Transcript right patient

Managing Medicines
Laura Bucknell
Lead Pharmacist
May 2012
Medicines
• POM (Prescription Only Medicine)
Patient can only obtain the medicine with a
prescription
• P (Pharmacy Medicine)
Medicine available through a pharmacy. It can
only be sold under the supervision of a
pharmacist
• GSL (General Sales List)
Medicines can be sold in general shops as well
and in pharmacies
• Often, P and GSL medicines are called
Over the Counter (OTC) Medicines.
• Some medicines are GSL in small
quantities, but P in larger quantities or
strengths e.g. paracetamol, ibuprofen.
• GSL medicines and P medicines are aslo
able to be prescribed
Authorisation to supply
and/or administer
• Patient Specific Direction (PSD)
• Patient Group Direction (PGD)
Patient Specific Direction
(PSD)
• used when a patient has been assessed by a
prescriber and instructs another health care
professional in writing, to supply or administer a
medicine directly to a named patient or to
several named patients.
• A prescriber can be a doctor, dentist,
independent non medical prescriber or
supplementary prescriber
Examples – correctly completed drug chart for
administration, FP10.
Patient group Direction
(PGD)
• A Patient Group Direction (PGD) allows specified
registered health care professionals to supply and / or
administer a medicine directly to a patient with an
identified clinical condition without the patient
necessarily seeing a prescriber.
• Generally used to manage specific treatment episodes
where supply/administration of a medicine is necessary
for example unscheduled care.
• not appropriate for managing an individual patient’s
condition over the long term where a prescribing
relationship with a prescriber is more appropriate.
As assistant practitioners you can administer medicines
• which have been prescribed by an authorised prescriber
• Prescribed for an individual patient
• You are trained and competent to do so
• The role of administration has been delegated from a
registered professional
Assistant Practitioners CANNOT administer medicines
under a PGD
POPAM
• Care Service’s Policy for Ordering,
Prescribing and Administration of
Medicines
• Must be familiar with and operate within
POPAM
6 Rights of Meds Administration
RIGHT DOSE
RIGHT
PATIENT
RIGHT TIME
Safe Medicine
Administration
RIGHT
DOCUMENTATION
RIGHT DRUG
RIGHT ROUTE
6 Rights of Meds Administration
RIGHT DOSE
RIGHT
PATIENT
RIGHT TIME
Safe Medicine
Administration
RIGHT
DOCUMENTATION
RIGHT DRUG
RIGHT ROUTE
Right Patient?
How can you /should you ensure the correct
identification of a service user?
POPAM states:
‘The identity of the patient must be confirmed. For
inpatient units the wristband and prescription
chart should be checked. In the community or if
no wristband is available, then the identity must
be checked using verbal checking of patient’s
name and date of birth’.
6 Rights of Meds Administration
RIGHT DOSE
RIGHT
PATIENT
RIGHT TIME
Safe Medicine
Administration
RIGHT
DOCUMENTATION
RIGHT DRUG
RIGHT ROUTE
Right Drug
• Check the medication name carefully.
• Make sure you read what is actually there
not what you think is there!
• Commonly confused drugs:
Check the formulation
Liquids
- Suspensions
- Syrups
Controlled Release
- MR
- SR
- XL
- XR
Multiple Routes
e.g. salbutamol
- tablets
- SR tablets
- inhalers
- combination inhalers
- injections
- nebules
Drops
- eye
- ear
- nose
6 Rights of Meds Administration
RIGHT DOSE
RIGHT
PATIENT
RIGHT TIME
Safe Medicine
Administration
RIGHT
DOCUMENTATION
RIGHT DRUG
RIGHT ROUTE
Right dose
• Double check
• Check the dose on the drug chart vs the strength
of the medication
• Dose calculation
e.g.
drug charts states:
Furosemide 80mg in the morning
Furosemide box states ‘40mg tablet’
How many tablets are required?
Measuring liquid medication
• If less than 5mls use an oral syringe
• Consider how many 5mls spoonfuls are
required to give the correct dose
e.g paracetamol 250mg/mls
Dose = 1g four times a day
How many 5ml spoonfuls?
