Drug administration clinical competencies Name: Role: Band 5/6/7 Base: Date initial training completed: Competency Statement: The participant demonstrates clinical knowledge and skill in drug administration without assistance and/or direct supervision (level 3 - see level descriptors). Assessment in practice must be by a Registered Nurse who can demonstrate competence at level 4 or above. Performance Criteria Assessment Method Level achieved Date The Participant will be able to: 1. Demonstrate the knowledge of principles and theory of drug administration required to meet the patient s medication needs a) Identify the principles of accountability and responsibility for medicines administration b) Describe the purpose of a Standard Operating Procedure (SOP) c) Identify the differences between administering a medicine from a prescription and from a Patient Group Direction (PGD) d) Identify the situation in which a verbal order may be used e) Demonstrate knowledge and understanding of the standards for medicines management (NMC 2008) f) Can accurately describe whose responsibility is it to check that a medication is prescribed correctly prior to administration g) Can explain what to do if asked to administer medication: At dose exceeding BNF recommendation OR Through route not specified in BNF for drug h) Can explain what to do if asked to leave a prepared injection or pot of medication unsupervised i) Can explain how to obtain up to date information about any medication j) Can describe the symptoms and management of Anaphylactic Shock
2. Demonstrate knowledge of the theory of drug administration procedure/ undertaking a drug round a) Can explain which healthcare staff may hold drug keys b) Can explain the correct course of action if the prescription chart: Is missing Is hard to read If there are errors on the prescription chart c) Can explain the correct course of action if the prepared medication cannot be administered: At the prescribed time Immediately to the service user The person declines their prescribed medication d) Can explain what to do if a drug administration error occurs e) Describe what should be checked on prescription charts when administering i) regular medication ii) prn medication f) Describe what issues should be considered before PRN medication is administered. g) Can describe ordering procedure for stock medication and / or non stock drugs h) Can describe procedures for disposal of tablets i) (Only for inpatient areas where patient self administration used) Can describe what must happen before a service user may self administer medication j) Can describe where a list of medications which can be administered at the discretion of nurses can be found 3.1 Demonstrate knowledge of the management and administration of controlled drugs a) Can explain the procedure for ordering CD s b) Can explain the procedure for accepting and storing controlled drugs from pharmacy
c) Can name controlled drugs most likely to be used in own area and why they might be prescribed d) Can explain the procedure for administering a CD and what recording must take place e) Can explain who can be the second checker and the role of the second checker when administering CD s f) Can explain the record keeping requirements when making an amendment to the CD register g) Can describe what should be done if a discrepancy is noticed between medication present and entry made in CD register h) Can describe correct disposal procedure when: A CD is out of date An attempt has been made to administer a CD but it has been declined by service user Who is allowed to hold the CD keys Who can access the CD cupboard 3.2 Demonstrate practical skill in administration of controlled drugs a) Wash hands and prepare equipment Check that prescribed drug has not Route. Prescribed Dose. Calculation if any. For PRN check size & time previous dose administered c) On medicine label/blister pack check: Drug name Drug strength Dose (if not stock) Patient name ( if not stock) d) Before administering a Controlled Drug: Check total amount of ward stock corresponds to the entry in the controlled drug register (CDR)
Enter details in CDR with signatures of both the witness and person who is administered the drug, include: dose given, patient details, date/time of administration and remaining stock balance Check the volume if the remaining volume is less than the required dose before giving the dose then correct the register with the nurse and witness signing the register. Inform the clinical pharmacist if any discrepancies. e) Once the medication has been administered: Register counter signed by witness. Drug chart signed. Details of dose given, patient details, date and time of administration and remaining stock balance to be recorded on register. CD register stored in the correct place. 4.1 Demonstrate knowledge of the management and administration of oral drugs a) Can discuss alternative strategies for medication administration should a person be unable to swallow tablets b) Can describe the distinguishing features of tablets which cannot be cut or crushed c) (If drug used in own area) Can describe what you should do before administering DIGOXIN d) (if drug used in own area) Can explain why WARFARIN is prescribed at a variable dose, and where this is recorded. Evidence that the staff member Knows how to act appropriately on knowing: 1. Target INR 2. Latest INR result 3. Latest dose 4. Date of next test 5. Blood test date and latest result. e) (if used in own area) Can describe how to order monitored dosages systems/compliance aids, e.g. dosette & NOMAD boxes f) Can name a medication that can be administered at the discretion of nurses and where to record that it has been given 4.2 Demonstrate practical skill in administration of oral drugs a) Wash hands and prepare necessary equipment
