1. The Role of the Healthcare Professional in Drug Administration Richard Lake January 2004

2. Who is involved in drug administration? Prescriber Prescriber Doctor Doctor Nurse Prescriber Nurse Prescriber Health Visitor Health Visitor Other professionals Other professionals

3. Drug admin (2) Pharmacy department Pharmacy department Pharmacist Pharmacist Pharmacy Technician Pharmacy Technician Pharmacy Assistant Pharmacy Assistant

4. Nurse Nurse Other health care professionals Other health care professionals Informal carers Informal carers Family members Family members Patient Patient

5. Legal considerations Medicines Act 1968 Medicines Act 1968 Misuse of Drugs Act 1971 Misuse of Drugs Act 1971 Medicinal Products: Prescription by Nurses etc Act 1992 Medicinal Products: Prescription by Nurses etc Act 1992 Nurse Midwives and Health Visitors Act 1997 Nurse Midwives and Health Visitors Act 1997 Consumer Protection Act 1987 Consumer Protection Act 1987

6. Patient group directives Specific written instruction for the supply and administration of a named medicine in an identified clinical situation. e.g. analgesia on arrival at Triage in A&E departments Specific written instruction for the supply and administration of a named medicine in an identified clinical situation. e.g. analgesia on arrival at Triage in A&E departments For patients not individually identified before presenting for treatment For patients not individually identified before presenting for treatment Drawn up locally by senior doctors, pharmacists and other health professionals Drawn up locally by senior doctors, pharmacists and other health professionals

7. All patient group directives must be authorised by and signed by a senior doctor and senior pharmacist All patient group directives must be authorised by and signed by a senior doctor and senior pharmacist Both must have been involved in developing the directive, and be approved by the health care body Both must have been involved in developing the directive, and be approved by the health care body

8. Administration of Medicines Regulated by Medicines Act 1968 Regulated by Medicines Act 1968 3 legal categories 3 legal categories Prescription Only Medicines (POM) Prescription Only Medicines (POM) Pharmacy medicines (P) Pharmacy medicines (P) General sales list medicines (GSL) General sales list medicines (GSL) No person shall administer other than to himself any such medicinal product unless he is an appropriate practitioner or a person acting in accordance with the directions of an appropriate practitioner No person shall administer other than to himself any such medicinal product unless he is an appropriate practitioner or a person acting in accordance with the directions of an appropriate practitioner

9. Why administer drugs Diagnostic – e.g. radio-opaque dyes Diagnostic – e.g. radio-opaque dyes Prophylactic – prevention e.g. heparin to prevent thrombosis Prophylactic – prevention e.g. heparin to prevent thrombosis Therapeutic – treatment of specific conditions e.g. Thyroxine for hypothyroidism; Analgesic agents for pain Therapeutic – treatment of specific conditions e.g. Thyroxine for hypothyroidism; Analgesic agents for pain

10. Routes of drug administration Orally (liquid) – solutions, suspensions, syrups, elixirs, emulsions, oils Orally (liquid) – solutions, suspensions, syrups, elixirs, emulsions, oils Orally (solid) – tablets, capsules, granules, lozenges, beads Orally (solid) – tablets, capsules, granules, lozenges, beads Inhaled – metered dose inhaler, powder device, compressed air nebulisers Inhaled – metered dose inhaler, powder device, compressed air nebulisers Into the ear (Otic) – solutions, suspensions, drops Into the ear (Otic) – solutions, suspensions, drops Into the eye (Optic) – solutions, suspensions, drops, ointments Into the eye (Optic) – solutions, suspensions, drops, ointments

11. Into the nose (nasal) – solution, suspensions, drops, ointments, sprays Into the nose (nasal) – solution, suspensions, drops, ointments, sprays On the skin (topical) – solutions, suspensions, ointments, sprays, creams, lotions, pastes, powders, shampoos, soaps On the skin (topical) – solutions, suspensions, ointments, sprays, creams, lotions, pastes, powders, shampoos, soaps Into the mouth (buccal) – lozenges, chewing gum, sublingual tablets (rarely) Into the mouth (buccal) – lozenges, chewing gum, sublingual tablets (rarely) Into the rectum – enemas, water solutions suspensions, oils, suppositories, ointments Into the rectum – enemas, water solutions suspensions, oils, suppositories, ointments

12. Injected Subcutaneous Subcutaneous Subdermally Subdermally Intramuscular Intramuscular Intravenous Intravenous Intrathecal Intrathecal Intraosseous Intraosseous Intravesical Intravesical

13. Drugs Charts & Prescriptions All drugs must be prescribed on an appropriate chart or form All drugs must be prescribed on an appropriate chart or form Drug chart format is standardised but some hospitals have slightly different formats Drug chart format is standardised but some hospitals have slightly different formats Different forms for take home medication, community prescriptions and hospital in patient charts Different forms for take home medication, community prescriptions and hospital in patient charts

14. All charts should Be completed in black ink and legible Be completed in black ink and legible Have the name and address of the patient Have the name and address of the patient The prescribed drug written clearly The prescribed drug written clearly Dose Dose Route Route Times of administration Times of administration The signature of the Prescriber and date The signature of the Prescriber and date The date of signing The date of signing Any special information about the administration of the drug Any special information about the administration of the drug

15. Prior knowledge Before administering any drug the health care professional should be aware of: Before administering any drug the health care professional should be aware of: The indications for the drug and appropriate route The indications for the drug and appropriate route Any cautions or contra-indications Any cautions or contra-indications Side effects Side effects Appropriate dose limits Appropriate dose limits Appropriate intervals between administration Appropriate intervals between administration

