Mandatory Competency Assessment for Medicines Management (Not Injectable Medicines) for Registered Practitioners IN HOSPITAL Document Author Written by: Lead Pharmacist/Lead Technician Medicines Use and Safety Team, Pharmacy Department Authorised Authorised by: Head of Practice Education and Development Date: September 2015 Date: September 2015 Effective Date: October 2015 Review Date: October 2017 Approval at: Clinical Competency Group and Mandatory Training Group Date Approved: September 2015 1
Nursing staff in the best interests of their s must know the therapeutic uses of the medicine to be administered, normal dosage, side effects, precautions and contraindications. They must have considered the dosage, method of administration, route and timing of the administration in context of the s condition, co-existing therapies and meals (NMC, Standards for Medicines Management 2010). The core mandatory assessment requirements for Medicines Management IN HOSPITAL are applicable to the following practitioners: NEW REGISTERED PRACTITIONERS OR EXISTING PRACTITIONERS WHERE MEDICINES MANAGEMENT IS NEW TO THEIR ROLE ARE TO COMPLETE ALL THE ELEMENTS BELOW PRIOR TO UNDERTAKING MEDICINES MANAGEMENT UNSUPERVISED. EXISTING REGISTERED PRACTITIONERS WHERE MEDICINES MANAGEMENT IS PART OF THEIR ROLE ARE TO COMPLETE THESE ELEMENTS EVERY TWO YEARS ENSURING THAT ONE ELEMENT IS COMPLETED ON AN ANNUAL BASIS. REQUIRED ELEMENTS: 1. Ward based IN HOSPITAL Competency Assessment for Medicines Management (this document) 2. E Learning Training Tracker Module for Medicines Management a) Clinical Medicines Scenarios 100% b) Maths and Medicines Calculations - 100% IF REQUIRED 3. Electronic Prescribing and Medicines Administration system (EPMA) training commonly referred to as JAC Medicines Management system, if in use on the ward. 4. Electronic Medicines Storage Cabinet training (e.g. Omnicell and MDG Cabinet) if the electronic medicines storage cabinet is in use on the ward. 2
Learning outcome 1 Safely & Effectively Administer Medicines (not injectable medicines) 1. Observed administration of medicines (not injectable medicines) 1.1 Using the electronic or paper drug chart the RP must satisfy the assessor that: Registered practitioners (RP) to be observed undertaking administration of medicines to 4 different s covering a minimum of 4 different formulations 1 the correct drug chart is being used for the correct the whole drug chart has been checked (to identify prn, stat doses & range of doses) e.g.to check if once only doses have, or have not been administered e.g. methotrexate, or to ensure that prn medicines e.g. paracetamol, are administered within recommended maximum dose/dose range the s allergies have been considered the s weight has been considered (if necessary) identify if other drug /recording charts are being used for that e.g. warfarin, insulin identify which medicines are to administered at that time 1.2 The assessor witnesses the RP with the : 1 asks the to confirm identity (wrist band and verbally) full name & DOB (or according to Patient Identification policy) asks the about allergies or sensitivities explains details of medicines to be administered obtains consent 2 3 4 2 3 4 1.3 The assessor witnesses the RP selecting the medicine for administration (the medicine label must correspond to the prescription) the correct medicine the correct strength and dose the correct formulation the correct frequency/time the correct route the medicine has a valid expiry date 1 2 3 4 1.4 RP is able to demonstrate /explain where to obtain information about a medicine e.g. dose, contraindications, side effects, how to prepare the medicine, route, drug interactions and obtaining stock RP to include the following: Intranet- Medusa & Electronic Medicines Compendium (EMC) medicine pack insert in date BNF/ web BNF JAC clinical information on ward pharmacy team on call pharmacist (out of hours) bed manager (out of hours) 1.5 RP is able to demonstrate completion of administration of medicine/s : 1 observes the taking/using the medication documents administration on JAC/Paper prescription orders a specific medicine using resupply orders 3 2 3 4
can explain process when delaying or omitting a prescribed medicine demonstrates disposal of equipment/waste medicines 1.6 RP is witnessed administering a selection of formulations during assessment; tick preparations/routes assessed *mandatory Oral tablet Dispersible tablets* Liquid- oral syringe/spoon/medicine measure* Inhalers* Cream/ointment Eye drops/ointment* Rectal suppositories Vaginal - pessaries patch Nebules* Sublingual Others please state: 1.7 RP to explain what action to take if they are unable to administer a prescribed medicine to include: if a is unable to swallow (determine reason e.g. size of table, refer for SALT assessment, refer to doctor for review form of medication) if a medicine is not available(contact pharmacy, bed manager- out of hours,prescriber) there should be NO delay, especially with critical medicines) unable to tolerate 1 2 3 4 nurse unable to give by prescribed route (contact prescriber without delay) 1.8 RP is witnessed administering a subcutaneous injection (tick boxes 1.1 1.8) demonstrates ability to select appropriate equipment with rationale for us prepares the medicine for injection appropriately 1 2 3 4 identifies correct, explains procedure, checks any contraindications, potential side effects and obtains valid consent demonstrates ability to ensure correct administration technique of the medicine via the subcutaneous route in the prescribed site demonstrates understanding of the anatomy and physiology of sites used for injection technique 1.9 RP is witnessed administering an intramuscular injection 1 demonstrates ability to select appropriate equipment with rationale for use prepares the medicine for injection appropriately identifies correct, explains procedure, checks any contraindications, potential side effects and obtains valid consent 2 3 4 4
