Derby Hospitals NHS Foundation Trust. Drug Assessment

Transcription

1 Drug Assessment for Preparation and Administration of Oral, Enteral, Ophthalmic, Topical, PR, PV, Inhaled, Subcutaneous and Intramuscular Medicines to Patients (N.B. The preparation and administration of all intravenous medicines is assessed by the Trust Intravenous Therapy Study Day and completion of the Scope document) A Publication of the Medicines Management Sub-Committee Edition 5 June 2007 Review November 2008 Further information can be found in the Trust s Medicines Code on the DHFT Intranet Kate Appleby, Mark Cannell, Sue Abdulla, Val Garner, Anne Meadows, Mandy Patrick, Lesley Hancock, Yvonne Jackson, Shirley Pagett, Jenny Sinclair and Joanne Parker Version 7 June 2007 Version 7 1 Date Prepared: July 2006

2 Drug Assessment for Preparation and Administration of Oral, Ophthalmic, Topical, PR, PV, Intravenous, Subcutaneous and Intramuscular Medicines to Patients Purpose of Assessment Safety To ensure the safe administration of medications to the correct patient, at the right time, providing the prescribed medicine safely. Knowledge To ensure that the individual has the knowledge of normal doses, regimens, desired effects, side effects and contraindications. To ensure that the individual has the ability to link symptoms to treatment (illness and drug reactions) To ensure that the individual knows how to store and order medicines. To ensure that the individual has the knowledge and the skill to prepare medications. To ensure that the individual has the knowledge and the skill to administer medications via the following routes oral, enteral, ophthalmic, topical, PR, PV and inhaled. To ensure that the individual has the knowledge and skill to perform subcutaneous and intramuscular injections. To ensure that the individual has knowledge and skill to initiate, administer and manage subcutaneous infusions. What is being assessed? The preparation and administration of oral, enteral, ophthalmic, topical, pr, pv, inhaled, subcutaneous and intramuscular medicines. The competency of the preparation and administration of all intravenous medicines will be assessed by the Trust Intravenous Therapy study day and completion of the Scope document. Who Can Assess Sisters/Charge Nurses, Clinical Facilitators, Senior Staff Nurses, Midwifery Matrons, Midwife 2 grades and Practice Development Midwives, or preceptors/mentors as designated by the Sister/Charge Nurse Who and When to Assess Who? Compulsory Newly Qualified Nurses/Midwives, Registered Nurses new to the Trust, or Nurses/Midwives returning after a period of absence from practice of greater than 12 months. Any other designated practitioner from a Health Care Group (approved by the Trust) at the ward Sister s or line manager s discretion e.g. midwifery support workers. (Medicines Code 2.1) Version 7 2 Date Prepared: July 2006

3 Any designated practitioner from a Health Care Group (approved by the Trust) who does not fit the compulsory criteria but who requests an assessment. (Medicines Code 2.1) When? Criteria for Assessment The individual must read the 'Multidisciplinary Standard of Practice for Doctors, Nurses, Pharmacists, Midwives and other Healthcare Staff', any relevant professional body guidance, e.g. Guidelines for the administration of medicines (NMC 2004) and Patient Group Directions for the speciality. The individual is not permitted to administer drugs unsupervised until the assessment is completed satisfactorily. Until then he/she may not be the primary or sole signature for medications, though he/she may countersign. The assessment should be taken when the individual is ready and their preceptor or line manager deems them competent. If the individual is unsuccessful when taking the assessment he/she should be given support and advice prior to any further assessment being taken. The drug assessment can be undertaken up to a maximum of THREE times. After this the Assessor should meet with the Clinical Facilitator and the candidate to discuss further action. As soon as the assessment is satisfactorily completed the individual can administer medications. Assessment Guidelines When administering medication the individual must be seen to consider the prescription, the patient and the product (drug). The assessment should be carried out as follows. The individual under assessment prepares and administers the medications without assistance. The assessor observes and only intervenes for matters of safety. Drug knowledge should be assessed during clinical practice and by formal questioning by the assessor. The individual must be deemed competent in all of the assessment criteria in order to pass. If not competent in any of the assessment criteria, this must be reassessed following feedback from the assessor. Competency should be assessed for each individual route of administration. The assessor can deem the individual competent to administer by the assessed route. When the assessment is completed the relevant pages must be copied four times. One copy to senior sister/line manager/midwifery Matron, one to the individual being assessed, one to the midwife s named Supervisor of Midwives and one to the Chief Technician for Medicines Management, Pharmacy, Derby City General Hospital. See below for specific information regarding the assessment of the preparation and administration of medicines via different routes. Version 7 3 Date Prepared: July 2006