16. Information on drugs British National Formulary – British National Formulary – Every ward has one which should be on drug trolley Every ward has one which should be on drug trolley Updated and published every March and September Updated and published every March and September Always look at most recent available as advice about drugs changes regularly Always look at most recent available as advice about drugs changes regularly Electronically www.bnf.org Electronically www.bnf.orgwww.bnf.org Has information on every drug available in UK Has information on every drug available in UK

17. Association of British Pharmaceutical Industry Data Sheet Compendium Association of British Pharmaceutical Industry Data Sheet Compendium Published every year Published every year Detailed information on every drug available in UK Detailed information on every drug available in UK Full manufacturers data sheets Full manufacturers data sheets Usually copies only held in pharmacy department or library Usually copies only held in pharmacy department or library

18. Information on drugs always available from pharmacy department Information on drugs always available from pharmacy department Every clinical area has a pharmacist that ‘links’ with that area Every clinical area has a pharmacist that ‘links’ with that area Ward pharmacist has detailed knowledge of drugs and treatments used in that area Ward pharmacist has detailed knowledge of drugs and treatments used in that area Excellent resource to use when you require more information on a specific drug Excellent resource to use when you require more information on a specific drug

19. Nursing Midwifery Council (2002) G uidelines for the administration of medicines Regulatory body guidance and standard Regulatory body guidance and standard Registered Nurse is accountable for any action or omission Registered Nurse is accountable for any action or omission Must know the therapeutic uses of the medicine to be administered, its normal dosage, side effects, precautions and contra indications Must know the therapeutic uses of the medicine to be administered, its normal dosage, side effects, precautions and contra indications Be certain of the identity of the patient to whom the medicine is to be administered Be certain of the identity of the patient to whom the medicine is to be administered

20. Be aware of the patients care plan Be aware of the patients care plan Check the prescription, or the label on medicine dispensed by a pharmacist, is clearly written and unambiguous Check the prescription, or the label on medicine dispensed by a pharmacist, is clearly written and unambiguous Consider the dosage, method of administration, route and timing of the administration in the context of the condition of the patient and co existing therapies Consider the dosage, method of administration, route and timing of the administration in the context of the condition of the patient and co existing therapies Check the expiry date of the medicine to be administered Check the expiry date of the medicine to be administered

21. Check the patient is not allergic to the medicine before administering it Check the patient is not allergic to the medicine before administering it Contact the Prescriber or other authorised Prescriber without delay where: Contact the Prescriber or other authorised Prescriber without delay where: contra-indications to the prescribed medicine are discovered contra-indications to the prescribed medicine are discovered the patient develops a reaction to the medicine the patient develops a reaction to the medicine Assessment of the patient indicates the medicine is no longer suitable Assessment of the patient indicates the medicine is no longer suitable

22. Make a clear, accurate and immediate record of all medicine administered, intentionally withheld or refused by the patient Make a clear, accurate and immediate record of all medicine administered, intentionally withheld or refused by the patient All entries on drugs charts and notes must be legible, clear, signed and in black ink All entries on drugs charts and notes must be legible, clear, signed and in black ink It is the registered nurses responsibility to ensure a record is maintained where the task of medicine administration is delegated It is the registered nurses responsibility to ensure a record is maintained where the task of medicine administration is delegated Where supervision occurs of a student nurse administering medicines there must be a clear countersignature next to that of the student Where supervision occurs of a student nurse administering medicines there must be a clear countersignature next to that of the student

23. Self administration of medicines Practice on the increase in hospital settings Practice on the increase in hospital settings Encourages patient independence Encourages patient independence Ensures patient has true partnership in care Ensures patient has true partnership in care Nurse still maintains drug chart record to ensure medication has been taken Nurse still maintains drug chart record to ensure medication has been taken Even if patient is self administering nurse remains accountable for patient treatment and medication Even if patient is self administering nurse remains accountable for patient treatment and medication

24. Informed consent Adults who can give legal consent are said to be competent Adults who can give legal consent are said to be competent A competent adult has the right to refuse treatment even when the clinical experience or beliefs of professionals differ A competent adult has the right to refuse treatment even when the clinical experience or beliefs of professionals differ Should we covertly administer medicines to the elderly and confused? Should we covertly administer medicines to the elderly and confused?

25. Covert administration This can be dangerous due to changes in drug pharmokinetics if dissolved in food, drink or crushed This can be dangerous due to changes in drug pharmokinetics if dissolved in food, drink or crushed Is the patient giving consent to the treatment or is the professional causing harm? Is the patient giving consent to the treatment or is the professional causing harm? NMC has issued guidelines NMC has issued guidelines

26. Professionals should work collaboratively as a multidisciplinary team to discuss the necessity for covert administration of medication. NMC (2002) Professionals should work collaboratively as a multidisciplinary team to discuss the necessity for covert administration of medication. NMC (2002) Can medication be administered by another route Can medication be administered by another route Is there another form of the drug which may be easier for the patient to take Is there another form of the drug which may be easier for the patient to take Consideration should be given to why the patient refuses the medication Consideration should be given to why the patient refuses the medication

27. Often difficulty occurs with the elderly confused taking medication as there are a number of psychomotor tasks occurring at the same time. Often difficulty occurs with the elderly confused taking medication as there are a number of psychomotor tasks occurring at the same time. For example drugs are often given out with meals, most elderly have polypharmacy (the taking of 4 or more medications) For example drugs are often given out with meals, most elderly have polypharmacy (the taking of 4 or more medications) Over stimulation with trying to eat and taking medication may add to the confusion and hence non compliance Over stimulation with trying to eat and taking medication may add to the confusion and hence non compliance

28. Summary Ensure right drug Ensure right drug The right form of drug The right form of drug For the right patient For the right patient Via the right route Via the right route At the right time At the right time

29. Questions