Drug Administration by Nurses, Drug Administration by Midwives, Safe Drug Administration Procedure, Controlled vs Non-Controlled Drug Administration, and Drug Administration Delegation.

Drug Administration by Nurses

This study guide is an article about drug administration by nurses. Adapt it to write excellent essays concerning effective drug administration.

Introduction to Drug Administration by Nurses Essay

The purpose of this article is to look into the suggested techniques for safe drug administration by nurses, both controlled and non-controlled. The Nursing and Midwifery Council’s (NMC) guidelines for nurses in medication administration will be covered, as well as common drug administration routes that a nurse may be required to employ. Situations in which nurses delegate drug administration to someone else, such as a student nurse or a healthcare assistant, will also be examined. Finally, drug administration security will be established.

Who has the authority to administer certain drugs and under what situations?

Nurses can prescribe or administer drugs in line with their training, the law, and any local or national rules and advice, according to the NMC Code (2015). This includes adhering to the precise guidelines for the administration of prohibited substances. Nurses should not prescribe for anyone with whom they have a close personal relationship, nor should they prescribe medications for themselves unless it is really required, according to prescribing guidelines for other healthcare professionals.

Drug Administration by Midwives

Can midwives administer drugs?

It should be emphasized that midwives are subject to unique drug administration regulations. They may, for example, possess and administer regulated medications such as pethidine as analgesic for laboring women or prescription-only pharmaceuticals such as synotocin to increase the third stage of labor and manage postpartum hemorrhage. These medications are often obtained through a supply order countersigned by either a doctor or a midwifery supervisor. This is due to the fact that they require immediate access to these medications in order to provide appropriate patient care. The medications that the midwife has access to are normally determined by local policy and in compliance with the precise instructions in the NMC Code (2015).

Drug Administration Preparation

What is the correct procedure for preparing drugs before administration?

Medication should never be prepared ahead of time (save for certain chemotherapy treatments) and should only be delivered by a registrant who was engaged in its preparation. No healthcare worker should ever administer medicine that they did not assist in the preparation of. Nurses must grasp the weight systems used in prescriptions and be able to appropriately calculate medicine doses. They should also comprehend common acronyms used in prescribing, but keep in mind that any lack of clarity in the instructions should be questioned.

It’s also crucial to be aware of any rules for the proper handling of potentially dangerous pharmaceuticals, such as cytotoxic drugs used to treat cancer. Because these medications have the potential to harm cells by their very nature, extra caution should be exercised when handling and preparing them in line with local practice. Many of these medications, for example, are known to be dangerous during pregnancy, and it may be local policy that nurses who are pregnant or fear they are pregnant are not allowed to administer these treatments. In addition, the nurse should be aware of the proper local process for dealing with spills and the proper disposal of any contaminated equipment.

Without the consent of a pharmacist, medicines in tablet form should not be routinely crushed to make it simpler for the patient to swallow. This is due to the fact that crushing alters the way the medication is absorbed into the body, perhaps making the drug less effective. Many tablets are manufactured by the manufacturer with an enteric coating, which keeps the tablet from breaking down in the acidic environment of the stomach, allowing it to move to the small intestine, where it may break down gradually and be absorbed more easily. Crushing destroys the protective properties of this covering.

Safe Drug Administration Procedure

How can a nurse safely administer drugs?

The NMC Standards for Medicines Management (2016) go into further depth about the nurse’s responsibility for safe drug delivery. With a single signature, a registered nurse can deliver any prescription-only drug, general sales list medication, or pharmacy medication. Before delivering a medicine, a nurse should validate the patient’s identification by using wrist bands and asking the patient for their name and date of birth, as well as making sure the patient is not allergic to the drug. The nurse should be well-versed on the medication they are to deliver – for example, the medication’s therapeutic usage, regular dose, recognized side effects, and any special contraindications or warnings. The nurse should also be familiar with the patient’s treatment plan and the requirement for the medicine to be administered.

