MEDICATION SAFETY & MONITORING CHECKLIST
A structured tool for evaluating medication administration, monitoring, reconciliation, and adverse‑event response in hospital and acute‑care settings.
Medication safety is a critical component of hospital care. Errors in ordering, administering, or monitoring medications can lead to rapid deterioration, adverse drug events, and preventable harm. This checklist outlines the required steps for safe medication management and helps attorneys identify deviations from standards of care.
Use this tool during breach analysis, deposition preparation, and timeline reconstruction.
MEDICATION ORDER SAFETY
✔ Verify Provider Orders
• Correct medication
• Correct dose
• Correct route
• Correct frequency
• Correct timing
• Correct patient
✔ Required Documentation
• Time order was received
• Clarifications requested
• Any verbal orders documented per policy
Red Flags
• Illegible or unclear orders
• Verbal orders not confirmed
• Wrong dose or frequency
• Medication ordered but never administered
MEDICATION ADMINISTRATION STANDARDS
✔ The “Five Rights” Must Be Followed
• Right patient
• Right medication
• Right dose
• Right route
• Right time
✔ Required Documentation
• Time administered
• Dose administered
• Site (if applicable)
• Patient response
✔ Additional Safety Checks
• Allergy verification
• Two‑identifier patient check
• Barcode scanning
• High‑alert medication protocols
Red Flags
• Missed doses
• Late doses
• Wrong medication
• Wrong route
• No documentation of administration
REQUIRED MONITORING AFTER MEDICATION ADMINISTRATION
✔ Vital Sign Monitoring
• Blood pressure
• Heart rate
• Respiratory rate
• Oxygen saturation
• Temperature
✔ Lab Monitoring (When Indicated)
• INR
• Potassium
• Creatinine
• Glucose
• Drug levels (e.g., vancomycin, digoxin)
✔ Clinical Monitoring
• Pain reassessment
• Mental status
• Respiratory effort
• Cardiac rhythm
• Neurological changes
Red Flags
• No reassessment after high‑risk medications
• Missed vital signs
• Abnormal vitals not addressed
• Lab results not reviewed
HIGH‑RISK MEDICATIONS (REQUIRING EXTRA MONITORING)
✔ Anticoagulants
• Heparin
• Warfarin
• DOACs
Risks: bleeding, stroke, clotting
Monitoring: INR, PTT, CBC, signs of bleeding
✔ Cardiac Medications
• Beta blockers
• Antiarrhythmics
Monitoring: heart rate, EKG, blood pressure
✔ Opioids
Risks: respiratory depression, sedation
Monitoring: respiratory rate, O2 saturation, sedation scale
✔ IV Sedatives / Anesthetics
Monitoring: continuous vitals, airway status
✔ Insulin
Risks: hypoglycemia
Monitoring: glucose checks, mental status
Red Flags
• No monitoring after high‑risk meds
• Delayed recognition of adverse effects
• Failure to escalate deterioration
ADVERSE DRUG EVENT RESPONSE
✔ Required Actions When a Reaction Occurs
• Stop medication
• Reassess immediately
• Notify provider
• Notify charge nurse
• Activate rapid response if needed
• Document event
• Order diagnostics (labs, EKG, imaging)
✔ Required Documentation
• Time reaction noted
• Symptoms observed
• Interventions performed
• Provider response
• Patient outcome
Red Flags
• Delayed recognition
• Delayed provider notification
• No rapid response activation
• Missing documentation
MEDICATION RECONCILIATION
✔ Required at:
• Admission
• Transfer between units
• Discharge
✔ Must Include:
• Home medications
• Hospital medications
• PRN medications
• Allergies
• Duplications
• Interactions
Red Flags
• Missing home medication list
• Duplicate medications
• Interactions not addressed
• Incorrect discharge medication list
COMMON BREACH THEMES IN MEDICATION CASES
• Missed doses
• Wrong dose or wrong medication
• Failure to monitor after administration
• Missed abnormal vital signs
• Delayed recognition of adverse effect
• Failure to escalate deterioration
• Poor communication between providers
• Documentation gaps or contradictions
• Medication reconciliation errors
These are some of the strongest breach indicators in hospital medication‑related litigation.