conclusion

In an age where technological advancements are transforming healthcare, the core principles of safe medication administration remain constant. What are the three checks of drug administration? They are the systematic process of verifying medication orders at the time of retrieval, preparation, and administration to a patient. This practice, combined with the 'rights' of medication administration, forms an essential defense against preventable medication errors, ensuring that patient safety is the highest priority. While technology like eMARs can modernize the process, the healthcare provider's careful attention to detail and unwavering commitment to following these steps is what ultimately protects the patient. The three checks are more than just a procedural task; they represent a steadfast commitment to delivering high-quality, safe, and effective patient care.

Explore more on medication safety at the Institute for Safe Medication Practices.

Frequently Asked Questions

The purpose of the three checks is to provide a multi-stage verification process that acts as a safety barrier to prevent medication errors before a drug is administered to a patient.

The three checks are performed at three distinct points: when retrieving the medication, during the preparation of the medication, and just before administering the medication to the patient.

The 'rights' of medication administration are a set of principles that include the right patient, drug, dose, route, time, and documentation. These are the details confirmed during each of the three checks.

Healthcare professionals who administer medication, most commonly nurses, are responsible for performing the three checks for each drug they give to a patient.

If a discrepancy is found, the healthcare provider must not proceed with administration. They should immediately investigate the issue, report it to the pharmacist or supervising clinician, and resolve it before proceeding.

Yes, the principles of the three checks still apply when using electronic systems like eMARs. Technology often automates and reinforces these checks, for example, by requiring barcode scanning at each stage.

While not one of the core three verification points, proper documentation is a critical component of the overall safe medication administration process and is often considered a separate 'right' that must be completed after administration.

Common causes of medication errors include distractions, complex medication schedules, miscalculations, poor communication, and failing to perform proper verification checks.

Patients can be involved by being asked to confirm their name and date of birth and by being educated about their medications, including what they are taking and why, so they can also act as a safety check.