The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [537]
Ensure that in other clinical areas, storage and use of high-strength midazolam are replaced with low-strength midazolam (1 mg/mL in 2 mL or 5 mL ampoules).
Review therapeutic protocols to ensure that guidance on use of midazolam is clear and that the risks, particularly for the elderly or frail, are fully assessed.
Ensure that all healthcare practitioners involved directly or participating in sedation techniques have the necessary knowledge, skills and competences.
Ensure that stocks of flumazenil are available where midazolam is used and that the use of flumazenil is regularly audited as a marker of excessive dosing of midazolam.
Ensure that sedation is covered by organizational policy and that overall responsibility is assigned to a senior clinician which, in most cases, will be an anaesthetist.
(NPSA 2008b)
Procedure guideline 13.2 Medication: controlled drug administration
Essential equipment
Prescription chart
Controlled drug record book
Appropriate medication container, for example medicine pot or syringe
Preprocedure
Action Rationale
1 Consult the patient’s prescription chart, checking the name, date of birth, hospital number, allergy status and then ascertain the following: To ensure that the patient is given the correct drug, in the correct formulation, in the prescribed dose using the appropriate diluent and by the correct route (DH 2003b, C; NMC 2008a, C).
(a) Drug name (generic)
(b) Dose
(c) Date and time of administration
(d) Frequency
(e) Route and method of administration
(f) Formulation of oral preparation, e.g. modified release, immediate release To ensure the correct formulation is given as many different formulations are available for the same drug. E
(g) Diluent as appropriate
(h) Validity of prescription Ensure prescription is legal (DH 2003b, C).
(i) Legible signature and contact details of prescriber. To ensure prescription is legal and complies with hospital policy (DH 2003b, C).
(j) Check when the drug was last administered. To ensure that the patient requires the drug at this time. E
Procedure
2 With the second Registered Nurse, take the keys and open the controlled drug cupboard. Take the ward controlled drug record book that contains the prescribed controlled drug and turn to the relevant page headed with the name and strength of the controlled drug. To be able to check the stock and to enter the details into the controlled drug record book (DH 2003b, C).
3 With the second Registered Nurse, select the correct drug from the controlled drug cupboard. To comply with hospital policy and to ensure patient receives the correct medicine (DH 2003b, C; NMC 2008a, C; NPSA 2006, C).
4 With the second Registered Nurse, check the stock level against the last entry in the ward record book. To comply with hospital policy (DH 2003b, C; NMC 2008a, C; NPSA 2006, C).
5 With the second Registered Nurse, check the appropriate dose and concentration/strength (e.g. 10 mg in 1 mL or 5 mg in 5 mL) and formulation against the prescription chart and remove the dose from the box/bottle and place into an appropriate container, e.g. medicine pot or syringe. To comply with hospital policy and to ensure patient receives the correct dose and strength of medicine (DH 2003b, C; NMC 2008a, C; NPSA 2006, C).
6 Return the remaining stock to the cupboard and lock the cupboard. To comply with hospital policy (DH 2003b, C; NMC 2008a, C; NPSA 2006, C).
7 Enter the date, dose, new stock level and the patient’s name in the ward record book, ensuring that both you and the second Registered Nurse sign the entry.
NB: May require entry into different sections if the dose is to be made up of different doses, e.g. 70 mg = 1 × 50 mg and 2 × 10 mg). If any is wasted then ensure it is documented correctly, e.g. 5 mg given and 5 mg wasted. To comply with hospital policy (DH 2003b, C; NMC 2008a, C; NPSA