4 Assessment Guidelines The individual must be assessed on his/her ability to administer medicines safely and knowledgeably to a group of patients. This must include the administration of medicines to at least five adult patients (plus five children and neonates where applicable). The assessment should be done to correspond with the usual ward routine. For example if the ward is split into two teams and the nurse/midwife usually administers medicines to one team then this should be replicated for the drug assessment. In respect of parenteral (subcutaneous and intramuscular) administration The individual must be assessed on his/her ability to prepare and administer medicines safely and knowledgeably to a patient via each route under assessment. For the purpose of this assessment parenteral refers only to intravenous, subcutaneous and intramuscular routes. References Southern Derbyshire Acute Hospitals NHS Trust, Multidisciplinary Standards For The Administration Of Medicines To Patients, June 2003 Derby Hospitals NHS Foundation Trust, Policy for Expanding the Scope of Professional Practice, 2006 NMC, Guidelines for the administration of medicines, 2004 The Royal Marsden Hospital, Manual of Clinical Nursing Procedures Southern Derbyshire Acute Hospitals NHS Trust, Subcutaneous Therapy Guidelines Derby Hospitals NHS Foundation Trust, Medicines Code 2005, Edition 4 (currently being reviewed) British National Formulary (BNF) Document Control Approved By: Medicines Management Sub-Committee Amendments Approved: September 2007 Document Location: Policies and Procedures for Medicines folder; Medicines Intranet Version 7 4 Date Prepared: July 2006

5 Name: Site: Ward: Drug Assessment for Preparation and Administration of Oral, Enteral, Ophthalmic, Topical, PR, PV, Inhaled, Subcutaneous and Intramuscular Medicines to Patients Safety of administration Assessment is usually carried out during drug round or usual clinical practice. If any of the criteria cannot be met during clinical practice it is acceptable to use oral questions to determine competence. Check prescription sheets Yes No N/A Date Check patient's identity against prescription Check ward name and hospital site Check for relevant information (allergies/instructions) Prescription is complete, legible and signed by an authorised prescriber Date and time medication prescribed Prescribed medication is known and in accordance with the BNF Check medication has not previously been given Individual prescription has drug name, dose, route, start date Drug Preparation Yes No N/A Date Prepares and dispenses tablets and capsules Prepares and dispenses oral liquids, measurement, use of oral / enteral syringes Prepares and assembles the correct equipment (e.g. choice of correct syringe, checks expiry date, packaging) Prepare and dispense parenteral bolus for subcutaneous & intramuscular injections (aseptic technique) Preparation method is known and in accordance with the manufacturer s/trust instructions Obtains second check for all parenteral medicines and calculations Follows correct procedure for disposal of equipment (e.g. syringes, Needles, lines etc) and unused medicines (Refer to Trust Sharps Policy) Drug administration Yes No N/A Date Re-check patient s identity immediately before administration (use wristband and positive patient identification) Check for allergy Administration method of drug is known and in accordance with the manufacturer s/trust instructions Administers and checks that patient has taken correct medication Signs treatment card or follows the procedure for reporting/ recording omissions or refusals Appropriate use of Parenteral Infusion Checklist and Record sheet Appropriate use of Controlled Drug Register, if appropriate Obtains a second check for parenteral medications, complex calculations, CD s, and paediatric medications All neonatal drugs must be checked by two qualified staff Version 7 5 Date Prepared: July 2006

