The rights of medication administration: 5, 6, 7 and 10 rights explained

The "rights" of medication administration are a short checklist that anyone giving a medicine runs through for each dose. The best-known version has five: right person, medicine, dose, route and time. Longer lists add the right to refuse, right documentation, reason, response and information, giving 6, 7, 8 or 10 rights. This guide explains each one, what it looks like on a care home medicine round, and the question to ask at the trolley.

The short answer

The five rights are right person, medicine, dose, route and time. NICE's care home guideline and CQC use six: those five plus the person's right to refuse. Lists of 7, 8 or 10 add right documentation, reason, response and the right to information. The rights are a memory aid, not a law, and lists vary.

Where the rights come from, and why the lists vary

The rights are a long-standing memory aid from nurse training, and different authors and trainers have added to the original five over the years. There is no single official list, and no law that says there must be five, seven or ten.

In England's social care, the list you're most likely to meet is NICE's. NICE guideline SC1, Managing medicines in care homes, asks providers to consider including "the 6 R's of administration" in their medicines process (recommendation 1.14.1): right resident, medicine, route, dose and time, and the resident's right to refuse. NICE's homecare guideline, NG67, uses the same six, and CQC's guidance on medicines records tells providers to follow the principles of the 6Rs.

Elsewhere, especially in nursing textbooks, the sixth right is often "right documentation". Skills for Care's eLearning on medication administration teaches 10 rights. The professional guidance on administering medicines published in January 2019 by the Royal Pharmaceutical Society (now the Royal College of Pharmacy) and the Royal College of Nursing, written mainly for registered healthcare professionals, doesn't use the word "rights" at all. It lists checks such as the person's identity, the prescription, consent, allergies, the medicine and its expiry date, and whether the dose has already been given.

So no number is "correct". In England, the legal duties are in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which CQC enforces: safe care and treatment, including the proper and safe management of medicines (Regulation 12), consent (Regulation 11) and good governance, including records (Regulation 17), alongside the Mental Capacity Act 2005. The rights help you meet them at the trolley. Pick one list, put it in your medicines policy, and train everyone on it.

The rights at a glance

The labels vary too: right patient for right person, right drug for right medicine, right evaluation for right response. Some lists add right form or right expiry date.

Each right on a care home medicine round

1. Right person. On a busy round it's easy to rely on the room number, the order of the list or someone answering to a name. None of those is enough, especially for agency staff, or for a person living with dementia who may answer to any name. Check the photo and details on the MAR every time. Check: have I confirmed who this is from the photo and details on the MAR, not the room or the list?

2. Right medicine. Match the pharmacy label to the MAR, and the MAR to the current prescription: name, strength and form. Watch for similar names, and for changes after a hospital stay or GP review. If the label and the MAR don't agree, stop and ask. Check: does the label match the MAR exactly, and is the MAR up to date with the latest prescription?

3. Right dose. The strength on the box is not always the dose: one 5 mg tablet and two 2.5 mg tablets are the same dose. For variable doses ("one or two"), record exactly how many you gave. Measure small liquid doses with an oral syringe. For PRN medicines, check the minimum gap and 24-hour maximum in the protocol. Check: is this the dose on the MAR, measured properly, and not already given by someone else?

4. Right route. By mouth, on the skin, in the eye, inhaled or through a feeding tube are all routes. Crushing a tablet, opening a capsule or mixing a medicine into food changes how it's given, and some medicines become unsafe or stop working. Only do it if the prescriber agrees and a pharmacist has advised that it's safe, and record it on the MAR or care plan. Check: is this the route on the MAR, and has anyone changed the form (crushed, opened, mixed) without the prescriber's agreement and a pharmacist's advice?

5. Right time. Give each dose at the time on the MAR, follow food instructions, and respect the gap between doses. Some medicines are time-critical, such as many medicines for Parkinson's disease and epilepsy, and insulin for diabetes: a late or missed dose can cause harm. Ask the pharmacist which of each person's medicines are time-critical, and make sure the MAR shows it. NICE SC1 says the best time should be agreed with the person, the prescriber and the pharmacist, avoiding busy times (1.14.4), and your process should say what to do if the person is asleep or eating (1.14.1). Check: is this the right time for this medicine and this person, including food and the gap since the last dose?

6. Right to refuse. A person who has capacity to decide can refuse a medicine, even if staff or family think it unwise. That's in CQC's guidance and it's a principle of the Mental Capacity Act. Explain what the medicine is for, and offer it again later if your policy and the medicine allow. Record the refusal with what you offered, how, and whether you re-offered it, and tell the GP if the medicine is critical or refusals repeat. Our guide to MAR chart codes covers recording a refusal.

If you doubt the person's capacity for this decision, follow the Mental Capacity Act: assess capacity for that decision, and if they lack it, decide in their best interests. Hiding medicines in food or drink (covert administration) is only for someone who lacks capacity to make the decision, when the medicine is essential to their health and covert administration is the least restrictive option. It needs a best-interests meeting with care staff, the prescriber, the pharmacist and a family member or advocate (NICE SC1 1.15.3). CQC's guidance says the need must be agreed for each medicine, and agreed again when a medicine or dose changes; the plan goes in the care plan and is reviewed regularly. Covert medicines may be a factor in depriving someone of their liberty, so check whether a DoLS authorisation is in place or needed, following your local authority's current guidance. Our Mental Capacity Act and DoLS checklist covers covert medication in more detail. Check: did the person agree, and if not, have I recorded the refusal, what I offered and who I told?

