1. Accountability and Delegation Medicines Management
Maureen Spinetto SRO - RCN

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

3. 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.

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

5. 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”

6. 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

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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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?

15. 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

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

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

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

19. 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

20. 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.

21. 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

22. Thank you for listening Any questions?