1. Safe Medication Practice January 2011
THIS IS
Safe Medication Practice January 2011

2. Objectives of this session
To discuss the importance of medication safety
Incidences reported from unsafe practice
How to improve medication safety
Professional responsibilities

3. Objectives for this session (cont)
Legal responsibilities
NMC medication management guidelines
NMC recommendations when drug errors occur
Summary

4. Discuss the importance of medication safety
Firstly: We have a duty of care to protect our patients ( first do no harm!)
Secondly: We must protect our staff ( from the stress of an error and disciplinary action)
Thirdly: We need to protect the organisation (reputation and risk of litigation)

5. Incidences reported from unsafe practice
Aspirin 300mg suppository inserted into rectum with plastic outer wrapping still in place
Patient in Room 117 received the medication of the patient in Room 116
Metronidazole 400mg tablets prescribed (200mg tablets in the box)
The Rapid Response Report, produced by the NPSA in conjunction with key stakeholders and NHS organisations across England and Wales, is as a response to 3,881 patient safety incidents reported between 2004 and   These included one death and one case of severe harm that occurred after clinicians misinterpreted the abbreviation of the term ‘unit’.   A further three deaths and 17 other incidents occurred between January 2005 and July 2009 where an intravenous syringe was used to measure and administer insulin.   The Rapid Response Report asks NHS organisations to ensure that: • All regular and single insulin (bolus) doses are measured and administered using an insulin syringe or commercial insulin pen device (never using intravenous syringes); • The term ‘units’ is used in all contexts.  Abbreviations, such as ‘U’ or ‘IU’, are never used; • A training programme is in place for all healthcare staff that are expected to prescribe, prepare and administer insulin; • All clinical areas and community staff treating patients with insulin have adequate supplies of insulin syringes and subcutaneous needles. NHS Diabetes has developed an e-learning training course on the safer use of insulin to help healthcare professionals implement today’s guidance. 5

6. Incidences reported from unsafe practice
Amiloride was prescribed instead of amlodipine
Ceferoxime 750 mg IV only 3 doses prescribed ( 4 given)
Augmentum 1.2 gr IV prescribed to a patient allergic to penicillin

7. How to improve medication safety
Document the patient’s allergy status
Apply the 5 “Rs” of medication management:
The Right Patient
The Right Medication
The Right Dose
The Right Route
The Right Time
Australia have an extra ‘R’ …… Right Documentation 7

8. How to improve medication safety
The Right patient:
Identify the patient with the use of verbal and written information
If appropriate, ask the patient to confirm their name and date of birth with an open ended question
Review the patient details on the drug chart and compare this with the identification band

9. How to improve medication safety
The Right Medication
Ensure the correct transcription of the drug name
Check the appropriateness of the drug to the patient – any allergies
Be aware of any relevant assessments that are required
Resolve any discrepancies before administrating the medication prescribed.
Discuss re assessments i.e. digoxin – levels, manual pulse check, anti hypertensives.
Discuss re verbal orders – 2 nurses to hear and repeat back, then 2 nurses to administer and document. Prescriber to sign within 24hrs as per policy.
No verbal orders for CDs.
Discuss importance of identifying allergies – how documented (no abbreviations for example NKDA), red wristband, asking patient. Anxious patient may forget to mention allergies on admission despite being asked. 9

10. How to improve medication safety
The Right dose
Check the medication order and the appropriateness of the dose prescribed, taking into consideration the usual dose ranges and the patient’s clinical status
Ensure relevant serum drug level results are reviewed prior to administration (e.g Gentamycin / Vancomycin levels
Discuss importance of drug calculations – 2 nurses to check calculation independently to avoid errors.
Discuss importance of knowing the drugs – reference to BNF or injectable medicines on grapevine. Paper versions also available, check in date. On-line updated more regularily than paper copies. Ask pharmacist. 10

11. How to improve medication safety
The Right route
Check the route of administration on the prescription chart
Ensure the appropriateness of the route prescribed to the clinical status of the patient

12. How to improve medication safety
The Right time
Review the drug chart and determined the last time the medication was administered
Clarify the frequency of the drug administered
The time of the drug prescribed, should never be altered to minimise workload

13. What can you do to improve medication safety
Break into groups. Ask each group to consider barriers to medication safety and how these can be overcome 13

14. Professional responsibilities
Work within NMC The Code 2010
Work within NMC /HCA medication standards /policy
Work as part of a multidisciplinary team
Maintain safe competent practice
Maintain and update your knowledge and skills relevant to medication management
Discuss re nurses who do not regularily give out medication i.e. out patients department. Reinforce that contracted to work anywhere within HCA so might on occasion be asked to assist in other clinical areas therefore important to ensure up to date with drug administration policies/procedures. 14

15. Professional responsibilities
Maintain accurate documentation
Familiarise yourself with the reporting procedure of your hospital
Acknowledge limitations and seek support when required
Mentor and support new staff and students to facilitate their development.

16. Legal responsibilities
Duty of care
Breech of duty of care
Resulting in harm to patients
(can expose professionals to the risk of litigation and professional discipline)

17. Legal Responsibility Contract Law Criminal Law Civil Law Inquests
NMC – Professional Competence and Conduct Committee

18. NMC Medication Management Guidelines
Drugs should be administered according to the NMC “Standards of Medicine Management” ( Aug 2008, HCA Infection control, Health and safety and Medication policy ( April 2009)
As a registered nurse, you are accountable for your own actions and omissions ( NMC code of conduct)
Discuss re accountability – not prescriber but accountable as administering drug. Importance of questioning prescription and documenting any discussions re prescription. If not happy to give, discuss with senior nurse immediately and prescriber. Refer to document re Patient Harm from Omitted and Delayed drugs NPSA. 18

19. NMC recommendations when drug errors occur
Open culture
Immediate reporting should be encourage
Report to Line manager
Local disciplinary actions have often deterred open and honest reporting
Require a thorough and careful investigation at local level
Emphasise importance of open culture and learning from near misses or errors. 19

20. NMC recommendations when drug errors occur
The following needs to be taken in account before a professional and managerial decision is reached on the appropriate way to proceed:
Context
Circumstances
Position of the practitioner involved

21. THIS IS Clinical Induction

22. THIS IS Clinical Induction
-The importance of medication safety -Incidences reported from unsafe practice -How to improve medication safety -Professional responsibilities -Legal responsibilities -NMC medication guidelines -NMC recommendations when drug errors occur

23. THIS IS Click to add header
NMC Standards of Medicine Management – Aug 2008 HCA Medication Policy – April Grapevine/G -drive HCA Control Drug policy – July 2009 Grapevine / G- Drive HCA Grapevine – BNF, Injectable Medicines Guide, EMC, PSNC.