That prescribed drug has not Route Prescribed Dose Calculation if any For PRN check size & time previous dose administered c) On medicine label/blister pack check: Drug name Drug strength Dose (if not stock) Patient name ( if not stock) d) Prepare and record correctly e) Administer correctly to service user checking identity, obtaining consent and respecting dignity before moving on to next patient f) Appropriate disposal of medicines (if necessary) or other equipment used 5.1 Demonstrate knowledge of the management and administration of drugs by Intramuscular injection (IM) a) Can explain why it is important to obtain informed consent before giving an injection b) Can explain ways of protecting the person s privacy and dignity while administering an injection c) Can describe an appropriate site for injecting IM medication d) Can explain why care should be taken to avoid blood vessels and nerves. f) Can explain how to check that a blood vessel has not has not been punctured while the needle is in situ g) Can explain why injection sites should be alternated in people who receive regular IM injections
5.2 Demonstrate practical skill in administration of Intramuscular injection (IM) a) Wash hands and prepare necessary equipment That prescribed drug has not Route Prescribed Dose Calculation if any For PRN check size & time previous dose administered c) On vial &container check: Patient name (if not stock) Drug name & strength Route & expiry date Visual check of vial/ampoule that it has not been tampered with Check medicine was stored as recommended, e.g. refrigerator d) Injection drawn up correctly (including correct needle selection, vial opened safely, bubbles removed) e) Service user fully consulted, consent maintained & person given opportunity to ask questions/raise concerns. f) Ensure therapeutic environment is considered for administration. g) Appropriate site chosen, area clean and good technique used. Equipment disposed of safely. h) Check/ ensure appropriate monitoring & care plan in place. 6.1 Demonstrate knowledge of the management and administration of drugs by Subcutaneous injection (SC) including insulin a) Can describe an appropriate site for subcutaneous injection
b) Can explain why INSULIN might be prescribed and its method of action c) Can describe the symptoms of hypoglycaemia and hyperglycaemia and actions needed should this occur. Should include normal ranges. d) Can describe when to monitor a patient s blood sugar and where to record readings. f) Can explain why on medication charts the word UNITS and not U must be clearly written next to the dose and what action to take if prescription not written as units. g) Can describe the correct storage and preparation of INSULIN. h) What information should be discussed in handover if an insulin dependent diabetic patient is on the ward? i) If a patient is prescribed insulin what other preparation must also be prescribed as PRN? 6.2 Demonstrate practical skill in administration of subcutaneous injection (SC) a) Wash hands and prepare necessary equipment That prescribed drug has not Route Prescribed Dose Calculation if any For PRN check size & time previous dose administered c) On vial &container check: Patient name (if not stock) Drug name & strength Route & expiry date Visual check of vial/ampoule that it has not been tampered with Check medicine was stored as recommended, e.g. refrigerator
d) Injection drawn up correctly (including correct needle selection, vial opened safely, bubbles removed) e) Blood sugar level checked and within safe range for INSULIN administration of (if applicable) f) Service user fully consulted, consent maintained & person given opportunity to ask questions/raise concerns. g) Ensure therapeutic environment is considered for administration. h) Appropriate site chosen, area clean and good technique used. Equipment disposed of safely. i) Check/ ensure appropriate monitoring & care plan in place. 7.1 Demonstrate knowledge of the management and administration of medication rectally (PR) a)can describe why enemas and suppositories might be given and their method of action b) Can describe how to reduce the risk of discomfort to the person and/or damage to the bowel wall during administration of any of the above c) Can describe appropriate disposal of equipment after use d) Can describe how to protect the dignity and privacy of service users during administration 7.2 Demonstrate practical skill in rectal administration of medication a) Applies standard precautions for infection control and adheres to hand hygiene policy. That prescribed drug has not Route. Prescribed Dose. Calculation if any.
For PRN check size & time previous dose administered c) On medicine label/blister pack check: Drug name Drug strength Dose (if not stock) Patient name ( if not stock) d) Ensures the privacy and dignity of the individual is maintained. e) Prepares necessary equipment including lubricant. f) Uses correct administration method in line with best practice & manufacturers guidelines. g) Monitor s and records the response to the medication administered & takes any necessary action. 8.1 Demonstrate knowledge of the management and administration of vaginal medication a)can describe why pessaries might be given and their method of action b) Can describe appropriate disposal of equipment after use c) Can describe how to protect the dignity and privacy of service users during administration 8.2 Demonstrate practical skill in vaginal administration of medication a) Applies standard precautions for infection control and adheres to hand hygiene policy. That prescribed drug has not Route. Prescribed Dose. Calculation if any.
