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Medication Administration - seminar
Transcript of Medication Administration - seminar
1) Understand nurses' role in administration
2) Detail the 5 'Rights' of administration & NMC standards for medication administration (pre-reading) and discuss importance of these
3) Identify key knowledge needed for safe administration (including controlled drugs)
4) Understand the role key legislation plays in practice and the importance of error reporting
5) Become aware of ordering and storage issues (CD's)
6) Demonstrate safe reading of a drug chart
7) Review own pharmacology guided study work
8) Be introduced to first years medication workbook
Standard 8 NMC Standard (2008)
be certain of patient's identity
know therapeutic use, dosage, side effects, precuations and contraindications
be aware of patients plan of care
check the prescription and label
check expiry date
consider dosage, weight, method of administration, route and timing
administer or withhold in context of patient's condition
contact prescriber to query if necessary
where not given, record reason.
registered nurses may administer with a single signature: POM (prescription only medications), GSL (general sales list) or pharmacy (P) medication
The 5 Rights
1) right Patient
2) right drug
3) right dose
4) right time
5) right route
Learning outcome 3 : What do I need to know?
Right patient: (patient history and background, capacity to consent, diagnosis and physical capabilities, hypersensitivity or allergies, special instructions (NBM), identity band (4 key identifiers)
Right drug: generic approved name eg diazepam, propriety or manufacturers brand name eg valium, appropriateness of drug for patient eg amitryptilline (treats depression but also alleviates chronic pain)
Right dose: administration is an intellectual event carried out thoughtfully - must also understand actions, interractions and side effects. Use BNF where unsure (especially appendix 1 - interractions). V important to claculate correct dose! (in practice - take your time, always re-check, do not be rushed, do an initial 'sense check' of the calculation, DO NOT AGREE if you are unsure.
Right time: as per prescription, night time if causes drowsiness, insulins and Parkinson's drugs.
What do these latin abbreviations stand for? bd, tds, qds, om, mane, on, prn, stat?
Right route: medicines are designed and formulated to be absorbed according to route of delivery (PO, NG, SL,IV,IM, Subcut, PR, PV, etc)
Learning outcome 4 Legislation
Medicines Act 1968 - defines the three legal categories of medicines (P, POM, GSL) Most medicines can only be supplied and sold in a pharmacy under care of pharmacist (P). GSL's (General Sales List) can be sold at other shops if pre-packed, there are limits to size and strength eg only upto 16 paracetamol, and only 200mg ibuprofen. POM's (prescription only medicines) must be prescribed by GP (or nurse, dentist or pharmacist).
Standards for Medicines Management (NMC 2008) - outlines responsibilities and guidance for all qualified nurses
Misuse of Drugs Act 1971 - prohibits certain activities in relation to controlled drugs (CD) in terms of manufacture, supply and posession. Outlines 3 classes of CD:
class A (eg morphine)
class B (eg codeine)
class C (eg buprenorphine)
Misuse of Drugs Regulations (2001) - defines who can authorize supply and possession of CD's for import and export, production, supply, possession, prescribing and record keeping. Has 5 schedules 1-5.
eg schedule 1 eg cannabis - possession and supply prohibited unless under Home Office rule
eg schedule 2 eg morphine - full controlled drug restriction, register required.
Trust and local hospital policies.
NMC guidelines for mentors and students: At all times the responsibility and accountability to maintain all aspects of Section 4 : Standard of the NMC Standards for Medicines Management (2008) remains with the registered practitioner
Role of nurse: Discuss - explain to patients how drugs act, give advice regarding side effects and interactions (other drugs and diet), teach patients about their medication (what it does to them, what to look out for).
NOT a 'mechanistic task' (NMC 2015) - requires 'thought and professional judgement'.
Medication Administration - seminar
1) covert administration - NOT consented therefore TRESPASS by law (Human Rights Act 1998)
2) for consent patient needs the mental capacity to understand an explanation, be able to choose, and be able to communicate,
3) Best interest - in exceptional circumstances but have to show best interest and reasonable standard of care
4) parental consent - responsibility to consent on behalf of children (Fraser Guidelines allow children and young adults to agree medical treatment without parental consent if Drs are satisfied they meet certain requirements)
5) Relatives CANNOT give consent without legal intervention. in practice must rely on principle of necessity - treatment should only be given when necessary for patients' health and well being. However, nurses must work in partnership with relatives and carers who have a detailed understanding of patients circumstances and best interests.
6) unless under EXCEPTIONAL circumstances must not hide medicines in food or drink (covertly).
6) Alteration of medicines - there are pharmacological dangers to patients and legal implications of tampering with drugs eg crushing tablets or opening capsules (liquids, change prescription, alter route eg PEG or NG)
7) Reporting errors - open culture to prevent happening again, report via local method eg datix, critical incident reflection, no blame culture. To ignore is to breach the legal duty of care owed to the patient and to not follow NMC standards (2008) and Code (2015).
Supply and administration of medications
Nurses not just administrators; the can supply and administer under PGD, and prescribe under certain circumstances.
PGD - Patient Group Direction (administering without prescription until after the event)
Written instructions to supply drugs to homogenous groups of patients who require same treatment. Clear advantage for patient care without compromising safety (Barber and Robertson 2012).
1998 Suppply and Administratin of Medicines under Group protocols (DH 1998) - legal framework for PGD's.
PGD policy must include:
date of introduction and expiry of direction
heatlhcare professional who can supply or administer medication
the clinical situation to which the direction applies
circumstances where further advice should be sought
details of drug, dose, route & frequency
Nurses can now autonomously prescribe and are responsible for assessment, diagnosis and treatment for pateints in their specialist field. Can now prescribe from whole BNF ( some restrictions with CD's and non-licensed drugs).
New drug chart standards Royal Pharmaceutical Society
Sources of information:
pharmacy, BNF, Prescriber, online resources (medusa, online BNF, manufacturer guidelines)
First Year Medications
Guided Study pharmacology quiz answers
How to read a drug chart : demonstration and practice in seminar
Non technical skills in safe administration - think about: communication, human factors, situational awareness, interruptions, untidy/poorly stocked environment
Maths calculations - attendance at maths sessions mandatory in year 1 but not in years 2 and 3, reflect: do you need to put some time and energy into improving your calculation and maths skills? Use all the help you are offered!
LDU, maths sessions, online resources, taking opportunities in clinical practice to calculate.
Learning outcome 1&2
Learning outcome 7
Learning outcome 8
Learning outcome 3
Controlled drugs (CD's)
Storage: separate cupboard within a cupboard. Separate keys held by nurse in charge. Red warning light when open. Ordered using specially designed order book. Pharmacy keeps specimen signatures of all staff ordering.Separate CD register - ongoing tally of drugs used, patients given to, 2 signatures of RN's who administered, time and date.
Checked against last amount entered
Remove drug and re-lock
Prepare for administration
Detail date, time, patient name, amount given and who gave and who witnessed, new stock balance.
Delivery to clinical area:
locked box or sealed bag. Sign for receipt from porter/pharmacy. Checked by 2 nurses. Entered into CD register.
Learning outcome 6
Learning outcome 5: ordering and storage