6 Rights of Meds Administration
RIGHT DOSE
RIGHT
PATIENT
RIGHT TIME
Safe Medicine
Administration
RIGHT
DOCUMENTATION
RIGHT DRUG
RIGHT ROUTE
Right time
•
•
Abbreviations
OD– daily
BD – twice a day
TDS – three times a day
QDS – four times a day
Double check the times marked on the drug
chart
• Special attention to ‘when required ‘ medicines
to ensure the maximum daily dose is not
exceeded
6 Rights of Meds Administration
RIGHT DOSE
RIGHT
PATIENT
RIGHT TIME
Safe Medicine
Administration
RIGHT
DOCUMENTATION
RIGHT DRUG
RIGHT ROUTE
Right route
• Some medicines are formulated for
various routes:
• - salbutamol- tablets, inhaler, injection,
nebules
• Some drops are for administration by more
than one route e.g. betamethasone drops
for eye, ear or nose
• Tablets – oral, vaginal, sublingual
6 Rights of Meds Administration
RIGHT DOSE
RIGHT
PATIENT
RIGHT TIME
Safe Medicine
Administration
RIGHT
DOCUMENTATION
RIGHT DRUG
RIGHT ROUTE
right documentation
• By law medicine administration must be
documented
• The exact time and date of the administration
and the name of the prescriber and the person
administering must be recorded
• Record of administration
- initial the drugs chart to indicate administration
OR
- Annotate the chart to explain why the medicine
was not administered
Medication not administered
must be recorded
Patient refuses
Patient not present
Medicine not available
Instructions not clear or legal
Patient self administering medication/or prepared for
Patient to self administer
Nil by mouth
Asleep/comatosed/drowsy
Unable to swallow
Vomiting/nausea
Time varied on doctor’s instructions
• Venflon not insitu or not patent
• Other (Specify in review notes)
A
B
C
D
E
F
G
H
J
K
L
M
The 6 rights
• If a person administering a medicine is
unsure of the drug , dose or regime- do
not guess. Check with a second person
prior to administration
• Never administer a medicines you do not
know about
• Part of the administration is ensuring the
patient actually takes the medication
Principles of medicines administration apply
to all individuals who administer medicines
whether a registered practitioner or not
General Standards for Safe Medicine
Administration
• Only administer from a valid prescription
• Do not administer from illegible, incomplete or unclear
prescriptions
• Check the identity of the service user
• Know the general therapeutic use of the medicines they
are administering (normal dose range, side effects,
precautions etc)
• Be aware of the patient’s care plan
• Check the expiry date of the medicine
• Check the allergy status of the patient
• After administration check the medicine has been taken
• Complete the administration record
Covert Administration
• By disguising medication in food or drink, the
patient/client is being led to believe that they are not
receiving medication, when in fact they are.
• Must be in the best interests of the patient/client
• a clear distinction should always be made between:
-Those patients/clients who have the capacity to refuse
medication and whose refusal should be respected
-Those patients/clients who lack capacity
• Any decision regarding covert administration must be
made with the MDT and the carers/relatives
2 staff administration
• Certain procedures e.g administration of
controlled drugs, IV drug administration –
best practice for 2 registered nurses to
check all aspects
• POPAM allows in certain circumstances
one registered nurse and another suitably
trained member of staff or a relative/carer
to carry out the check
Controlled drugs
• Some prescription medicines contain drugs that
are controlled under the Misuse of Drugs
legislation e.g morphine, benzodiazepines
• Stricter legal controls apply to controlled
medicines to prevent them being misused,
causing harm or being obtained illegally.
• These controls govern how these drugs are
obtained, stored, prescribed, supplied and
disposed of.
• In the community medication is the
property of the person it is prescribed for
• CS have procedures in place for stock
checking Controlled drugs in patient home
• To protect staff
Patches
• Disposal of a used patches containing
Controlled Drugs e.g. fentanyl,
bupronorphine:
• Patches removed from patients should be
folded in on themselves, place back in the
packaging and disposed of in the
household waste.
• Gloves should be worn during this process
• Different process for inpatient units
Unwanted medicine
• Patient medication in the community is the personal
property of the patient.
• Community staff should not offer to remove unwanted
out of date medication but should advise the
patient/carer to take to a community pharmacy for safe
disposal.
• In exceptional circumstances when this is not possible
and leaving the medication in the home would be a risk,
a risk assessment should be carried out by a registered
particitioner before removing medication from the home
and taking to a community pharmacy. This must be
documented this in the patient’s notes
Risk
• Medication errors are the third most
common incident reported to the NPSA
• 72,000 medication incidents were reported
to the NPSA from Jan- Dec 2007
• Majority have cause no or low harm but
are important tools for learning
(NPSA 2009)
If things go wrong
• Tell someone
• Well being of the patient is paramount
• Complete a datix (be sure you are familiar
with the incident reporting procedure)
• Incidents are followed up and investigated
NOT to apportion blame but to allow
others to learn and minimise the risk of
someone else making the same mistake
Any Questions?
contact details
Laura Bucknell
08456 598200
07909533414
[email protected]