Transcript Slide 1
The Role of the Healthcare Professional in Drug Administration Richard Lake January 2004 Who is involved in drug administration? Prescriber Doctor Nurse Prescriber Health Visitor Other professionals Drug admin (2) Pharmacy department Pharmacist Pharmacy Technician Pharmacy Assistant Nurse Other health care professionals Informal carers Family members Patient Legal considerations Medicines Act 1968 Misuse of Drugs Act 1971 Medicinal Products: Prescription by Nurses etc Act 1992 Nurse Midwives and Health Visitors Act 1997 Consumer Protection Act 1987 Patient group directives Specific written instruction for the supply and administration of a named medicine in an identified clinical situation. e.g. analgesia on arrival at Triage in A&E departments For patients not individually identified before presenting for treatment Drawn up locally by senior doctors, pharmacists and other health professionals All patient group directives must be authorised by and signed by a senior doctor and senior pharmacist Both must have been involved in developing the directive, and be approved by the health care body Administration of Medicines Regulated by Medicines Act 1968 3 legal categories Prescription Only Medicines (POM) Pharmacy medicines (P) General sales list medicines (GSL) No person shall administer other than to himself any such medicinal product unless he is an appropriate practitioner or a person acting in accordance with the directions of an appropriate practitioner Why administer drugs Diagnostic – e.g. radio-opaque dyes Prophylactic – prevention e.g. heparin to prevent thrombosis Therapeutic – treatment of specific conditions e.g. Thyroxine for hypothyroidism; Analgesic agents for pain Routes of drug administration Orally (liquid) – solutions, suspensions, syrups, elixirs, emulsions, oils Orally (solid) – tablets, capsules, granules, lozenges, beads Inhaled – metered dose inhaler, powder device, compressed air nebulisers Into the ear (Otic) – solutions, suspensions, drops Into the eye (Optic) – solutions, suspensions, drops, ointments Into the nose (nasal) – solution, suspensions, drops, ointments, sprays On the skin (topical) – solutions, suspensions, ointments, sprays, creams, lotions, pastes, powders, shampoos, soaps Into the mouth (buccal) – lozenges, chewing gum, sublingual tablets (rarely) Into the rectum – enemas, water solutions suspensions, oils, suppositories, ointments Injected Subcutaneous Subdermally Intramuscular Intravenous Intrathecal Intraosseous Intravesical Drugs Charts & Prescriptions All drugs must be prescribed on an appropriate chart or form Drug chart format is standardised but some hospitals have slightly different formats Different forms for take home medication, community prescriptions and hospital in patient charts All charts should Be completed in black ink and legible Have the name and address of the patient The prescribed drug written clearly Dose Route Times of administration The signature of the Prescriber and date The date of signing Any special information about the administration of the drug Prior knowledge Before administering any drug the health care professional should be aware of: The indications for the drug and appropriate route Any cautions or contra-indications Side effects Appropriate dose limits Appropriate intervals between administration Information on drugs British National Formulary – Every ward has one which should be on drug trolley Updated and published every March and September Always look at most recent available as advice about drugs changes regularly Electronically www.bnf.org Has information on every drug available in UK Association of British Pharmaceutical Industry Data Sheet Compendium Published every year Detailed information on every drug available in UK Full manufacturers data sheets Usually copies only held in pharmacy department or library Information on drugs always available from pharmacy department Every clinical area has a pharmacist that ‘links’ with that area Ward pharmacist has detailed knowledge of drugs and treatments used in that area Excellent resource to use when you require more information on a specific drug Nursing Midwifery Council (2002) Guidelines for the administration of medicines Regulatory body guidance and standard Registered Nurse is accountable for any action or omission Must know the therapeutic uses of the medicine to be administered, its normal dosage, side effects, precautions and contra indications Be certain of the identity of the patient to whom the medicine is to be administered Be aware of the patients care plan Check the prescription, or the label on medicine dispensed by a pharmacist, is clearly written and unambiguous Consider the dosage, method of administration, route and timing of the administration in the context of the condition of the patient and co existing therapies Check the expiry date of the medicine to be administered Check the patient is not allergic to the medicine before administering it Contact the Prescriber or other authorised Prescriber without delay where: contra-indications to the prescribed medicine are discovered the patient develops a reaction to the medicine Assessment of the patient indicates the medicine is no longer suitable Make a clear, accurate and immediate record of all medicine administered, intentionally withheld or refused by the patient All entries on drugs charts and notes must be legible, clear, signed and in black ink It is the registered nurses responsibility to ensure a record is maintained where the task of medicine administration is delegated Where supervision occurs of a student nurse administering medicines there must be a clear countersignature next to that of the student Self administration of medicines Practice on the increase in hospital settings Encourages patient independence Ensures patient has true partnership in care Nurse still maintains drug chart record to ensure medication has been taken Even if patient is self administering nurse remains accountable for patient treatment and medication Informed consent Adults who can give legal consent are said to be competent A competent adult has the right to refuse treatment even when the clinical experience or beliefs of professionals differ Should we covertly administer medicines to the elderly and confused? Covert administration This can be dangerous due to changes in drug pharmokinetics if dissolved in food, drink or crushed Is the patient giving consent to the treatment or is the professional causing harm? NMC has issued guidelines Professionals should work collaboratively as a multidisciplinary team to discuss the necessity for covert administration of medication. NMC (2002) Can medication be administered by another route Is there another form of the drug which may be easier for the patient to take Consideration should be given to why the patient refuses the medication Often difficulty occurs with the elderly confused taking medication as there are a number of psychomotor tasks occurring at the same time. For example drugs are often given out with meals, most elderly have polypharmacy (the taking of 4 or more medications) Over stimulation with trying to eat and taking medication may add to the confusion and hence non compliance Summary Ensure right drug The right form of drug For the right patient Via the right route At the right time Questions