Medicines management

10 Medicines management




Introduction


Regardless of your field of nursing or year of training, you will have learning outcomes that focus on medicines management because it is one of the Nursing and Midwifery Council (NMC) Essential Skills Clusters (NMC 2010) from year 1 to entry to the register. Box 10.1 provides some examples of the Essential Skills Cluster – Medicines Management (NMC 2010).



In every ward you are placed on, all of your patients will have one thing in common – a prescription chart. Some patients will have very few medications prescribed while others may have more than one chart. Medications can be a daunting area for students and you may wonder when you should start to learn about medications.


You need to start being involved in administering medication to your individual patients as early as possible, or as appropriate to your individual course of study and practice requirements. Many medications you come across will belong to common groups of drugs, for example antibiotics, analgesics and cardiac drugs. You need to start learning some of the common medications used, side effects, cautions and routes. It can be quite nerve wracking at first and you may find that your hands shake as you try to dispense medications into the receptacle in front of a qualified nurse. You may also feel that you are very slow and that you are holding up your mentor and making patients wait.


You are not alone, but it is not something that should be rushed. It is essential that you know what you are doing and why you are doing it, and it must always be under supervision. If you have not yet covered this topic in theory at university, then please refer to the NMC, university and trust guidelines for the administration of medications.





Nurse prescribing and patient group directives


Within your medical placements you may be exposed to a range of nurses who have completed an advanced course in nurse prescribing. Only those who have undergone appropriate training and are registered with the NMC as an independent prescriber can prescribe (NMC 2006). It must also be judged that it is part of the nurse’s role. Some clinical nurse specialists, advanced nurse practitioners, practice nurses, district nurses, health visitors and community matrons will have completed this course and will have undergone intensive supervision and academic assessment to meet the competencies required (Kaufman 2010).




Self-administration


In some of your medical placements, patients may be self-administering their medication and there should be a policy within the organisation that supports this practice. Nurses must assess that the patient is willing to do this, has the knowledge and is not forgetful or confused before self-administering their medication. It can work very effectively for patients as they do not need to wait for a nurse to administer their medication and they are able to have control over this aspect of their care. Within the essential skills clusters, there is an expectation that student nurses will ‘involve people and carers in administration and self-administration of medicines’ (NMC 2010) and from your second year this will be one of your learning outcomes under the supervision and guidance of your mentor.


There is also an assessment that can be undertaken when admitting or discharging a patient. Nurses can make arrangements for medication to be packaged in different ways to aid compliance. This can be arranged on discharge to allow health and social care practitioners within the community to help patients take their medicines. The NMC expects nurses to continually assess their patients regarding the appropriateness of the medication compliance aid. Patients who have been taking long-term medication are usually very knowledgeable about their medication. The following are examples of compliance aids:






Covert administration


Covert administration of medicines means administering medicines to your patient without their knowledge, for example disguising it in food or drink. This is not considered good practice (NMC 2008a). If your patient is refusing their medicines, it is important that you first establish why they do not want to take them. Often it will be because they don’t know what they are or why they need to take them. Spending some time explaining the medicines and reassuring your patient may be all that is needed for your patient to agree to take their prescribed medicines.



If you are not sure about the medicines, use this as an opportunity to brush up on your own knowledge. Your patient may be having difficulty swallowing their tablets and it may be possible to order them in a different preparation, for example as a liquid. Crushing medication could also affect its metabolism/absorbance and may alter the affect of the drug. This could cause harm to the patient.


It may be that your patient does not understand the importance of the medicines and the potential side effects of not taking them. In this case, the team looking after the patient will need to determine if the patient has capacity to decide whether to take the medicines (see Ch. 6 for a discussion on capacity). Within the Essential Skills Clusters (NMC 2010) there is an expectation that ‘people can trust the newly registered graduate nurse to work within the legal and ethical frameworks that underpin safe and effective medicines management’.


If it is decided that a patient does not have the capacity to make the decision, the multidisciplinary team, along with those who know the patient best (e.g. relatives/carers), must make a decision in the best interests of the patient and this may be to administer medicines covertly. If this is the case, how and when the medicines are given must be decided and documented clearly in the patient’s notes. This decision must also be regularly reviewed.


As you progress in your nurse training, your learning outcomes will incorporate ethical issues in relation to medicines and consent. You will need to be able to demonstrate that you are aware of religious, cultural and ethical beliefs pertaining to medications and that you are sensitive to these issues.





Medicines management for controlled drugs


Since the fourth report of The Shipman Inquiry (2004) there has been tighter legislation in relation to controlled drugs, and nurses need to familiarise themselves with the latest NMC, Department of Health and local trust and university policies. As a student, you will be placed in a variety of placements – community, independent sector and acute sector trusts – and will need to make sure that you are aware of the placement policies regarding controlled drugs. The NMC (2008a) emphasises that student nurses must be involved in the administration of all medicines when they are deemed competent by a registrant and also feel confident and competent themselves. One of the essential skill outcomes states that ‘people can trust the newly registered graduate nurse to safely order, receive, store and dispose of medicines (including controlled drugs) in any setting’ (NMC 2010).


Controlled drugs are kept in a double-locked cupboard and the nurse in charge will hold a separate set of keys to this cupboard. These keys are not to be left on hooks in the office nor on the ward desk, but on the person of the key holder at all times.


The national guidance for drugs considered to be controlled drugs can be found here:





Quiz: management of controlled drugs


Here is a quiz to help you with the above activity.


(Answers on p. 197.)



10.1. Are student nurses allowed to give any medication without supervision?


10.2. Which of these policies do student nurses need to read and understand prior to taking part in drug administration?








10.3. A staff nurse checks paracetamol with you in the clinical room and then asks you to take the medication to Mrs Smith in bed 8. Would you say yes or no? Explain your answer.


10.4. Mrs Patel is confused and refusing her antibiotic which she really needs. The staff nurse crushes the tablet and disguises it in a spoon of porridge and asks you to give this to the patient. Would you agree to this? Explain your answer.


10.5. Your patient requires a subcutaneous injection of insulin which the staff nurse allows you to draw up under his/her supervision. The staff nurse then takes you to the patient and allows you to administer the injection. Would you agree to do this? Explain your answer.


10.6. You have just undertaken a blood glucose measurement which is 10 mmol. The patient is on an insulin infusion which is currently running at 1 mL/hour. The prescription states that the infusion should run at 2 mL/hour if the blood glucose is 10 mmol. You inform the staff nurse and she tells you to increase the rate on the pump. Would you agree to do this? Explain your answer.


10.7. What is a controlled drug?


10.8. Who would need to be present when preparing and administering a controlled drug?


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Feb 25, 2017 | Posted by in NURSING | Comments Off on Medicines management

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