Patient Safety and Pharmacology: What are the three stages of medication administration?

October 14, 2025 •

4 min read

Globally, medication-related errors are responsible for 5% to 41.3% of all hospital admissions [1.5.1]. Understanding what are the three stages of medication administration—preparation, administration, and post-administration—is crucial for minimizing these risks and ensuring patient safety.

Quick Summary

A detailed look at the three critical stages of medication administration: preparation, giving the medication, and post-administration follow-up. It covers best practices for patient safety and error prevention.

Key Points

Three Core Stages: Medication administration is divided into three critical stages: pre-administration (preparation), administration (giving the drug), and post-administration (documentation and monitoring).
Pre-Administration is Key: This first stage involves verifying the order, performing three checks against the MAR, assessing the patient, and confirming the '10 Rights' of administration [1.4.2].
Administration Requires Focus: The second stage includes correctly identifying the patient with two identifiers, providing patient education, and using the proper administration technique for the specified route [1.3.3].
Post-Administration Ensures Safety: The final stage is crucial for continuity of care and involves immediate documentation, monitoring for therapeutic and adverse effects, and reporting any issues [1.6.1].
High Error Rates: Medication errors harm at least 1.5 million people in the U.S. annually, with error rates during the administration phase as high as 25% [1.5.2, 1.5.3].
The '10 Rights': An expansion of the original five, these rights include right patient, drug, dose, route, time, documentation, reason, response, education, and right to refuse [1.4.1].
Technology's Role: Systems like Barcode Medication Administration (BCMA) and eMARs significantly reduce errors by automating verification of the 'five rights' at the bedside [1.7.5, 1.7.6].

The Critical Importance of Safe Medication Administration

Medication administration is a cornerstone of patient care, yet it is a process fraught with potential risks. In the U.S. alone, medication errors harm at least 1.5 million people every year [1.5.2]. These errors can occur at any point in the medication use process, which includes prescribing, transcribing, dispensing, administering, and monitoring [1.2.1]. The global cost of these errors is estimated at a staggering $42 billion annually [1.5.4]. To mitigate these dangers, healthcare professionals follow a structured process built around three core stages: preparation (pre-administration), the act of administration itself, and post-administration monitoring and documentation. Adhering to this framework is essential for patient safety, legal compliance, and effective therapeutic outcomes.

Stage 1: Pre-Administration and Preparation

This initial stage is foundational to safety and involves meticulous checking and verification before any medication reaches the patient. It is a systematic process of review and preparation designed to catch potential errors before they can cause harm [1.3.4, 1.3.6]. A significant portion of medication errors, up to 91% in some studies, are prescribing errors, highlighting the importance of this verification phase [1.5.4].

Key activities in the pre-administration stage include:

Verifying the Order: The first step is to confirm the medication order on the Medication Administration Record (MAR) is accurate, complete, and appropriate for the patient [1.3.2].
The 'Three Checks': Nurses perform three checks with the medication against the MAR: when retrieving the medication, when preparing it, and at the patient's bedside before administering it [1.4.8].
Upholding the 'Rights': This is the time to begin verifying the "Rights of Medication Administration." While traditionally there were five or six rights, the framework has expanded to ten or more to improve safety [1.4.2]. These include confirming the Right Patient, Right Medication, Right Dose, Right Route, and Right Time [1.3.7, 1.4.5].
Patient Assessment: Before administration, the nurse must assess the patient for any contraindications, allergies, or necessary clinical parameters (like blood pressure or lab values) that could affect the medication's safety or efficacy [1.3.4, 1.4.8].
Gathering Supplies: The nurse prepares all necessary supplies, such as cups, syringes, and alcohol swabs, ensuring a clean and organized workspace to prevent contamination [1.3.4].

Stage 2: The Act of Administration

The second stage is the physical act of giving the medication to the patient. This moment requires focused attention and clear communication. The error rate during the administration phase itself is estimated to be between 8% and 25% in hospitals and long-term care facilities [1.5.3, 1.5.5].

This stage involves:

Patient Identification: It is critical to confirm the patient's identity using at least two identifiers, such as name and date of birth, and comparing them to the patient's ID band and the MAR [1.3.3, 1.4.6].
Patient Education: The nurse should explain what the medication is, why it is being given, and any potential side effects. This upholds the patient's 'Right to Education' and 'Right to Refuse' [1.4.1, 1.4.6].
Final Verification: The third of the 'three checks' is performed at the bedside, once again confirming the medication against the MAR before it is given [1.4.8].
Correct Administration Technique: The medication must be administered via the correct route (e.g., oral, intravenous, topical) using the proper technique as specified in the order [1.3.5]. For example, some oral medications cannot be crushed, and some injections have specific site requirements.
Observing the Patient: The nurse should stay with the patient to ensure the medication is taken correctly (e.g., swallowed) and to observe for any immediate adverse reactions [1.3.8].