demonstrates ability to ensure correct administration technique of a medicine via the intramuscular route in the prescribed site safely demonstrates understanding of the anatomy and physiology of sites used for injection technique 1.10 RP to demonstrate the correct procedure for administering Controlled Drugs ( including appropriate record keeping) preparation and administration (must be carried out by two RPs ) how to ensure security of the CD cupboard how to complete a stock balance use of electronic medicines storage cabinet for supplementary restock and cycle counts ( if in use on ward) 1.11 RP to demonstrate correct process to follow when administering and documenting Oxygen therapy flow rate and duration appropriate percentage according to s saturation rate appropriate device used correct documentation what action to take if oxygen not prescribed and requires oxygen 1.12 RP to demonstrate/explain how to prescribe/administer Homely Remedies on JAC or paper prescription chart which medicines can be given( paracetamol, Gaviscon Advance, simple linctus, senna, lactulose and aqueous cream) check for contraindications correct procedure for administering medicines length of time these medicines can be administered before review (24hours) 1.14 RP to explain the use of a Patient Group Direction (PGD) and records required explains when are they used explains who can use them explains appropriate recording/documentation 1.15 RP to explain the process to initiate and monitor a on the Self Administration of Medicines Scheme (SAM) the following should be mentioned: assessment SAM levels consent only medicines reconciled(checked by pharmacy)can be used medicines not suitable to self-administer 1 2 3 4 5
key security Medicines Information Card/JAC administration chart where to store medicines nurse responsibility for monitoring (mention deteriorating and withdrawal from scheme) 6
Learning outcome 2 Medicines Safety 2.0 Medication errors and safety 2.1 RP to define the following: Medication errors: are incidents in which there has been an error in prescribing, dispensing, preparing, administering or monitoring, regardless of whether harm has occurred Near miss: are incidents that did not cause harm but which are judged to have had the potential to cause harm 2.2 RP to explain what process to follow upon discovery of a medication error (including near miss) complete incident on electronic incident report Datix the Management of medication related incidents protocol (see Intranet)must be followed 2.3 RP to explain how they would manage the following: Adverse drug reaction(preventable and nonpreventable)(mhra- Yellow Card Scheme) a missed dose a sensitive to prescribed medicine (e.g. upset stomach) no stock of the first dose antibiotic incorrect stock balance of a Controlled Drug a has been given two doses of Paracetamol within 1 hour by a colleague a discovery of a near miss you have given a medicine to the wrong 7
Learning outcome 3 Order, Receive, Store, Transfer and Dispose of Medicines 3.1 RP is able to demonstrate/explain the process for ordering, receiving and storage of urgent medicines used on the ward including : cardiac arrest, anaphylaxis, intubation boxes. which packs are stocked on your ward? when are they used? where are they stored? how are they ordered? 3.2 RP can demonstrate/explain the correct process for ordering, receiving and storage of ward stock medicines urgent medicines for cardiac arrest, anaphylaxis, extravasation, intubation and neonatal resuscitation boxes order a ward stock item for Top Up and Non Top up wards ( use stock item request form or green stock profile order folder) request a new stock item by using the New Stock Request form receiving medicines on to a ward including signing transportation of medicines register returning, supplementary re -stock and cycle count for medicines using the electronic medicines storage cabinet, if in use on ward storage of the following ward stock: Intravenous fluids - should be stored off the floor in their original containers in a designated area/electronic medicines storage cabinet medicines for internal use medicines for external use diagnostic reagents medical gases 3.3 RP to explain the correct storage and documentation requirements for refrigerated medicines: demonstrate/explain daily temperature monitoring and recording (using an electronic max/min thermometer to maintain temp between 2-8 0 C or electronic display on automated fridges) or web monitoring (electronic medicines storage cabinet) action to be taken following disconnection of electrical supply or refrigerator breakdown action following the discovery of medicines that have not been stored in recommended conditions 8
3.4 RP can demonstrate the process for ordering, receiving and storage of named medicines ordering medicines for named s receiving medicines in secure green pharmacy bag, checking and signing transportation of medicines register storage of the following: insulin unopened eye drops dosette box ( s own medicines) oral tablets 3.5 RP can demonstrate/explain correct procedures for dealing with the following: Expired medicines Lost/missing medicines Returns to pharmacy Disposal of medicines (see Trust Waste Policy) Medicines on death of a 3.6 RP can demonstrate the process for ordering, receiving, returning and storage of Controlled Drugs to include: ordering a Controlled Drug for stock receiving stock Controlled Drugs storing and stock checking process for Controlled Drugs returning Controlled drugs to Pharmacy including documentation how to obtain supplies of Controlled drugs out of hours explain the process for dealing with discrepancies in ward stock levels of Controlled Drugs why a Controlled Drugs record book needs to be used on the ward (include requirements for documentation) how to manage s own Controlled Drugs brought into the hospital process for managing Controlled Drugs when a ward or clinical area is closed or transferred to another clinical area 9
