The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [532]
7 Monitor changes in the patient’s prescription. To ensure that changes are put into effect promptly; drugs are properly relabelled or redispensed; any discontinued drugs are retrieved from the patient (DH 2003b, C; NMC 2008a, C; Shepherd 2002b, E).
8 Check when drug supplies are expected to run out and make arrangements for resupply. Order drugs to take out (TTO) as far in advance as possible. To ensure that drugs are represcribed and dispensed in time to allow uninterrupted treatment and to facilitate planned discharge (DH 2003b, C; NMC 2008a, C; Shepherd 2002b, E).
9 Evaluate the effectiveness of the self-administration teaching programme and record any difficulties encountered and interventions made. To identify further learning and teaching needs and modify care plan accordingly (NMC 2008a, C; NMC 2008b, C; NMC 2009, C; Shepherd 2002b, E).
Table 13.5 Assessment form
Assessment criteria Rationale
Is the patient willing to participate in self-administration after being given information explaining the scheme with associated time to read and understand it? Patient’s agreement should be recorded with a date and time (RPSGB 2005)
Has the patient signed a consent form agreeing to self-administration? Patient’s agreement should be recorded with a date and time (RPSGB 2005)
Is the patient sufficiently well to take part in the scheme? Patients who are not well enough or who are undergoing surgery will not be able to self-administer until they have recovered and have been reassessed If frequent changes of drug or dose are expected, immediate self-administration may be undesirable and/or impractical
Is the patient confused, forgetful or disorientated? Patients who are confused, forgetful or disorientated will need to have their medicines administered by a nurse in the usual way. This may be assessed by asking relatives or carers or by asking specific questions for assessing state of mind
Does the patient have a history of drug/alcohol abuse/self-harm? Patients with this history can self-administer under the supervision of a nurse
Does the patient self-administer medicines at home? Patients who are not responsible for self-administering their medicines in the community will need to have their medicines administered by a nurse in the usual way
Can the patient read the labels on the medicines? These patients can either self-administer with supervision or have their medicines administered by a nurse. Referral can be made to pharmacy around assessment of labels. Can they be given extra large or Braille labels if necessary?
Can the patient open the medicine bottles and foil strips? These patients can either self-administer with supervision or have their medicines administered by a nurse. Referral can be made to pharmacy for assessment and provision of appropriate containers
Can the patient open the locker where the medicines are stored while they are in hospital? Patients who cannot open the locker can self-administer with nurse supervision
Does the patient know what their medicines are for, their dosage, instructions and potential side-effects (Shepherd 2002b)? Patients who don’t know this can be allowed to self-administer with nurse supervision. Re-education can take place in order to achieve full self-administration
Postprocedural considerations
Ongoing care
The nurse must monitor for any changes in the patient’s prescription and condition. They must check when drugs supplied are expected to run out and ensure that drugs are ordered along with any TTOs. The effectiveness of the self-administration teaching programme must be evaluated (Shepherd 2002b).
Documentation
Particular care with record keeping is needed in the period of gradual transition from nurse administration to self-administration. Any