The Six Right Principles of Drug Administration to Patients with Diabetes Mellitus in Hospitals: A Case Study

Background: About one-third of adverse events are drug-related medication administration errors (MAE). One method to improve drug administration safety is the application of the six rights of drug administration which include right patient, right drug, correct dose, right time, right route, and proper documentation. Nurses must apply it generously and nursing professional students must be able to use it well too. Purpose: The purpose of this case study is to compare the application of the six right medicine principles between nursing and nursing professional students to Mrs. E with Diabetes Mellitus in Hospital. Methods: This case study uses a quantitative study approach with a comparative descriptive design. Data were obtained through observation for seven days with an observation measuring instrument for applying the six correct drug administration are consist of 33 statements. Respondents were obtained from purposive sampling consisting of 7 Nursing Profession students at the Faculty of Nursing, University of Jember, and seven nurses at the Hospital. Results: The difference in applying the six right principles of drug administration to Mrs. E for seven days (14 shifts) by 11 students and nurses (4.8%). Conclusion: An indicator that still really needs to be improved by students and nurses is the true indicator of patients who are still below 50%. Meanwhile, the other indicators have achieved a total implementation of >70%.


Currently, in which eraUniversal
Health Coverage (UHC) patient safety is increasingly becoming a condition for health services that must be of high quality and safe to achieve the success of the service system (WHO, 2019).The implementation of patient safety has the goal of minimizing unwanted events that often occur in healthcare centers or The Six Right Principles of Drug Administration to Patients with Diabetes Mellitus in Hospitals: hospitals.Drug safety is one of the targets in achieving patient safety while receiving health services, but not a few adverse incidents are caused by errors in medication.Drug administration has caused a large number of adverse events in health care (Anderson, 2018).About a third of drug-related adverse events are medication errors, also known as medication errors in medication administration error (MAE) which can actually be prevented (WHO, 2016).

National Map of Indonesian Patient
Safety Incidents in the 2019 PERSI Congress reported there was an increase in reports of patient safety incidents at Indonesian Hospitals from 2018 which were originally 5% to 12% in 2019.In addition, errors in drug administration ranked first, namely with a percentage of 24.8% of the top ten incidents reported (PERSI, 2020).Typing errors that tend to occur in drug administration are 40.9% wrong dose, 16% wrong drug, and 9.5% wrong route (Nuryaniet al., 2022).A similar incident also occurred in the Cempaka Room at the Bali Mandara Hospital; from the results of interviews with the Head of the Room, it was found that there had been a near-miss incident (KNC) related to a drug administration error where patient A should have received drug B but in fact, received drug C.
Factors causing these incidents include the nurse's workload which is too high, the use of inappropriate tools, ineffective communication, and so on (Patricia, et al., 2022).In addition, the work saturation of nurses also contributed to this (Afandi & Ardiana, 2021).The impact of errors in the implementation of patient safety is not only harmful or causes physical illness, but the psychology of the patient is also affected.Not only that, patients may also experience suffering in the form of disabilities in bodily functions and daily limitations (KKPRS, 2015).
In an effort to minimize the incident medication error then the correct principles of drug administration are applied.

METHODS
This research is a quantitative study with a comparative descriptive design.The nurse checks the drug label three times (before pouring the drug) before giving the drug to the patient 6 (85,7%) 5 (71,4%)
If the patient has doubts about the drug being given, the nurse informs that the drug has been prescribed correctly.(Afandi, 2023).In checking the drug labels before and after pouring the medicine, the percentage of students was slightly higher because they had a habit of removing the drug label and affixing it to the syringe so that it was almost always done.Whereas confirmation of the patient's allergy history was not carried out because nurses and students had read the patient's medical record beforehand and were sure that the patient did not have allergies, so they did not re-confirm when giving medicine.

3) Correct Dose Indicator
The According to (Nuryani, 2020) in ensuring drug safety, it is not only the type of drug that must be considered, but also the dosage that must be according to the detached so that it needed to be reinstalled as a result of the drug being put in too late as experienced by Mrs. E on the 3rd treatment day.But even so, the nurse did not confirm with the DPJP on the grounds that the patient's condition was still stable.

