Fundamentals of Pharmacology. Группа авторов
be an accountable professional;
promote health and prevent ill health;
assess needs and plan care;
provide and evaluate care;
lead and manage nursing care and work in teams;
improve safety and quality of care;
coordinate care.
As well as understanding the principles of safe and effective administration and optimisation of medicines and adhering to local and national policies, the nurse must also demonstrate proficiency and accuracy when they are calculating dosages of prescribed medicines. The nurse has to demonstrate knowledge of pharmacology and the ability to recognise the effects of medicines, allergies, drug sensitivities, side effects, contraindications, incompatibilities, adverse reactions, prescribing errors and the impact of polypharmacy – and also over‐the‐counter medication usage. See Table 1.1 for the procedural competencies for nurses (registered and associate) that are essential for best practice, evidence‐based medicines administration and efficacy.
Table 1.1 Registered nurse procedural competencies and the procedural competencies required by the nursing associate
Source: Adapted, NMC (2018b).
| The registered nurse | The nursing associate |
|---|---|
| Undertake initial and continued assessments of people receiving care and their ability to self‐administer their own medications.Understand the various procedural routes under which medicines can be prescribed, supplied, dispensed and administered; and the laws, policies, regulations and guidance that underpin them.Make use of the principles underpinning safe remote prescribing and directions for the administration of medicines.Undertake accurate drug calculations for a variety of medications.Undertake accurate checks, including transcription and titration, of any direction to supply or administer a medicinal product.Apply professional accountability so as to ensure the safe administration of medicines to those who are receiving care.Administer injections using intramuscular, subcutaneous, intradermal and intravenous routes and manage injection equipment.Administer medications using a range of routes.Administer and monitor medications using vascular access devices and enteral equipment.Recognise and respond to adverse or abnormal reactions to medications.Undertake safe storage, transportation and disposal of medicinal products. | Continually assess people who are receiving care and their ongoing ability to self‐administer their own medications.Know when and how to escalate any concerns.Perform accurate drug calculations for a variety of medications.Use professional accountability in order to ensure the safe administration of medicines to those receiving care.Administer medication via oral, topical and inhalation routes.Administer injections using subcutaneous and intramuscular routes and manage injection equipment.Administer and monitor medications using enteral equipment.Administer enemas and suppositories.Manage and monitor effectiveness of symptom relief of medications.Recognise and respond to adverse or abnormal reactions to medications and know when and how to escalate any concerns.Undertake safe storage, transportation and disposal of medicinal products. |
Medicine management and standards
Nurses and health and social care staff often manage medicines on behalf of those people who use their services. It is a requirement of care providers to promote the safe and effective use of medicines. If healthcare organisations fail to do this, the Care Quality Commission (CQC) (2018) suggest that this poses real risks to people who may be vulnerable, including:
older people;
people with reduced mental capacity, reduced mobility or a sensory impairment;
people who rely on help to take their medicines.
Medicine management standards provide nurses with a framework for safe practice. All nurses must read and comply with these standards, and undergraduate students must also be familiar with them. The requirements laid out in the various standards consider issues essential for the safe management of all medications and also include controlled drugs.
Episode of care: Mental health
Mr. Murphy, an 80‐year‐old man, has vascular dementia and lives in a care home; he relies on the care home staff to manage his medicines safely.
Mr. Murphy was admitted to hospital after he had displayed signs of a venous thromboembolism and he was discharged four days later; he was prescribed and was taking anticoagulant therapy. When he was discharged from hospital, he was discharged with an 18‐day supply of medicine. The care home staff failed to order a new prescription for Mr. Murphy after the 18 days lapsed. The systems within the care home had failed to identify that the medication was not given for between 30 and 33 days.
Mr. Murphy was taken back into hospital with a pulmonary thromboembolism and deep vein thrombosis. He was in hospital for over three months where he eventually died.
The care home had failed to adhere to local policy and procedure that helps to minimise medication errors. Regulations and standards are put in place to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm. Medicines must be supplied in adequate quantities, managed in a safe way and administered appropriately to ensure that people are safe.
In England, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12, for example, aims to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm. Those who provide care must undertake a risk assessment with regards to people's health and safety when receiving care or treatment and make sure that their staff have the appropriate qualifications, competence, skills and experience to maintain people's safety. If an organisation fails to comply with laws and regulations, they may be prosecuted.
Clinical considerations
Managing medicines in care homes
The National Institute for Health and Care Excellence (NICE) (2014) has published guidelines that address good practice for managing medicines in care homes. The guideline aims to promote the safe and effective use of medicines in care homes, and it offers advice on processes for prescribing, handling and administering medicines. The guideline also recommends how care and services relating to medicines should be provided to those people who are living in care homes.
The Nursing and Midwifery Council (2010) previously issued standards and guidance for the administration of medicines; however, they no longer do this. Professional guidance produced by the Royal Pharmaceutical Society (RPS) (2018a) provides a framework for the safe and secure handling of medicines; this replaces the NMC's previous standards. This guidance uses an all professional approach providing information and advice for all healthcare professionals on medicines management and administration. The RCN and RPS (2019) have co‐produced Guidance on the Administration of Medicines in Healthcare Settings, offering principles‐based guidance to ensure the safe administration of medicines by healthcare professionals.
Clinical considerations
Managing medicines for those receiving social care in the community
The National Institute for Health and Care Excellence (NICE) (2017) has published guidelines that cover medicines support for adults who are receiving social care in the community. It aims to ensure that people who receive social care are supported to take and look after their medicines effectively and safely at home. Guidance offers advice on assessing if people will require help with managing their medicines, who should provide medicines