• Choose a category
• All
• Classic-Fiction

Level of supervision Role of patient Role of nurse

Level 1 None Nurse administers medicine from cabinet

Key locked in cabinet and nurse uses master

Nurse signs drug administration chart

Level 2 Patient administers medicine with nurse supervision Cabinet is opened by nurse

Nurse supervises patient administration

Nurse signs drug administration chart

Level 3 Key kept by patient

Patient administers their own medicines

Nurse must check that the appropriate medication was taken and endorse the chart with an identifier to indicate that the patient is self-administering and their initials

NPC (2007).

Even if a patient is self-administering their medication, continual assessment of this aspect of their care while they are in hospital is important. The nurse must continually be aware of the patient’s capability to self-administer and the action of the drugs the patient is taking (NPSA 2007c).

Preprocedural considerations

A medicines reconciliation needs to be carried out with the patient and they will be assessed for their ability to self-administer. Any constraint such as physical or visual handicap must be addressed. Changes in performance status may result from the underlying condition or its treatment, and must be allowed for (NMC 2008a, Shepherd 2002a).

If a compliance aid such as a ‘dosette’ box is to be used, responsibility for filling and labelling the aid, especially whilst used on the ward, must be agreed and documented in local policies (NMC 2008a, Shepherd 2002a).

Procedure guideline 13.1 Medication: self-administration

Essential equipment

Drugs to be administered

Recording sheet or book as required by law or hospital policy

Patient’s prescription chart, to check dose, route and so on

Any protective clothing required by hospital policy for specified drugs, such as antibiotics or cytotoxic drugs

Preprocedure

Action Rationale

1 Carry out a medicines reconciliation with the patient on admission by reviewing proposed (inpatient) prescription in liaison with the pharmacist and compare with details given by the patient and medicines in their possession. Any differences should be investigated and highlighted with the medical team. To ensure an accurate record of: all medicines being taken (prescribed or otherwise); dietary supplements, for example multivitamins, herbal remedies, complementary therapies; allergies or hypersensitivities; understanding of current medicines; possible problems with self-administration (Jordan et al. 2003, E; NMC 2008a, C; NMC 2009, C; Shepherd 2002b, E NPSA/NICE 2007, C).

2 Carry out an assessment of the patient’s ability to self-administer medication using an assessment form with the criteria in Table 13.5. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital (NPSA/NICE 2007, C).

3 Consider whether there are any constraints on self-administration and if so, how they might be overcome. Discuss this with appropriate members of the multidisciplinary team. To promote successful and safe self-administration and ensure that medicines are dispensed and labelled appropriately for the patient’s needs (DH 2003b, C; NMC 2008a, C; Shepherd 2002a, E).

4 Following the assessment, a level of supervision will be recommended and entered on the assessment form. The assessment form and the consent will be filed in the nursing notes. For examples of levels see Table 13.4. To ensure that the correct level of supervsion is selected and communicated to other staff. E

Procedure

5 Discuss with the patient their medication and any problems they may be having with the regimen. Document discussions in the care plan. Teach any special skills required, for example correct use of aerosol inhalers. Reassess whether they need any changes to their levels of supervision, either up or down. To promote the informed commitment and involvement of patients in their own care, where appropriate. To ensure that treatment is received as intended (NMC 2008a, C; Shepherd 2002b, E).

Postprocedure

6 Check