Workshop to introduce local selection of monographs from national midwifery formulary

Welcome and Housekeeping Introductions Breaks and refreshments Fire alarms Facilities Mobile phones and pagers Programme of the day

Programme 0830 – Introduction, Pre course work discussion, presentation – use of Midwife Formulary, Clinical Governance, Patient Safety Agency 0945 – 1015 BREAK 1015 – 1200 group workshop and feedback 1200 – 1230 Completion of Multiple Choice Questionnaire (MCQ) – 20 questions, with access to reference materials 1230 – 1300 Next steps - Portfolio, Evaluation MCQ feedback, certificates of attendance

Aim By the end of the workshop the participants will be able to clarify and define roles and responsibilities in relation to medicines and use monographs the local NHS board has selected from the national midwifery formulary within their sphere practice.

Objectives Demonstrate safe practice in the administration of medicines by working within the legal and ethical framework that underpins the use of Midwife Exemptions arrangements and atient Group Directions. Apply knowledge of safe and effective medicines management in relation to PGD’s, and local policies. Apply knowledge of the legal status of medicines and of how the status for the same medicine can vary with pack size, formulation, indication and dosage. Describe the indication, dosage, contra-indications, caution, side effects and the categorisation of the medicines in the monographs selected by your NHS board from the national midwifery formulary. Document accurately the administration and supply of medicines in the monographs selected locally from the national midwifery formulary. Critically evaluate the information on the medicines used within the midwifery formulary in order to give accurate information to women.

Pre course Worksheet Click to add local information

The administration of medicines is an important aspect of professional practice of persons whose names are on the council’s register. It is not solely a mechanistic task to be performed in strict compliance with the written prescription of a medical practitioner (now independent/supplementary prescriber). It requires thought and the exercise of professional judgement.” NMC 2007

Governance Medication has become increasingly complex in recent times Medication error is a major cause of preventable patient harm You have an important role in making medication use safe

Insert local board information Heat target of 15% reduction in medicine errors Current situation…

Knowledge Requirements Understand the scale in medication error Understand the steps involved in a patient using medication Identify factors that contribute to medication error Learn how to make medication use safer Understand your responsibility when using medication

Steps in using medication Prescribing Administering Monitoring Note – self administering over the counter medicines ( GSL) or at home

Choosing an appropriate medication for a given clinical situation taking individual factors into account eg allergies Selecting the administration route, dose, time and regimen Communicating details of the plan with : - woman - whoever will administer the medication ( record /transcribing) Documentation

How do medicine errors occur?

Inadequate information about medicine indications and contraindications Not considering individual factors such as allergies, pregnancy, co-morbidities or other medications Wrong patient, wrong dose,wrong time, wrong medicine, wrong route Inadequate communication ( written, verbal, electronic) Documentation – illegible, incomplete, ambiguous Mathematical error when calculating dosage

Ambiguity Tegretol 100 mg S/C 1.0 mg.1 mg Tegreto 1100 mg S/L 10 mg 1 mg

Avoiding Avoid trailing zeros e.g write 1 not 1.0 Use leading zeros e.g. write 0.1 not.1 Know accepted terminology Write neatly print if necessary

How can administration go wrong?

Many wrongs…. Wrong patient Wrong route Wrong dose Wrong time Wrong drug/medicine Omission, failure to administer Inadequate documentation

The 8 Rs Right drug Right route Right time Right dose Right patient Right effect Right education Right documentation

What women are most at risk of medicine error?

Some suggestions… Women on multiple medication Women with another medical condition e.g essential hypertension, renal impairment, substance misuse Women who cannot communicate well Women who do not take an active role in their own medication use Children and babies (dose calculation required)

How do we contribute to medicine error?

Inexperience Rushing/ Doing two things at once Interruptions Fatigue, boredom, being on “automatic pilot” leading to failure to check and double check Lack of checking and double checking habits Poor team work and/or communication between colleagues Reluctance to use memory aids

Know your medicines well Do your homework on medicines you administer – BNF Pharmacology Indications Contraindications Side effects Special precautions Dose and administration Regimen

Why have we selected monograph from the national midwifery formulary for our local use? Developed to support midwifery practice in administration of medicines Evidence based practice tool with clear guidance for midwives role in administering medicines relevant to practice NMC extension to exemption medicines list

Student Midwives Exemption medicines Patient group directions Controlled drugs Prescribed medication

Skill station

Multiple Choice Questionnaire

Next Steps Portfolio and competency assessment

Evaluation Pre course reading Pre course MCQ Workshop Portfolio

Thank you