The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [518]
(NPSA 2007a)
Incidents involving injectable medicine represented 62% of all reported incidents leading to death or severe harm (NPSA/NRLS 2009). There are seven key actions to improve medication safety (Box 13.2).
Box 13.2 Seven key actions to improve medication safety
Increase reporting and learning from medication incidents.
Implement NPSA safer medication practice recommendations.
Improve staff skills and competencies.
Minimize dosing errors.
Ensure medicines are not omitted.
Ensure the correct medicines are given to the correct patients.
Document patients’ medicine allergy status.
(NPSA 2007a)
The effective and safe prescribing, dispensing and administration of medicines to patients demands a partnership between the various health professionals concerned, that is doctors, pharmacists and nurses. The revised Duthie Report, The Safe and Secure of Handling of Medicines: A Team Approach (RPSGB 2005) defined a medicine as ‘all products administered by mouth, applied to the body or introduced into the body for the purpose of treating or preventing disease, diagnosing disease or ascertaining the existence, degree or extent of a physiological condition, contraception, inducing anaesthesia, or otherwise preventing or interfering with the normal operation of a physiological function’. It follows from this definition that infusions or injections of sodium chloride 0.9% and water for injection are included, as are all medicinal products covered by the European Directive on Medicines. This report details how the key principles of compliance with legislation, adherence to guidance and safety of patients and staff should be applied to the management and handling of medicines. In order to achieve this, organizations should have in place Standard Operating Procedures (SOPs) for each activity in the medicines trail, also indicating clear responsibilities, training, competencies and performance standards for each member of staff. Processes for validation, audit and risk assessment of the activities also need to be included.
The activities defined in the medicines trail are:
prescribing/initiation of treatment
procurement/acquisition of medicines
manufacture/manipulation of medicines
receipt of medicines
issue to point of use/dispensing or supply
preparation/manipulation of medicines for administration
use of medicines/administration
removal/disposal of surplus/waste medicines from wards and departments
removal/disposal of surplus/waste medicines or related materials from the hospital.
Principles of care
Prescribing
All medicines administered in hospital must be considered prescription only. This is because administration, whether by a nurse or by a patient to themselves, may only take place in accordance with one or more of the following processes:
patient-specific direction (PSD)
patient medicines administration chart may also be called a medicines administration record (MAR)
patient group directions (PGD)
Medicines Act exemplar
standing orders
homely remedy protocol
prescription form.
(NMC 2008a, pp. 13–16)
Prescriptions can be handwritten on a chart, a prescription pad or provided electronically. E-prescribing has been defined as the ‘utilization of electronic systems to facilitate and enhance the communication of a prescription or medicine order, aiding the choice, administration and supply of a medicine through knowledge and decision support and providing a robust audit trail for the entire medicines uses process’ (NHS Connecting for Health 2009). Some of the benefits include:
prescibers can accurately and clearly enter complete medication orders
the system can provide relevant patient information, for example allergies
prescription data can be stored securely and communicated to other members of the healthcare team without the risk of paper records being lost
pharmacists can access medication orders remotely and check and amend as required
nurses have clear and legible medication orders
medication records can be accessed remotely by all healthcare professionals (NHS Connecting