The nurse should also double-check that the medication’s prescription and container labels are both clear and unambiguous. If any component of the recommended instructions is unclear, the nurse should inquire further by calling the prescribing healthcare practitioner for clarification. Although this may be difficult owing to the historical power and position imbalance between physicians and nurses, the nurse has a responsibility to double-check any unclear information and discuss it constructively.

In addition, the nurse should evaluate the specified dose, route, and time to their expertise and experience. Any concerns should be communicated with the prescribing healthcare practitioner, as this may aid in the detection of a prescription error and thereby safeguard the patient’s safety. Finally, the nurse should always double-check the medication’s expiration date.

When delivering a prescription medicine, the patient’s present state should also be considered. For example, if the patient’s present state or vital signs suggest that the treatment is contraindicated, the drug should not be administered and advice should be sought. Digoxin, for example, is contraindicated in people with a pulse rate of 60 beats per minute. If a nurse discovers that the patient’s pulse rate is lower than this, the scheduled dose of Digoxin becomes contraindicated and should not be administered.

Similarly, the patient’s present state may indicate that this amount of medicine is unnecessary, in which case the nurse should call the prescriber to explore the situation further. If the patient is judged as having the mental ability to refuse treatment, the patient may opt to withdraw their permission to receive the medicine, which should be respected and followed.

Medication administration should be documented as soon as possible in the patient’s records, with the nurse signing and printing their name, as well as the date and time the drug was given. If the medicine was not delivered on purpose, such as if the nurse felt compelled to query the prescriber about it or if the patient refused it, it should be included in the notes along with the explanation. Nurses have a legal obligation to ensure that this information is recorded accurately. If the registered nurse has delegated drug administration to another person, this should also be done.

Finally, following administration of the medicine, the patient should be observed for any signs of an adverse reaction, such as a response consistent with a known or unknown side effect, or an allergic reaction. Nurses should seek the prescriber’s assistance in this situation, but they should also be aware of the emergency care needed to support a patient experiencing a significant response. Allergic responses are often characterized by a rash, hives, sneezing, and bronchospasm, but they can escalate to anaphylaxis, a systemic allergic response that causes respiratory distress and loss of consciousness.

Patients who are suspected of having an allergic reaction should be closely monitored for signs of the reaction progressing to anaphylaxis, such as regular monitoring of vital signs such as blood pressure, oxygen saturation, and respiratory rate, which can also be used to confirm that the patient’s condition is improving. An antihistamine like hydroxyzine, as well as a corticosteroid like prednisolone, should be given. If anaphylaxis is suspected, patients should be treated with high-flow oxygen and an emergency intramuscular injection of adrenaline, which should be repeated every 5 minutes until the patient is stable. Salbutamol, administered by a nebuliser, can be used to treat bronchospasm.

The “5 rights” rule, which pushes the nurse to examine these issues in an easy-to-remember manner, may be used to compress the nurse’s obligations under the NMC Standards for Medicines Management (2016). The rule consists of recommendations intended to reduce medication errors and harm. The five rights are the right patient, the right drug, the right dose, the right route, and the right time. The appropriate dosage of the right drug should be given to the right patient at the right time via the right channel. Some experts have renamed this the “7 rights rule” or even the “9 rights rule” to encompass the additional elements of medication administration discussed in this section.

These guidelines go beyond the “5 rights rule” by ensuring that the correct medicine form has been prescribed, that the drug is being supplied for the correct cause, and that the patient is responding appropriately to it. Finally, after providing the drug, the nurse should fill out the appropriate paperwork. These rules are depicted in Figure 1 below.

