1. How to find your way around …
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2. How to find your way around …
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This is important!
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3. Medicines Management Training for Qualified Nurses (Mental Health & Learning Disability):
Part 2 - Calculations
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4. Course Objectives
On completion of the “Medicines Management Training for Qualified Nurses (Mental Health & Learning Disability) Part 2 - Calculations” course you will understand:
The 3 parts to the Medicines Management Training Programme for Qualified Nurses (MH&LD);
How to perform calculations when administering medicines;
Medicines definitions;
Labelling;
Conversion formula;
Calculation formula;
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5. Introduction
There are 3 parts to the Medicines Management Training Programme for Qualified Nurses (MH&LD).
Part 1: A one day classroom entitled ‘Medicines Management for Qualified Nurses (MH&LD)’;
Part 2: A calculations training module and assessment on OLM (this course);
Part 3: An Observed in Practice Assessment of the handling of medicines, done in the workplace.
You will next see a brief overview of the Programme, before continuing to your calculations training and test.
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6. Part 3: Observed in Practice Assessment (accessed through OLM)
How to complete the training
The Medicines Management Training Programme for Qualified Nurses is to be completed every 3 years. The training is to be completed in the following order:
You have 3 months to complete all 3 parts. You will then have completed your training requirements for 3 years.
As a guide you should start your training cycle with the classroom.
You will get the most out of the training if this order is followed, but if Part 1 & 2 are done out of order you will not be penalised. But you should aim to complete all parts within 3 months.
Part 1: Classroom
Part 2: Calculations assessment on OLM
Part 3: Observed in Practice Assessment (accessed through OLM)
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7. Part 1: Classroom
You will have recently completed, or should shortly complete the 1 day classroom “Medicines Management for Qualified Nurses (MH&LD)”. You will be invited to attend the classroom by the SEPT Training department.
This classroom covers the following topics:
Procedural Guidelines for the Safe and Secure Handling of Medicines
Clinical guidelines for the Pharmacological Management of Acutely Disturbed Behaviour
Practice at calculations and conversions
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8. Part 2: Medicines calculations Definitions
When talking about conversions and calculations with medicines it is important to understand the different words used. Here are definitions of some words used in this training module.
Units
This is a label telling you which system of standard weights and measures has been used to give something a numerical value describing its quantity or size (e.g. grams, milligrams, litres or millilitres).
Conversions
This is when you change from one unit to another, or find out the quantity of something using different units (e.g. how many milligrams there are in a product labelled in grams).
Strength
This is a phrase of one or more words expressing how much drug is in a product, e.g.
“40mg” - tablets/ capsules
“40mg / 5ml” - liquids/ injections
“1 in 1000” – liquids/ creams
“10%” - eye drops
Notice that the strength does not always have units.
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9. Medicines: Written Format
Ideally the strength of a medicine should be written without using a decimal point, both on prescriptions and on packaging. However this practice is not always followed by the prescriber or the manufacturer, leading to possible confusion and errors.
For example, a tablet of 500 micrograms may be written 0.5 mg.
The quantity of drug is the same, but the units are different.
Look at this photograph of a box of haloperidol capsules and risperidone tablets - they both contain the same amount of drug in their respective dose units.
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10. Conversion of Units of Weight
When the units given on the medicine label do not match those on the prescription you can use a conversion so that both the prescribed dose and the medicine have the same units.
For example, if the prescribed dose is 1.5mg and the medicine only comes in 500 microgram capsules, how much should be given?
The next page shows the conversions you will need.
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11. Conversion of Units of Weight
You need a weight conversion when you need to know how much drug there is in a tablet or liquid. Conversions for units of weight can be found in the back of the BNF and are:
1000 nanograms = 1 microgram
1000 micrograms = 1 milligram (mg)
1000 milligrams = 1 gram (g)
1000 grams = 1 kilogram (kg)
Let's return to our question of how many 500 microgram haloperidol capsules to give for a dose of 1.5mg. There are two ways to do this, by either converting the capsule units to match those of the dose, or by converting the dose units to match those of the capsule.
By converting the capsule units (micrograms) to those of the dose (mg):
There are 1000 micrograms in 1 mg.
So a 500 microgram capsule contains 0.5mg.
There are 1500 micrograms in 1.5mg.
So a dose of 1.5mg needs three capsules of 500 micrograms.
By converting the dose units (mg) to those of the capsule (micrograms):
1mg = 1000 micrograms.
1.5mg = 1500 micrograms.
So a dose of 1500 micrograms needs three capsules of 500 micrograms.
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12. Moving the Decimal Point
If you are not confident converting units in your head, this can be done on paper, by moving the decimal point to the right (for multiplication), or left (for division).
Move 1 place to multiply or divide by 10, move 2 places to multiply or divide by 100, move 3 places to multiply or divide by 1000, and so on.
Most changes between units for medicines involve multiplying or dividing by 1000, by moving the decimal point 3 places.
Tip - before converting, write the original value with a decimal point if there isn't one already (e.g. write 1 as 1.0)
What is 7.25g in milligrams? - multiply by 1000.