For PRN check size & time previous dose administered c) On medicine label/blister pack check: Drug name Drug strength Dose (if not stock) Patient name ( if not stock) d) Ensures the privacy and dignity of the individual is maintained. e) Prepares necessary equipment f) Uses correct administration method in line with best practice & manufacturers guidelines. g) Monitor s and records the response to the medication administered & takes any necessary action. 9.1 Demonstrate knowledge of the management and administration of topical medication e.g. eye, ear and nasal preparations a) Can describe common reasons for eye preparations, nasal preparations & ear preparations being prescribed. b) Can explain expiry date for eye preparations once in use. c) Can explain when it is necessary to have separate containers for each eye and when and if one is needed. d) Can explain the time delay needed if patient receives more than one type of eye preparation at the same time. e) Can describe standard precautions which should be taken when administering any of the above f) Can explain where and how to store eye preparations, nasal sprays and ear preparations and how to check if unsure 9.2 Demonstrate practical skill in administration of topical medication
a) Apply standard precautions for infection control Check that prescribed drug has not already been given Route. Prescribed Dose. Calculation if any.. For PRN check size & time previous dose administered c) Service user fully consulted & consent sought d) Applies medication in a sensitive and dignified way, and one which minimises pain or discomfort. e) Use correct technique in application of eye drops, nasal sprays and ear drops. f) Respond appropriately to any adverse reaction. 10.1 Demonstrate knowledge of the management and administration of inhaled medication e.g. nebulisers and inhalers a) Can explain why metered dose inhalers and nebulisers might be prescribed b) Can describe the correct technique for using a metered dose inhaler in line with the equipment guidelines. c) Can discuss alternative strategies which could be used if a service user is unable to effectively operate a metered dose inhaler d) Can describe the correct technique for the administration of medication via a nebuliser e) Can describe the correct use of a spacer and how to maintain it.
10.2 Demonstrate practical skill in administration of inhaled medication a) Is able to set up equipment correctly in preparation for administration. Check that prescribed drug has not Route. Prescribed Dose. Calculation if any. For PRN check size & time previous dose administered c) On inhale/ nebule check: Drug name & strength Patient name (if applicable) d) Correct dosage delivered, with any necessary assistance or advice to service user given. e) Nebuliser used in accordance with operating instructions (if used in own area) 11.1 Demonstrate knowledge of the management and administration of buccal medication e.g. Midazolam a) Can describe situations where use of buccal Midazolam is required. b) Can describe the method of action for buccal Midazolam c) Can demonstrate knowledge of potential side effects. d) Can explain the correct storage and recording of Midazolam. e) Can describe the correct method of administration in line with manufacturer and best practice guidelines. 11.2 Demonstrate practical skill in administration of buccal medication
a) Is able to assess the service users need and identify when buccal Midazolam should be administered. Check that prescribed drug has not Route. Prescribed Dose. Calculation if any. For PRN check size & time previous dose administered c) On medicine label/blister pack check: Drug name Drug strength Dose (if not stock) Patient name ( if not stock) d) Prepares equipment correctly and safely. e) Administers Midazolam in line with manufacturer and best practice guidelines. f) Disposes of equipment safely. g) Monitors and records the response to the medication administered & takes any necessary action/emergency response as indicated. 12.1 Demonstrate knowledge of the management and administration of transdermal medication a) Can explain why transdermal patches might be prescribed b) Can describe safety precautions for the use of Fentanyl patches c) Can describe a common side effect which might occur d) Can describe appropriate sites for the application of transdermal patches
e) Can explain why gloves should be used when handling transdermal patches f) Can describe the how patches should be disposed of 12.2 Demonstrate practical skill in the application of transdermal medication a) On prescription chart check: Check prescribed drug has not Route. Prescribed Dose. Calculation if any. For PRN check size & time previous dose administered b) ) On medicine label/blister pack check: Drug name Drug strength Dose (if not stock) Patient name ( if not stock) c) Communicates with the service user: Information regarding the medication being administered Potential adverse reactions/side effects Action to be taken should an adverse reaction occur. d) Uses correct technique for applying transdermal patches (including selecting appropriate site & using gloves) or supervises service user doing this. e) Ensure appropriate removal of old patch. f) ) Monitor s and records the response to the medication administered & takes any necessary action. Source: HPFT medication administration competency assessment toolkit 2010 Date all elements of Competency Tool completed to level 3 Name Signature Status Date
I confirm that I have the above named individual and can verify that he/she demonstrates competency in drug administration Assessor Signature Status Date Review Competent Registered Verifier signature Comments Dates: Yes / No Nurse Signature