Rule Explanation
Right patient Is the nurse in possession of the correct patient and patient notations? Check wrist bands and ask the patient for their name and date of birth.
Right dosage Has the correct dosage of the medication been prescribed? Is it possible that an odd dose is the result of a medical error? Is the dosage sufficient to meet the goals of the patient care plan?
Right medication Is the drug right, or are the stated directions incorrect? Is the nurse sure she got the right medicine from the pharmacy? Is there a history of medication allergies in the patient?
Right route Is the proper administration route for this medicine listed in the patient’s medical record? Is it possible that a different method would be more appropriate?
Right time Is the medication being delivered at the specified time? Have prior doses of the medicine been given at the correct time? Is it necessary to change the timing of administration of this medication? For example, if a patient refused a prior dose of a recommended prescription, such as an analgesic, but subsequently requested it, the time of the following dosage would need to be adjusted to account for this.
Right form Has the medication been prescribed in the best possible way? Depending on the patient’s circumstances, some medications, such as morphine or paracetamol, might be given as an oral or IV formulation. Furthermore, delivering the incorrect version of a medicine via the incorrect route can be extremely harmful.
Right reason Is the justification for choosing the recommended medication correct? Would a different medication be more appropriate?
Right response Is the drug having the desired effect on the patient? Is the patient’s blood pressure dropping as a result of the administration of an antihypertensive medicine like propranolol, for example? If the patient is not reacting as expected, such as if blood pressure is not dropping as expected or the patient is becoming hypotensive, the prescription may need to be reviewed. Look for any symptoms of an adverse reaction to the medicine as well.
Right documentation Has the nurse appropriately completed the necessary documentation in compliance with NMC and local guidelines? Has the administration been seen by a second competent individual, if applicable? This may comprise the patient’s notes and, if necessary, a restricted drug record.

Controlled vs Non-Controlled Drug Administration

How do controlled and non-controlled drug administration compare?

Nurses can also deliver controlled medications, although this is subject to extra regulations and local protocols that must always be followed. Second signatories are often other nurses, student nurses, physicians, or pharmacists; however, if none of these professionals are present, the NMC suggests that patient care not be jeopardized by waiting for an appropriate professional to countersign, but instead consider another competent individual. According to best practices, this second signatory should preferably observe the complete medication administration procedure, which is frequently mirrored in local legislation.

In the hospital, a second signature is usually necessary for the delivery of restricted medicines. However, in the community environment, this is not always practicable, and in this situation, local policy and procedures should be followed. When a patient is given an oral controlled medication for immediate consumption, such as methadone in a substance abuse clinic, the administration and consumption of the medication should be witnessed by the administering nurse and a second registered nurse, as well as any other relevant local procedures.

The National Institute of Health and Care Excellence’s (NICE) recommendations for the use of controlled medications state that the name of the patient receiving the drug, as well as the date and time of the administration, the name, dose, formulation, and strength of the restricted drug, should all be noted. The name and signature of the licensed nurse delivering the medicine, as well as the name, date, and signature of the person witnessing the drug delivery, should all be clearly printed.

Drug Administration Delegation

What are the criteria for delegating medicine administration?

Drug administration can be delegated by a registered nurse to a healthcare assistant or student nurse, but it should never be done without supervision. Student nurses may testify in the management and administration of prohibited substances, although this will depend on local regulation. Delegation of drug administration should be carefully studied because it brings the chance of mistakes into the patient’s treatment. If it becomes essential to assign this role, for example, if the registered nurse has to divide their workload in order to focus on critical responsibilities, the nurse must ensure that the person to whom they delegate is competent.

Drug Administration by Nurses
Drug administration delegation

Furthermore, delegation to a competent student nurse is a vital part of their practical training, and a registered nurse should do so if they feel their student is capable. If the nurse has any questions about their expertise, they should refuse to delegate drug administration, even if it means turning down a direct request from another healthcare provider. This is because the registered nurse is held liable for the actions of any persons to whom they have assigned the responsibility.

