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Another "Five Rights" List? Sure, I'm Up For It

April 16, 2009
by Mark Hagland
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In my April 8 blog from the HIMSS Conference, I mentioned what I called my "most interesting vendor-related tidbit," and that was a list of the "Five Rights of Laboratory Testing" that was being promoted by the folks at Sunquest, a laboratory IS vendor. As we all know, the "five rights of medication administration," which for years have been discussed and promoted as part of a broader patient safety push, are: the right patient; time and frequency of administration; dose; route; and drug. And, as I said on April 8, Sunquest's lab-testing "five rights" list made sense to me. Those are: performing the right test on the right patient at the right time, using the right indicators, and resulting in the right diagnosis. I added that getting the documentation right is important as well (though of course this would add an asymmetrical "sixth right" to the list). Well, on the last day of the HIMSS Conference, I spoke with the people at the Philips booth, and they were promoting the idea, on one electronic display board, of the "Five Rights of Imaging": right patient, right exam, right protocol, right dose, and right time, as part of a push they're making towards ture "closed-loop imaging"--using modalities and information systems that are interfaced seamlessly. Now, of course, one could get carried away with these "five rights" lists. But I will say that I think this imaging-focused list can be useful, as can be the lab testing-oriented one, if it gets people in patient care organizations thinking in both a more systemic and a more systematic way, about what they are doing in these crucial patient care delivery areas. One of the things that is becoming an area of consensus these days is that care improvement requires systemic thinking, planning, and action; and sometimes, mnemonics can be helpful in that regard. Mnemonics also help to build an additional feeling of consensus around what is important to pursue at any particular moment in the evolution of care improvement. So, as long as we don't get collectively carried away and come up with a "five rights" list for every single set of tasks in health care, I think these lists, in moderation, could prove helpful and useful. The real challenge will be to comply with them and use them to broadly improve care in our institutions.



I agree that Mnemonic devices have their place.

Regarding getting carried away -

The other trend I see is people deciding that, if five is good, six or seven must be better. It's easy to throw
'6. right documentation' and
'7. right indication'

onto the 5 rights lists. Depending on the drug, you could add

'8. Right monitoring' or
'9. Right Precautions' or
'10. Right Collateral Orders,'
... I'll stop there.

Thanks for your great comments. Personally, I think one of the reasons these lists are "five rights" lists, rather than six, seven, or more, is that five is probably the largest number of "rights" that can easily be memorized and effectively used. I'm not an expert on mneomic issues, but I do recall reading something to that effect some time ago. In other words, I'm agreeing with youlet's not turn any "five rights" listsin whatever clinical areainto a "ten rights" listthat kind of "inflation" would only rob any such list of its effectiveness and usefulness. Again, thanks for your excellent comment!