Stage 3: Post-Administration and Documentation

The final stage occurs after the medication has been given and is just as critical as the preceding stages. This phase focuses on documentation and monitoring, which ensures continuity of care and creates a legal record of the treatment provided [1.6.1].

Key actions in the post-administration stage include:

Immediate Documentation: The nurse must document the administration immediately after giving the medication—never before [1.6.1]. This documentation includes the medication name, dose, route, and exact time of administration on the MAR [1.3.4]. Documenting hours after a visit can decrease accuracy to as low as 63% [1.6.2].
Monitoring for Response: This involves assessing the patient for the intended therapeutic effect of the medication (Right Response) as well as for any adverse effects or side effects [1.2.2, 1.4.5]. This observation is crucial for evaluating the effectiveness of the treatment plan.
Reporting: Any adverse reactions, medication errors, or patient refusals must be reported according to the facility's policy and documented accurately [1.3.2].
Patient Re-evaluation: For certain medications, follow-up assessments are required. For instance, checking a patient's pain level after an analgesic or blood pressure after an antihypertensive.

The Role of Technology

Modern healthcare leverages technology to enhance safety across all three stages. Systems like Barcode Medication Administration (BCMA) and Electronic Medication Administration Records (eMAR) help automate verification processes. BCMA requires scanning both the patient's wristband and the medication barcode, which can reduce administration errors by ensuring the 'five rights' are met [1.7.4, 1.7.6]. These technologies provide real-time alerts for potential mismatches, significantly reducing the risk of human error [1.7.1].


Stage of Administration	Key Focus	Common Errors	Prevention Strategies
1. Pre-Administration	Verification & Preparation	Wrong drug, wrong dose, misinterpreting order	'Three Checks' system, verifying the '10 Rights', patient assessment [1.4.8]
2. Administration	Patient Identification & Education	Wrong patient, wrong route, improper technique	Using two patient identifiers, patient education, barcode scanning (BCMA) [1.3.3, 1.7.4]
3. Post-Administration	Documentation & Monitoring	Failure to document, delayed documentation, poor monitoring	Documenting immediately after administration, assessing for therapeutic and adverse effects [1.6.1, 1.3.2]

Conclusion

Mastering the three stages of medication administration—preparation, administration, and post-administration—is non-negotiable for healthcare professionals. This systematic approach, fortified by the principles of the '10 Rights' and supported by technologies like BCMA, forms a robust defense against the preventable harm caused by medication errors. By diligently following these steps, clinicians uphold their duty to provide safe, effective, and high-quality patient care, ensuring that pharmacology serves its intended purpose of healing and not harm. For further reading, a comprehensive overview of the medication use process is available from the American College of Health Care Administrators.

Frequently Asked Questions

While errors can happen at any stage, more than half (53%) of medication errors occur during the prescribing or ordering stage, before the medication even reaches the nurse for administration [1.5.4].

The three checks are a safety protocol. A nurse checks the medication against the Medication Administration Record (MAR) 1) when retrieving it, 2) when preparing it, and 3) at the patient's bedside just before administering it [1.4.8].

Documenting immediately after administration is critical for accuracy and safety. It prevents potential duplicate doses, ensures the patient's record is current for other providers, and serves as a legal record of care. Documenting before administration is unsafe as the patient may refuse the drug or be unable to take it [1.6.1].

The 10 rights are a framework for safe medication administration. They include: Right Patient, Right Medication, Right Dose, Right Time, Right Route, Right Documentation, Right Reason, Right Response, Right Education, and the Right to Refuse [1.4.1].

BCMA systems require the nurse to scan the patient's ID bracelet and the medication's barcode. The system then verifies that it is the right patient, medication, dose, route, and time, alerting the nurse to any mismatch before the drug is given [1.7.6].

The entire medication use process involves five sequential steps: 1) prescribing by a provider, 2) transcribing and documenting the order, 3) dispensing by the pharmacy, 4) administering by the nurse, and 5) monitoring the patient's response [1.2.1].

If a patient refuses a medication, the nurse should respect their 'Right to Refuse.' The nurse should inquire about the patient's reason for refusal, provide education if it's based on a misunderstanding, and document the refusal and notify the prescribing provider according to facility policy [1.4.6].