Learning outcome 4 Managing Discharge and Transfer of Medicines 4.1 Registered practitioners can explain the procedure for managing medicines for discharge (TTOs)including timescales check the medicines: right drug, right, right strength, right route, right time (including any medicines stored in the fridge or electronic medicine storage cabinet or Controlled Drugs cupboard)and sufficient quantity(14 days) assessed on knowledge and ability to selfmedicate on discharge receives appropriate information (e.g. copy of discharge summary, treatment cards) regarding their discharge medicines given follow up appointments for monitoring of high risk medicines (e.g. warfarin) appropriate discharge paperwork is completed RP can explain how to arrange discharge medicines for a out of hours 4.2 Registered practitioners can demonstrate/explain the procedure for s being discharged on Controlled Drugs. (the following should be mentioned) CD prescription sent to Pharmacy sign out of the CD record book any medicines belonging to to be used for discharge counselled on discharge medicines If discharge is to be delayed then CDs should be entered into the CD register and locked in electronic medicine storage cabinet or CD cupboard as appropriate, until is discharged e.g. overnight 4.3 Registered practitioners can demonstrate/ explain the procedure for the transfer of s medicines to another ward area check and place all medicines from s own lockable bedside cabinet into a My Medicines Green bag check for medicines stored elsewhere e.g. in fridge or electronic medicine storage cabinet or CD cupboard that are needed for on next ward 4.4 Registered practitioners can demonstrate the process for issuing TTO packs from wards and clinics (see also section 1.3) after checking the s identity, date of birth and address, assemble appropriate TTO medicines pack/s according to the (electronic) prescription insert name in the space provided on the label and complete date of issue (if using an over the counter pack this step can be omitted) 10
insert administration instructions if not already present on the label according to the prescription obtain second check from another RP complete appropriate paperwork complete identity checks, sensitivities and allergies before issuing the medicine Give the full verbal instructions on taking the medicine and make aware of information leaflet inside the pack. If paper prescription is used, place the pink copy of the triplicate form with GP s letter and give to the. Send completed paper prescription to Pharmacy for filing 11
Assessment Outcome Please sign in relevant box Rating Outcome Actions Assessor and date Initial Assessment Green Pass - All essential competencies evidenced. Red Refer - One or more competencies not evidenced. No action required. Review annually at appraisal. Revisit any development learning points listed below as recommended by assessor. Clinical practice in relation to the specific competency not evidenced is to be supervised and reassessed within 2 weeks. Assessor and date 2 nd Assessment Assessor and date 3 rd Assessment Learning points to revisit following successful competency assessment: First Assessors : Registered Practitioners : Date: Inform Pro4updates@iow.nhs.uk of PASS outcome to update individuals Mandatory Training Profile 12
Action Plan following referral at FIRST assessment. To be completed following this assessment in preparation for second assessment. PART 1 First assessor to tick, initial and date once completed Outcome of assessment and feedback given to registered practitioner Initial: Date: Line manager informed of referral at first assessment Initial: Date: Registered Practitioner signposted to further underpinning knowledge/ Competency Lead Initial: Date: First Assessors : Registered Practitioners : ACTION PLAN PART 2 Individual Learning Plan between line manager and Registered Practitioner. To be completed following this assessment in preparation for second assessment. Date for re-assessment: Line Managers : Registered Practitioners : 13
Action Plan following referral at SECOND assessment. To be completed following this assessment in preparation for final assessment. PART 1 Second Assessor to tick, initial and date once completed Outcome of assessment and feedback given to registered practitioner Initial: Date: Line manager informed of referral at first assessment Initial: Date: Registered Practitioner signposted to further underpinning knowledge / competency Lead Initial: Date: Second Assessors : Registered Practitioners : ACTION PLAN PART 2 Individual Learning Plan between line manager and Registered Practitioner. To be completed following this assessment in preparation for final assessment Date for Reassessment: Line Managers : Registered Practitioners : 14
Managing a referral at Summative Assessment Referral following Initial Assessment The first assessor provides feedback to the candidate; documents the outcome and completes PART 1 of the action plan. The assessor will refer the outcome to the candidate s line manager. The line manager will complete an individual learning plan in preparation for the second re-assessment. A different assessor will be identified for the second assessment. The line manager will consider invoking informal capability. Referral following Second Assessment The second assessor provides feedback to the candidate; documents the outcome and completes PART 2 of the action plan. The assessor will refer the outcome to the candidate s line manager. The line manager will complete an individual learning plan and arrange for the candidate to undertake further simulated / supervised practice in preparation for the final reassessment. The line manager will consider invoking formal capability. Referral following Final Assessment Referral at the final attempt may lead to further performance management in line with Trust policy. This will be discussed in confidence with the candidate and their line manager. 15