7. Right documentation. NICE SC1 says staff must record each dose as soon as possible, only once the person has taken it, and finish with one resident before moving on (1.14.11). Record when and why a medicine wasn't given, record "when required" doses with the amount left where possible, and correct mistakes with a single line, never correction fluid. Controlled drugs also go in the controlled drugs register, signed by the person giving the dose and a trained witness (1.14.16). Check: have I recorded this dose now, after it was taken, with my name and the time?

8. Right reason. Know why each person takes each medicine. It helps you spot what doesn't make sense, such as a laxative for someone with diarrhoea. It matters most for PRN medicines: the reason should match the person's PRN protocol. A "when required" sedative given because someone is "unsettled", with no protocol or positive behaviour support plan behind it, is a red flag. Check: do I know why this person takes this, and for a PRN dose, does today's reason match the protocol?

9. Right response. Watch whether it worked and for side effects. For PRN pain relief, go back at the time set in the protocol and record whether the pain has eased. Report a suspected reaction as your policy sets out. NICE SC1 includes monitoring effects and reactions in the administration process (1.14.1). Check: did the medicine do what it was meant to, and have I recorded and reported anything unexpected?

10. Right to information. The person should know what they're taking and why, in a way they understand: easy-read information, pictures, a translated leaflet or time to ask questions. It goes both ways. The 2019 RPS and RCN guidance says the person giving a medicine should understand it, and ask a prescriber or pharmacist if unsure. Check: does the person know what this is and why they're taking it, and do I?

Checks the rights don't cover on their own

Build these into your process as well:

• Allergies. Check the MAR's allergy section, confirmed with the GP (NICE SC1 1.14.15).
• Expiry and storage. Check expiry dates, opening dates on bottles and tubes, and that fridge medicines were kept cold.
• Not already given. By another worker, a visiting nurse or the person themselves.
• Fewer interruptions. NICE SC1 suggests avoiding planned breaks at medicine times and reducing distractions (1.14.5).
• Errors and near misses. A wrong dose reported quickly is far safer than one hidden. See medication errors in care homes.

Using the rights in competency checks

Only staff who are trained and assessed as competent should give medicines (NICE SC1 1.17.1), with an annual review of their knowledge, skills and competence, sooner after an incident (1.17.5). When you observe a round, use the check questions above as prompts. Watch how the worker handles a refusal, a variable dose or a resident who's asleep, and what they record. Skills for Care publishes a medicines competency assessment guide for adult social care, with template records you can use.

How Kiwi handles this

In Kiwi (our product), staff record each scheduled dose on the eMAR as taken, refused, missed or not required, with their name and the time stamped on the entry and an optional note. The eMAR shows when a round is due. If a scheduled dose has nothing recorded for its day, Kiwi records it as missed from 02:00 the next day and marks it as a system entry. Every missed dose is counted on the dashboard and listed under Missed meds until a manager reviews it and records what was done. PRN protocols are recorded for each resident, and each person's MAR chart downloads as a PDF for the last 28 days, with the code key. The rights are still checked by the person at the trolley, whatever system you use.

If you'd like to see how Kiwi records each dose, refusals and the manager's review of missed doses, book a demo.

Frequently asked

What are the 5 rights of medication administration?

Right person, right medicine, right dose, right route and right time. Before giving any medicine, check it's for this person, it's the medicine on the MAR, the amount and the way it's given match the prescription, and it's the right time. In England, NICE and CQC add a sixth for care services: the person's right to refuse.

What are the 7 rights of medication administration?

There's no single official list. A common version is the five rights (person, medicine, dose, route and time) plus right documentation and the right to refuse; some lists use right reason instead. In England's care homes, NICE and CQC use six. Use the list in your home's medicines policy.

What are the 10 rights of medication administration?

The 10 rights usually add five more to the classic five: the right to refuse, right documentation, right reason (why the medicine is given), right response (checking the effect and side effects) and the right to information or education. Wording varies between lists and training providers. Skills for Care's eLearning on medication administration teaches 10 rights.

Are the rights of medication administration a legal requirement in the UK?

No. The rights are a teaching tool and a checklist, not a law. In England, the legal duties are in the regulations CQC enforces, including safe care and treatment, consent and good governance (which covers records), and in the Mental Capacity Act 2005. NICE guideline SC1 recommends that care homes consider including the six rights in their medicines process as a practical way to meet them.

What should a care worker do if a resident refuses their medicine?

Respect the refusal if the person has capacity, even if it seems unwise. Explain what the medicine is for, offer it again later if your policy allows, and record the refusal and what you offered. Tell the GP if the medicine is critical or refusals repeat. If you doubt capacity, follow the Mental Capacity Act. Never hide medicines in food without a best-interests decision.

Sources

• NICE SC1: Managing medicines in care homes (recommendations 1.14.1, 1.14.4, 1.14.5, 1.14.11, 1.14.15, 1.14.16, 1.15.3, 1.17.1, 1.17.5)
• NICE NG67: Managing medicines for adults receiving social care in the community (recommendation 1.7.1)
• CQC: Medicines administration records in adult social care
• CQC: Covert administration of medicines
• CQC: 'When required' medicines in adult social care
• CQC: Regulation 12, safe care and treatment
• CQC: Regulation 11, need for consent
• CQC: Regulation 17, good governance
• Royal Pharmaceutical Society (now the Royal College of Pharmacy) and Royal College of Nursing: Professional guidance on the administration of medicines in healthcare settings (January 2019; review date January 2023, still published by the Royal College of Pharmacy)
• West Suffolk NHS Foundation Trust: Take your medication on time, every time (time-critical medicines)
• Skills for Care: Medication
• Skills for Care: Medicines management resources
• Mental Capacity Act 2005, section 1 (the principles)
• GOV.UK: Mental Capacity Act 2005 Code of Practice

Sources last checked: 22 October 2026.