Accountability and Delegation Medicines Management Maureen Spinetto SRO - RCN

Objectives Understand Accountability and who are you accountable to The importance of Documentation Understand Effective Delegation Safe medicines management The Code

Accountability The law imposes a duty of care on practitioners, whether they are HCAs, APs, students, registered nurses, doctors or others. The duty of care applies whether they are performing straightforward activities such as bathing patients or undertaking complex surgery.

Continued And when it is reasonably foreseeable that they might cause harm to patients through their actions or their failure to act

The code states that you must: “Be accountable for your decisions to delegate tasks and duties to other people” “Act without delay if you believe that there is a risk to patient safety or public protection” “Raise concerns immediately if you believe a person is vulnerable or at risk and needs extra support and protection” “Uphold the reputation of your profession at all times”

Who are you accountable to Employer – Contract of employment Criminal Law – Ensure activities conform to legal requirements Civil Law – Ensure activities conform to legal requirements Regulatory and Professional Bodies – Standards of practise and patient care Healthcare / Other Regulation -CQC

Documentation Code of Conduct (2015): Section 10 – Keep clear and accurate records relevant to your practise

Documentation Documentation is essential to exercising accountability Documentation is essential to safe medicines management

Documentation Whatever I did I didn’t do it! Never underestimate the power of documentation! Central issue to so many cases Medication errors Observations Neglect Escalating / IR1 Dishonesty

Documentation It is accepted by those institutes that we are accountable to that the way records are kept is usually set by the employers and therefore that there will be different ways of doing things HOWEVER: - The principles of good record keeping are well established and should be the same across the board

Always…….. Ensure every record is: Factual, consistent and accurate Written up ASAP after the event Clear, legible and non-erasable Avoid abbreviations A record of what YOU observed Signed, dated and timed (including printed on first entry / 24 hour) None offensive statements

Never….. AVOID: Ambiguous statements Missing elements of care provided Patient identification issues NEVER erase errors – single line and initial NEVER destroy any records without being authorised to do so NEVER falsify records

Delegation Code of Conduct (2015): Section 11 – Be accountable for your decisions to delegate tasks and duties to other people Always ensure that you: Establish that anyone you delegate to is competent to carry out their instructions and understands the task Make sure that the person delegated to is supervised and supported Confirm that the outcome of any delegated task meets required standards

Delegation Checklist Ask yourself: Is it in the best interests of the patient? Is it necessary? Do they understand the task and how to perform? Do they have the skills and ability to perform the task competently?

Continued……. Have they accepted responsibility for the task? Is the task/duty in the JD Can the task be supervised adequately? Has the task been risk assessed

Continued ongoing development to make sure their competency is maintained. Policies, protocols and procedures which are up to date and reviewed

Medicines Policy which are… Up to date Current with legislation Based on Evidential best practice

Safe and effective Medicines Management keeping residents safe (safeguarding) accurately listing a resident's medicines (medicines reconciliation) reviewing medicines (medication review) ordering medicines

receiving, storing and disposing of medicines helping residents to look after and take their medicines themselves (self‑administration) care home staff administering medicines to residents, including staff training and competence requirements

care home staff giving medicines to residents without their knowledge (covert administration) care home staff giving non-prescription and over‑the‑counter products to residents (homely remedies), if appropriate.

Some Facts and Figures 17% of all cases investigated by the NMC in 2012/2013* were referred for misconduct or lack of competence solely or mainly for record keeping (708 cases) Record keeping will feature in other referrals e.g. medication errors

Thank you for listening Any questions?