6 The Assessor observes the individual s administration methods of the following: - oral solids (tablets and capsules) - oral liquids - enteral preparations via NG, PEG, JEJ - topical preparations - ophthalmic preparations - ear and nasal preparations - inhalation and nebuliser products - PR preparations - PV preparations - subcutaneous bolus (aseptic technique) - subcutaneous infusion bag (gravity) - intramuscular bolus (aseptic technique) Yes No N/A Date Knowledge Assessment carried out during practice and by formal questioning Knowledge and use of BNF Yes No N/A Date Demonstrates the ability to use the BNF Able to identify other sources of information about medicines Able to identify the difference between licensed and unlicensed medicines Awareness of Trust Medicines Code Demonstrates knowledge of a minimum of 3 common Yes No N/A Date drugs used in the Clinical area with regard to the following Therapeutic dose Desired effects and ability to link illness to medical treatment Side-effects & contra-indications & associated patient observations Calculations Yes No N/A Date Ability to perform a set of drug calculations e.g. Rate of administration for infusions or if prescription card asks for 60 mg Prednisolone how many 5mg tablets do you give? Aware that complex calculations should be checked by another appropriate practitioner prior to administration Patient Monitoring related to medicines administration Yes No N/A Date Temperature, pulse, blood pressure, respiratory rate Drug related medical emergencies Yes No N/A Date Can identify the treatment for common acute complications of drug therapies, e.g. anaphylactic shock, haemorrhage, respiratory depression. Patient Group Directions Yes No N/A Date Is aware of Patient Group Directions for the Directorate Is aware of recording procedures Controlled drugs Yes No N/A Date Follows the procedure for ordering and storage of controlled drugs Follows the procedure for checking controlled drugs What happens if an error is discovered? Version 7 6 Date Prepared: July 2006

7 Safe practice with oral/enteral medicines/feed Yes No N/A Date Infection control, e.g. single use syringes, use of sterile water, between patients Suitability of syringes, equipment Understanding of Trust policies, procedures and guidelines Awareness of potential interactions of medicines with feeds Knowledge of appropriate formulation for enteral use Knowledge of procedure following a blocked tube Safe practice with injection and infusions Yes No N/A Date Infection control, e.g. single use of patient vials and hand washing between patients Disposal of unused and partly used medicines Knowledge of safe techniques of administration of subcutaneous and Intramuscular injections Aware of Trust policy on the disposal of sharps Knowledge of procedure following a needle-stick injury Discharge/Transfer Medications Yes No N/A Date Follows the correct procedure for transferring medicines with patients Follows correct procedure for ordering discharge medications Ensure Home Enteral Feeding Dietician contacted Procedure is followed when dispensing medication to patient Gives information relevant to medication dispensed Follows correct recording procedure when dispensing TTOs from the ward Knowledge of relevant equipment to supply on discharge/transfer Ensures relevant training is given before discharge Ensures assessment of ability to self-administer prior to discharge has occurred if appropriate Safe Storage, Disposal and Return of Medicines Yes No N/A Date Correct disposal/return of patients drugs Correct disposal of expired/unused drugs Is aware of the procedure for storage and carriage of drugs Is aware of the procedure for patient s own drugs on admission Storage of stock and TTO medications Errors and omissions Yes No N/A Date Procedure for recording and reporting of medication errors Version 7 7 Date Prepared: July 2006

8 Name: Site: Ward: Drug Assessment for Preparation and Administration of Oral, Enteral, Ophthalmic, Topical, PR, PV, Inhaled, Subcutaneous and Intramuscular Medicines to Patients Assessors comments Please tick the areas of competence passed. It is not necessary to pass in all areas but the individual will only be allowed to administer in the areas approved below. Assessed as competent in administration of medications via the following methods: - oral solids (tablets and capsules) - oral liquids - Enteral preparations via NG, PEG, JEJ - topical preparations - ophthalmic preparations - ear and nasal preparations - inhalation and nebuliser products - PR and PV preparations - subcutaneous injections - subcutaneous infusions - intramuscular injections Date Yes No Print Names Signatures Date Assessor Assessed..... Please make four copies of pages 8 once completed. One copy to Senior Sister/Midwife/Line Manager; one to the individual being assessed; one to the midwife s named Supervisor of Midwives; and one to the Chief Technician for Medicines Management, Pharmacy, Derby City General Hospital. Version 7 8 Date Prepared: July 2006