Moving 3 decimal points (right), 7.25 becomes (i.e. 7250mg).
What is 0.01g in milligrams? - multiply by 1000.
Moving 3 decimal points (right), 0.01 becomes 10.0 (i.e. 10 mg).
What is 1500 micrograms in milligrams? - divide by 1000.
Moving 3 decimal points (left), becomes 1.5 (i.e. 1.5mg).
What is 2.5 milligrams in grams? - divide by 1000.
Moving 3 decimal points (left), 2.5 becomes (i.e g).
“Larger” units are converted to “smaller” units by multiplying (e.g. to convert grams to milligrams, multiply by 1000). “Smaller” units are converted to “larger” units by dividing (e.g. to convert milligrams to grams, divide by 1000).
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13. Medicine Strength
The strength of a liquid medicine is usually expressed in one of the following ways:
Weight per volume - the amount of drug in a volume of liquid. This is the most common way to express the strength of a liquid. For example, haloperidol liquid 2mg/mL contains 2 milligrams in each 1 millilitre.
Percentage (%), also known as percentage weight per volume (%w/v), is the number of grams of drug in 100mL of liquid. The term "w/v" is not always written on the box or the prescription. For example, timolol 0.25% w/v eye drops contain 0.25g timolol in 100mL of liquid.
Parts per volume - the amount of drug (in grams) in a volume of liquid (in mL). For example, adrenaline injection "1 in 1000" or "1:1000" contains 1 gram of adrenaline in 1000 mL of liquid.
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14. Calculating Volume of Liquid
If you know the strength of a liquid or injection, you can easily calculate the volume needed for any dose, using a formula. The formula used is:
Volume needed = (“What you want” / “What you have”) x “Volume it's in”
You take the numbers for "What you have" and "Volume it's in" directly from the strength on the label.
Note: the units for "What you want" and "What you have" must be the same. If they are not, one of them must be converted otherwise this formula will not work.
Example:
What volume of fluoxetine liquid (20mg / 5mL) is needed for a dose of 30mg?
The strength is 20mg in 5mL
What you want = 30mg
What you have = 20mg
Volume it's in = 5mL
Volume needed = (30mg / 20mg) x 5mL
= 1.5 x 5mL
= 7.5mL
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15. Example
Zuclopenthixol decanoate (Clopixol Conc.) is a depot antipsychotic, with a strength of 500mg/mL
What volume is needed for a dose of 600mg? (Assume you have not got any other strengths to use).
Volume needed = (what you want / what you have) x volume it’s in:
What you want = 600mg
What you have = 500mg
Volume it's in = 1mL
Volume needed = (600 / 500) x 1mL
= 1.2 mL
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16. Conversion and Calculation Example
Sodium valproate (“Epilim”) liquid has a strength of 200mg in 5mL. The dose you need to give is written 0.5g. What volume of liquid is needed?
Before using the formula to calculate the volume needed, you will need to have the strength and dose in the same units (e.g. milligrams):
Convert the dose of 0.5g to milligrams
1g = 1000 mg, so 0.5g = 500mg
Now "what you want" (500mg) is in the same units as "what you have" (200mg)
Next, calculate the volume needed:
Volume needed = (what you want / what you have) x volume it’s in
What you want = 500mg
What you have = 200mg
Volume it's in = 5mL
Volume needed = 500/200 x 5mL
=2.5 x 5mL
=12.5mL
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17. Reminder about Part 3: Observed in Practice Assessment
You have now completed the calculations training slides.
You will shortly be asked to do the test.
Before you do so please make a note of the name of Part 3 of your training, which can be accessed on OLM: “364 Medicines Management for Qualified Nurses (Mental Health & Learning Disability) Part 3 - Observed in Practice Assessment”.
If you are unsuccessful at the calculations test, or feel that you would like additional support with medicines calculations, please contact a member of the Education and Training team in the Pharmacy Department (Essex) who will discuss a way forward with you.
You can -
David Heath :-
Beryl Navti :-
Chris Smith : -
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18. Remember, if you want to find more information / evidence about this subject or anything else which is relevant to your work or study, join your local healthcare library.
For staff in Essex contact Basildon Healthcare Library.
EX3594 
It may be that you work in a different area,
for example Luton.
Details of all the Health Libraries in the East of England can be found at this site…
You are welcome to join any of these.
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19. Review of Objective(s)
Before completing the test, please ensure you have acquired the relevant knowledge against the modules objective(s) below:
“On completion of the “Medicines Management Training for Qualified Nurses (Mental Health & Learning Disability) Part 2 - Calculations” course you will understand:
The 3 parts to the Medicines Management Training Programme for Qualified Nurses (MH&LD);
How to perform calculations when administering medicines;
Medicines definitions;
Labelling;
Conversion formula;
Calculation formula;”
If not, please take this opportunity to revisit the presentation content.
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20. You now need to take the test!
Remember to click the ‘home’ icon when you have finished the test to save your results!
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