In the United Kingdom, a student nurse is legally liable for their practice but does not yet have the expertise or competence to be held entirely accountable. As a result, the supervising registered nurse bears legal and ethical responsibility. The nurse should ensure that the individual has received appropriate information and training to understand how and why the medicine should be delivered and should provide further assistance if necessary. Any training or education should be documented, and the NMC Standards for Medicines Management (2016) provide that a student’s drug administration should always be countersigned by the supervising registered nurse. The “5 rights of delegation” guideline, as depicted in Figure 2, can be used to facilitate safe and successful delegation.

Following this rule ensures that only the right task is delegated to the right person under the right circumstances, that they are given the proper instructions to complete the task safely, and that the delegation is properly planned to ensure quality patient care and a positive learning experience for the delegated person. Delegation must also be monitored and assessed in the proper (suitable) manner.

Rule Explanation
Right task Is the work particular and suitable to be delegated (for example, administration of a routine medicine rather than delivery of a restricted drug)?
Right circumstances Does the person to whom the work has been allocated have the necessary resources and equipment to do the assignment safely?
Right person Is the delegating being done by the correct person (i.e., someone who can monitor and be accountable for the process)? Is the individual to whom the task has been entrusted capable and willing?
Right communication and directions Has the individual to whom you’ve delegated received clear and precise instructions, and do they understand the goals, expectations, and limitations you’ve set for them? Do they know how to properly report and document the process?
Right supervision and evaluation Will the individual to whom authority has been transferred get adequate assessment and feedback? Will their performance be monitored, and will the person delegating be accessible to intervene or give assistance as needed to ensure great patient care?

Figure 2: The “5 rights” of delegation

Conclusion

Finally, this chapter discussed the role of the nurse in medication administration in the light of NMC advice and UK legislation. Good nursing practice in the context of medication administration has also been introduced, in preparation for a more in-depth discussion in the following chapter. We also discussed the advantages of delegating regular medication administration chores to other colleagues and how this may be done safely to guarantee patient safety and care quality. These principles will now be implemented in two hands-on scenarios to help you understand how to apply these rules and standards in regular nursing practice.

 

Frequently Asked Questions (FAQs)

1. Can nurses administer drugs?

 

Drug Administration by Nurses
Drug Administration by a Nurse

Nurses can prescribe or administer drugs in line with their training, the law, and any local or national rules and advice, according to the NMC Code (2015). This includes adhering to the precise guidelines for the administration of prohibited substances.

2. What should a nurse do before administering medication?

Medication should never be prepared ahead of time (save for certain chemotherapy treatments) and should only be delivered by a registrant who was engaged in its preparation. No healthcare worker should ever administer medicine that they did not assist in the preparation of. Nurses must grasp the weight systems used in prescriptions and be able to appropriately calculate medicine doses. They should also comprehend common acronyms used in prescribing, but keep in mind that any lack of clarity in the instructions should be questioned.

Without the consent of a pharmacist, medicines in tablet form should not be routinely crushed to make it simpler for the patient to swallow. This is due to the fact that crushing alters the way the medication is absorbed into the body, perhaps making the drug less effective. Many tablets are manufactured by the manufacturer with an enteric coating, which keeps the tablet from breaking down in the acidic environment of the stomach, allowing it to move to the small intestine, where it may break down gradually and be absorbed more easily. Crushing destroys the protective properties of this covering.

3. What are the 5 rights?

The rule consists of recommendations intended to reduce medication errors and harm. The five rights are the right patient, the right drug, the right dose, the right route, and the right time. The appropriate dosage of the right drug should be given to the right patient at the right time via the right channel. Some experts have renamed this the “7 rights rule” or even the “9 rights rule” to encompass the additional elements of medication administration discussed in this section.

4. What procedure should be followed when administering controlled drugs?

The National Institute of Health and Care Excellence’s (NICE) recommendations for the use of controlled medications state that the name of the patient receiving the drug, as well as the date and time of the administration, the name, dose, formulation, and strength of the restricted drug, should all be noted. The name and signature of the licensed nurse delivering the medicine, as well as the name, date, and signature of the person witnessing the drug delivery, should all be clearly printed.

Drug Administration by Nurses

 

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