5) Correct Route Indicator
On applying the correct route toward Mrs. E for seven days (14 shifts) by students and nurses had the same total The Six Right Principles of Drug Administration to Patients with Diabetes Mellitus in Hospitals: implementation of 24 times (85.7%).In the administration procedure, according to the route, students and nurses have implemented it 100% for seven shifts.
However, when checking the routes on the drug labels from nurses, only 85.7% were implemented, and 100% for students.
Whereas in the route safety check procedure for patients, 85.7% had been implemented by students and nurses, such as reconfirming area IVline in good condition (without phlebitis or obstruction), while for oral medication, students always informed the drug to be taken.In the procedure for checking drug labels, the majority of respondents only did it occasionally; 57.1% of students only done it, and 42.9% by nurses during seven observation shifts.
Almost the same results were also described by Utama, et al., (2021) where 80% of nurses are in a good category in applying the correct route of drug administration.In Rukmin's study, (2022) also had almost the same results where 86.7% of nurses had implemented the correct route of drug administration.
According to the researchers, the lack of correct application of the route was because the respondents, mainly nurses, tended to have memorized the routes of drugs that had been used frequently.Even if they found a drug that had just been used, the nurse again read a copy of the prescription and asked the team leader.E initially received nine drugs with two types of routes, namely IV and oral, from nurses and students who stated that they had often given these drugs to patients before.
Still, on the 3rd day of treatment Mrs. E received additional medication in the form of insulin injections and from students, even though they did not read the drug labels, they knew that the insulin was injected SC (subcutaneously) as well as the nurses.the same drug but a different way of administration.

6) Correct Indicator Documentation
On the application of the correct indicators of documentation of the drug  (Setiawan, et al.,2023).(Afandi, 2022).

CONCLUSION
The difference in applying the six correct principles of drug administration to Mrs. E for seven days (14 shifts) between students and nurses was as many as 11 patient's condition, such as age, weight, and also the severity of the patient.Diongana (2021) in his research also stated that the majority of nurses (52.95%) were disobedient in applying the correct dosage principle.According to researchers, drug doses were not always recalculated because nurses felt that doctors had written them down accordingly.There are still very few nurses who confirm prescriptions from doctors, it tends not to be due to nurse factors.However, sometimes prescribers are difficult to contact, so the nurse's first step is to confirm with the team leader or shift 4) True Time Indicator In implementing the true time indicator, the difference obtained between students and nurses had significantly different values, namely 3 (10.7%)with 21 (75.0%) for students and 18 (64.3%)for nurses.Drug-checking actions could not be fully carried out by both students and nurses, where only 28.6% of the two had been carried out.For students, the action of not changing the time of drug administration without confirmation cannot be fully carried out because there is no authority to contact a doctor.Still, during seven shifts, students 100% always confirm if the time of drug administration changes to the nurse first, while from nurses, the action was carried out as much as 71.4%.Of the two respondents, both students and nurses, 100% always checked the time of drug administration, even though the timeliness in giving it was only implemented by 71.4% of students and 57.1% of nurses.Setianingsih & Ria, (2019) also explained results that were not much different in their research where 28.8% of nurses did not properly apply the correct time indicator.Delay in administering medication to Mrs. E tends to be due to the condition of Mrs. E himself where on the day of Mrs.The 1st E in the afternoon shift and the 5th day in the night shift, Mrs. E felt nauseous, so the oral medication was not taken on time.It was delayed until the end of the shift, but no clarification was made afterward.Also, when the nurse will inject IV drugs line experienced swelling or Based on the results of the observation analysis related to the application of the six right principles of drug administration to Mrs. E for seven days (14 shifts), both by students and by room nurses showed not too much difference in the total application of 11 (4.8%) with respective values of 175 (75.8%) from students and 164 (71 .0%)by nurses.However, these results can also be interpreted that the application of the six right principles of drug administration is not fully optimal because, when compared to the results of previous studies, this value tends to be lower.In Simarmata's study (2019) the results showed that the percentage of applying the six correct principles by nurses was 91.9% and inMahfudhah's (2018) also showed the same results, namely that as many as 92.5% of nurses applied the six correct principles of drug administration properly.The Six Right Principles of Drug Administration to Patients with Diabetes Mellitus in Hospitals: Respondents have not optimally applied the six correct principles of drug administration due to a lack of awareness of responsibilities and obligations because basically both professional students and room nurses have understood the six correct principles of drug administration, and even nurses almost always remind students about these principles, but both are still not implemented properly.In addition, the room management system related to the management of nursing care that is applied in the room also greatly influences the application of the six correct principles because it is related to the management of the duties and functions of each individual nurse, which might lead to excessive workload if not appropriate

( 4 .
8%).An indicator that still really needs to be improved by students and nurses is the accurate indicator of patients who are still below 50%.Meanwhile, the other hand has achieved a total implementation of >70%.This condition was caused by various factors ranging from nurses and students, room management to Mrs. E himself as a patient.

Table 1 .
Distribution of the Application of the Six Right Principles of Drug Administration by Students and Nurses for seven days (n = 14).(Continue to page 25)

of the Application of Each Indicator of the Six Right Principles of Drug Administration by Students and Nurses to Mrs. E 1) Patient Correct Indicator
Afandi, A. T., et al. (2024)and by nurses by 38 (67.9%).Even though the percentage of the two respondents was The Six Right Principles of Drug Administration to Patients with Diabetes Mellitus in Hospitals: