bsc nursing 2015/2016) medicine administration workbook (year€¦ · · 2015-08-12standard for...
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School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 1
BScNURSING(Academicyear2015/2016)
MEDICINEADMINISTRATION
WORKBOOK(YEAR3)
STUDENT’SNAME: CLASS:SEP13
PERSONAL TUTOR’S NAME/SIGNATURE (Signature required for year 3 portfolio
oncethestudenthascompletedparts1,2and3ofthisworkbookbyMay2016):
………………………………………………………………………. DATE:
MENTOR(S)NAMES(S)andSIGNATURE(S):
……………………………………………………………………… DATE:
ToconfirmthatMentorisawareofthestudent’sparticipation/responsestothe
activitiesinpart3oftheworkbook.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 2
CONTENTS
Introductiontoworkbook Page2
Guidanceforstudents Page3
Year3OSCE Page4
Timeframesforcompletingtheworkbook Page5
Guidanceformentorsandpersonaltutors Page6
Learningoutcomes Page7
SECTION1 Page8
SECTION2 Page19
SECTION3 Page26
REFLECTIVESTUDY Page36
INFORMATIONSOURCES Page37
PERSONALNOTES Page38
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 3
INTRODUCTIONTOWORKBOOK
Medicinesarepowerful tools in treatment that, ifused improperly,arepotentially
dangerous. The safety and handling of medicines are of great importance to the
registerednursewhoisrequiredtobeabletoaccountforamedicinefromthetime
ofordering through to theadministration toapatient. As a senior studentnurse
youmustacknowledgethe limitsofyourdevelopingprofessionalcompetenceand
obtainhelpandsupervisionfromacompetentpractitioneruntilyouhaveacquired
your registration and the requisite knowledge and skill. The Code: Professional
standardsofpracticeandbehaviorfornursesandmidwives(NMC2015)states‘The
Code containsa seriesof statements that taken together signifywhatgoodnursing
andmidwiferypractice looks like. Itputs the interestsofpatientsand serviceusers
first, is safeandeffective,andpromotes trust throughprofessionalism.”TheCode is
relevant to all aspects of practice, including medicine administration and
management. Please familiarise yourselfwith the Code, and in particular, refer to
thespecificinformationinsection18.Additionally,re‐readtheinformationfromthe
NMCStandardsforMedicinesmanagement(2010)whichyouwereintroducedtoin
year1alongwiththeNMCcircularaboutPGDs(SEP2009)(seebelow).
NMCStandardsforMedicinesManagement(2010)
Beforeproceedingwiththeactivitieswithinthisworkbook,pleaseaccessthe‘NMC
Standard for Medicines Management’ (2010). An electronic copy (pdf) of the
StandardisavailableviatheNMCwebsite,whichyoucandownloadandsavefrom
thefollowingwebsite:http://www.nmc‐uk.org/Publications/Standards/
In theStandards sectionof theNMCwebsite there is other information regarding
the supply and/or administration of medicine by student nurses and student
midwivesinrelationtoPatientGroupDirections(PGDs).Pleasereadthecircular
(SEP09)fromtheNMCthatwasdistributedaboutPatientGroupDirections(PGDs)
in relation to the student nurse’s role in the supply/administration ofmedicines.
Student nurses cannot supply and/or administer medicines under a PGD even if
underdirectsupervision(NMC2009).PGDsarespecificwritteninstructionsforthe
supply and/or administration of a licensednamedmedicine including vaccines to
specificgroupsofpatientswhomaynotbeindividuallyidentifiedbeforepresenting
thetreatment(NMC2009).
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 4
GUIDANCEFORSTUDENTS
This workbook is organised into three sections. The fullworkbook should be
completedbytheendofApril2016.
IMPORTANTINFORMATION
● The administration of intravenous drugs is a skill which is learned by
registerednurses(i.e.Post‐registrationskill);thereforestudentnursescanonly
observethisskillinpractice.
●AlthoughtheNMC(2010)statesthatstudentnursescanbeasecondsignatory
in theadministrationof controlleddrugs, localpracticesandpoliciesvary. In
some areas, 2 registered nurses must participate in the administration of
controlleddrugs;thereforestudentnurseswouldbeathirdsignatory.
● The above points are also relevant to the administration of drugs or
controlleddrugsviasyringedriversandinfusionpumps.
When completing theactivitieswithin thisworkbookyouwill be cognisantof the
professional role and the accountability role of the nurse and the professional
guidanceprovidedbytheNMC.Togainthemaximumfromtheseactivitiesyoumust
reflect beyond the mechanics of administering medicines and other prescribed
substances to the act of identifying and minimising the risk to patients, clients,
friendsandcolleagues.
When facing professional dilemmas, a registered nurse’s first consideration in all
actsmust be the interests and safety of patients and clients. The purpose of the
theory and practice–based learning activities are to assist you towards safe and
competent practice in the administration of medicines, calculations, controlled
drugs and other prescribed substances as a registered practitioner. This will be
accomplished through your own personal investigation and self‐directed learning
andwiththeassistanceandsupportofyourmentorduringyouryear3placements.
Completionoftheactivitieswillenableyoutofurtherdevelopyourknowledgeand
skills of calculations, administering medicines, controlled drugs and other
prescribedsubstances.SpacehasbeenprovidedattheendoftheWorkbookforyou
torecordpersonalnotestosupplementyourknowledgeandskills.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 5
YEAR3OBJECTIVESTRUCTUREDCLINICALEXAMINATION(OSCE)
Inyear3,studentswillundertakeaMedicationsManagementOSCEwhichinvolves
demonstrating a safe and effective medicine administration procedure. By
completingtheactivities inthisworkbook, thiswillassistyouinpreparingforthe
OSCEandforfuturepractice.
TheMedicationmanagementOSCEallowsstudents todemonstrate theirability to
carryoutthisskillinpracticebyapplyingtheappropriateknowledgeanddecision‐
makinginaprofessionalmanner.Thiswillinclude:
Right patient – Introducing and checking the identity of the patient and
whetherthiscorrelateswiththewrittenprescription
Rightmedication; right route and form ‐ checking the prescription, the
prescribed medication and the route and form e.g. oral/tablets. Students
shouldcheckandquestionwhetherthereareanyerrorsordiscrepancieson
the prescription. Students should be knowledgeable of the common errors
that occur in medication management and how these can be identified
and/orprevented.Ifanerrorisidentified,studentsshouldbeknowledgeable
oftheappropriateactiontotake,e.g.contactanddiscusswiththeprescriber.
Rightdose – checking the prescribed dose ‐ is it accurate? Is this a usual
dose for apatient, e.g. according to their age,weight, clinicalhistory, renal
function,etc.?Studentsshoulduserelevantresourcesforthisandbeableto
find specific information in the British National Formulary (BNF) such as
side‐effects,indicationsandinteractions.
Right time – checking that the medication has not already been
administered and ensuring that the time of the prescribed medication is
satisfactory e.g. has the medication been prescribed at appropriate time
intervalsasindicatedintheBNF,e.g.6hourly?
Rightdocumentation–demonstratingthecorrectprocedureforrecording
when a medication has been administered, or not administered e.g. if the
medicationisoutofstock.
Professionalism – effectively communicating with the patient throughout
the procedure, ensuring patient comfort and safely disposing of used
equipment. Effectively communicating with the relevant multidisciplinary
team members if advice is sought regarding the prescription, medication,
etc.,e.g.pharmacist,prescriber.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 6
Ifyouhaveanyquestionsabouttheworkbook,pleaseusetheDiscussionBoard
ontheYEAR3SkillsandPracticemodulesite.
Suggestedtimeframesforcompletingtheworkbook
Sections1and2oftheworkbook
TobecompletedbyFebruary2016.
Section3oftheworkbook
TobeundertakenduringyourplacementinFebruary2016andsubmittedtoyour
LTF/personaltutorbythebeginningofMay2016.
In section 3 of the workbook, you are encouraged to record and reflect on any
significant events, e.g. personal, ethical, professional, or legal dilemmas, that have
occurred during recent or previous practice placements concerning the
administration ofmedicines, controlled drugs and other prescribed substances to
patientsandclients.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 7
GUIDANCEFORMENTORSANDPERSONALTUTORS
TheCode(2015)statesthatamentorhasadutytofacilitatestudentsofnursingto
developtheircompetence.Thisworkbookhasbeendevelopedforstudentnursesto
complete during their third year of the nursing programme (to be completed by
April 2016). The workbook aims to encourage student nurses to develop their
knowledge, understanding, experiences and competence in medicine
administration.Thisincludesdevelopingessentialskillssuchasnumeracyanddrug
calculationsinboththepracticesettingandcompletingtheenclosedactivities.Asa
mentor,weappreciateyour input tothestudents’ learningandweareaware that
questionsaboutwhatstudentscanandcan’tsooftenarise.Belowarethreeaspects
ofpracticewhichtheSchooloftenreceivesenquiriesabout.
NB. 1. Administration of intravenous drugs is apost‐registration skill, and
therefore student nurses can only observe this throughout their pre‐
registrationeducationprogramme.Thisincludesmedicinesadministeredvia
syringedriversandotherIVinfusiondevices.
NB. 2. Patient Group Directions (PGD) – the NMC (2009) circulated
information to state that student nurses cannot supply and/or administer
medicines under a PGD, even under direct supervision (see page 2 of this
workbookforfurtherinformation).
NB.3.‐Controlleddrugs–Dependingonlocalpolicy,insomeareasstudents
canbeasecondsignatory,howeverthisvariesindifferentspecialtiesand
areas(seepage3ofthisworkbookforfurtherinformation).
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 8
LEARNINGOUTCOMES
Followingcompletionofthisworkbook,thestudentwillbeableto:
1 Demonstratecompetenceindrugcalculations.
2 Criticallydiscusstheroleofthenurseinthepreventionofmedicationerrors.
3 Critically discuss the professional, legal, ethical, and safety issues
surrounding drug administration in preparation for becoming a competent
registeredpractitioner.
4 Demonstrate how to correctly locate information on medications, such as
side‐effects, interactions, indications and contra‐indications in the British
NationalFormulary(BNF).
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 9
SECTION1DRUGCALCULATIONS
Instructions
Pleasecompletethefollowingcalculationswithinsection1ofthisworkbook.Should
youhavedifficultywith these,pleasereviewdrugcalculationsbyreadingsomeof
thebooksinthelibrary,oraccessingsomeoftheresourceslistedattheendofthe
workbook.
Inadditiontothecalculationsinthisworkbook,further‘self‐directedstudy’fordrugcalculationrevisionsisavailableat:http://www.nursingnumeracy.info/
If youhave specificdifficulties inbasicnumeracy,please refer to ‘theUniversity’s
AcademicSkillsUnit:http://www.dundee.ac.uk/asc/programmes/
Section1
This section is sub divided into four parts. Part A includes general
arithmetic/mathematics,PartB involvesoraldrugadministration,PartCinvolves
drugsgivenbyinjection,andPartDinvolvesintravenousinfusioncalculations.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 10
PartA:Calculations
GoodPracticeinCalculations
Nursesneedtoachievecompetenceinnumeracyskillstoensuresafenursingpractice
(Starkings & Krause 2013). When dealing with calculations, especially complex
calculations,alwayswritethesedownfirst,andthenuseacalculatortocheck(Wright,
2011).
Thefollowingstepswillensuretheriskoferrorsisminimisedindrugcalculations:
Alwayswritedownyourcalculations
Useacalculatortocheckcalculations
Alwaysgetsomeoneelsetoindependentlycheckyourcalculation
Seekadvice,e.g.Pharmacist,fornewordifficultproblems
Takeyourtimeandavoidbeingdisturbed
Read prescriptions carefully, checking factors such as numbers, dose, always
questionabbreviationsorillegibleinformation
Make an approximate estimation as to what the answer should be before
performingthecalculationinearnest.Comparethiswiththeresult
Ifinanydoubtdonotadministerthedrug.Seekassistance
Alwaysquestionwhethertheanswermakessense,e.g.willyouhavetouselotsof
tabletsorvialstoadministerthedose?
SUGGESTEDREADING
STARKINGS,S.&KRAUSE,L.2013.Passingcalculationstestsfornursingstudents,
2ndedition.London:Sage/LearningMatters
WRIGHT,K., 2011.Drug calculations fornurses: context forpractice.Basingstoke:
PalgraveMacmillan.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 11
Multiplication
1 560x2.25=
Division
2 68.86÷100=
Fractions:writethefollowingintheirsimplestform
3 a)25/75=b)7/56=c)375/1000=
Conversions
4 a)1kilogram= grams
b)1gram = milligrams
c)1milligram= micrograms
d)1litre = millilitres
5 a)Change0.78gramstomilligrams=
b)Change294microgramstomilligrams =
6 a)Change2.4litrestomillilitres=
b)Change965millilitrestolitres=
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 12
Convert
7 a)0.055gtomg=
b)0.45gtomg=
Decimalsandpercentages
Writethefollowingasfractionsintheirsimplestform
8 a)0.125=
b)15%=
c)37½%=
d)0.02=
Divide.Calculatethevalueofeachfractiontothenearestwholenumber.
9 a)95
3 =
b)225
4 =
Multiply.Simplifywherepossible.
10 a)2x5
36 =
b)5x12
87 =
c)9x4
109 =
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 13
PartB:Oralmedication
Formula for tablets, capsules: what you want divided by what you have got
(tablets, capsules) e.g. if you want 10mg and the stock strength of the tablets is
10mg,then1tabletwouldbegiven.
Volume(amounttogive)= Strengthrequired
Stockstrength
Formula for liquidmedication: what you want divided by what you have got,
timesthevolumeoffluidthatthedrugstockstrengthisin,e.g.ifyouwant40mgand
thestockstrengthoftheliquidmedicationis20mg/ml,then2mlwouldbegiven.
Volume(amounttogive)= StrengthrequiredxVolumeoffluid
Stockstrength
1 ApatientisorderedRanitidine150mgorally.Youhave75mgtabletsinstock.
Howmanytabletsshouldyougive?
2 OralDigoxin125microgramsisordered.Youhave0.125mginstock.
Howmanytabletsshouldyougive?
3 Bearinginmindthatthenumberoftabletsgivenatanyonetimeshouldbeas
fewaspossible.Whichtabletswouldyougiveinthefollowingsituations?
a. OralWarfarin9mgisprescribed.Youhave0.5mg,1mg,2mgand5mg,
strengthsinstock.
b. OralVerapamil320mg is prescribed.Youhave40mg,80mg,120mg,
and160mgstrengthsinstock.
c. Oral Sulpiride 400mg is prescribed. You have 100mg, 200mg, and
400mgstrengthsinstock.
4 An oral medication solution contains Furosemide 10mg/ml. How many
milligramsofFurosemidearein3mlofthesolution?
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 14
5 AsolutioncontainsMorphineHydrochloride2mg/ml.Howmanymilligrams
ofMorphineHydrochloridearein7mlofthesolution?
6 A suspension contains Erythromycin 250mg/5ml.Howmanymilligramsof
Erythromycinarein20mlofthesuspension?
7 35mg Chlorpromazine Syrup has been prescribed. You have 25mg/5ml of
ChlorpromazineSyrupinstock.Whatvolumewouldyougive?
8 30mg of Fluoxetine has been prescribed. You have 20mg/5ml solution in
stock.Whatvolumewouldyougive?
9 8mgofDiazepamhasbeenprescribed.Youhave5mg/mlsolutioninstock.
Whatvolumewouldyougive?
10 ApatientisreceivingCiprofloxacinsuspension100mg.Theconcentrationof
thesuspensionis250mg/5ml.Howmanymlwillthepatientreceive?
11 Stockdiazepamis5mgtablets.Howmanywouldyouadministerifpatientis
prescribed12.5mg?
12 Morphine2.5mg isprescribed.The stock solution contains10mg/ml.What
volumewouldberequired?
13 Suspension contains phenytoin 125mg/5ml. How many milligrams of
phenytoinareinthefollowing?
a)20ml b)30ml c)40ml
14 StockBenperidol is 250micrograms. 1mg is prescribed.Howmany tablets
wouldberequired?
15 Zuclopenthixolissuppliedinthefollowingstrengths‐2mg,10mg&25mg
What combination of tablets would be required for the following
prescriptions?
a)6mg b)18mg c)37mg
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 15
16 Chlorpromazinesyrupcontains25mg/5ml.Howmanymilligramsareinthe
following?
a)10ml b)30ml c)50ml
17 Chlorpromazine syrup contains 100mg/5ml. What volume is required for
120mg?
18 Haloperidol tablets are supplied in the following strengths – 1.5mg, 5mg,
10mg & 20mg. What combination of tablets would be required for the
followingprescriptions?
a)3mg b)8mg c)11.5mg d)16.5mg e)25mg
19 Clozapinetabletsaresuppliedinthefollowingstrengths–25mg&100mg.
What combination of tablets would be required for the following
prescriptions?
a)12.5mg b)37.5mg c)150mg d)225mg e)450mg
20 ThestocksolutioncontainsFluoxetine20mg/5ml.Howmanymilligramsof
fluoxetineareinthefollowing?
a)10ml b)40ml c)25ml
21 ThestocktabletsavailableareLofepramine70mg.Howmanytabletswould
youdispensetoapatientprescribed210mg?
22 Quetiapine is supplied in the following strengths ‐ 25mg, 100mg,150mg&
200mg. What combination of tablets would be required for the following
prescriptions?
a)75mg b)450mg c)375mg d)175mg
23 StockThyroxinecontains25microgramsand50micrograms.Thepatientis
prescribed125micrograms.Whatwouldyoudispense?
24 Stock Procyclidine is 5mg tablets. What would you dispense to patient
prescribed?
a)2.5mg b)12.5mg c)15mg
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 16
PartC:Injections
1 Digoxin ampoules in the stock cupboard contain 500 micrograms in 2ml.
Whatvolumeisneededtogive350micrograms?
2 A patient is prescribed Flucloxacillin 250mg. Stock vials contain 1gram in
10mlafterdilution.Calculatethevolumerequired.
3 A patient is prescribed 6,500units of Heparin subcutaneously. Stock vials
contain5,000unitspermlHeparin.Calculatethevolumerequired.
4 Naloxone0.6mgistobegiventoapatientduringanemergency.Stockvials
contain0.4mg/2ml.Whatvolumeshouldbedrawnupforinjection?
5 Vancomycin 500mg is prescribed. Stock vials contain 1g in 10ml once
diluted.Whatvolumeisrequired?
6 Benzylpenicillin800mg isprescribed.Stockvials contain1.2g in6ml.What
volumeisrequired?
7 Atropine0.5mgisprescribed.Stockvialscontain0.6mg/ml.Whatvolumeis
required?
8 Clindamycin1.2gisprescribed.Stockvialscontain150mg/1ml.Whatvolume
isrequired?
9 Heparin1,750unitsisprescribed.Stockvialscontain1,000unitsperml.What
volumeisrequired?
10 Pethidine 60mg is prescribed. Stock vials contain 100mg in 2ml. What
volumeisrequired?
11 Haloperidol10mgisprescribed.Stockvialscontain5mg/ml.Whatvolumeis
required?
12 Zuclopenthixol acetate 50mg is prescribed. Stock vials contain 50mg/2ml.
whatvolumeisrequired?
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 17
13 IntramuscularProcyclidinehydrochlorideissuppliedin2mlampoules.Each
2ml ampoule contains a concentration of 5mg in 1ml. The patient is
prescribed5mg.Howmanymlwouldyoudrawup?
14 How many ml would you draw up for the following antipsychotic depot
injections?
Depixolcontains20mg/ml
a)10mg b)24mg c)30mg d)36mg
DepixolConc.contains100mg/ml
a)130mg b)60mg c)220mg
DepixolLowVolumecontains200mg/ml
a)160mg b)240mg c)120mg
ClopixolConc.contains500mg/ml
a)600mg b)200mg c)550mg d)450mg
Fluphenazinedecanoatecontains25mg/ml
a)12.5mg b)6.25mg c)75mg
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 18
PartD:IntravenousInfusion
Thisformulacanbeusedforcalculatingintravenousinfusionsdriprates(dropsper
minute)whenaninfusionpumpisnotavailable.Youwillneedtofindoutfromthe
infusion giving set packagehowmanydrops are equivalent to1ml.Most infusion
giving sets are designed for 20 drops perml in adult areas. Paediatric areasmay
havemoredropspermlasthedropswillbemuchsmaller,e.g.60dropsperml.
Formula:dropspermltimesvolumedividedbytimeinminutes.
Drops/mlxVolume
Timeinminutes=Dropsperminute
Example,Volume=100mlsxDropsperml=20=2000.Divide2000bythetimein
minutes that the infusion has been prescribed. Time = 1 hour (60 minutes).
Therefore2000/60=33.3,thereforethedropsperminutewillbe33drops.
1 150ml of Hartmann’s solution is prescribed to run over 6 hours. The
Microdropadministrationsetdelivers60dropspermillilitre(ml).Calculate
thedriprateindropsperminute.
2 500mlofdextrose5%isprescribedtorunover8hours.Theadministration
dripsetdelivers20dropsperml.Calculatetherateindropsperminute.
3 750ml of sodium chloride 0.9% is prescribed to run over 9 hours. The
administrationsetdelivers20dropsperml.Calculatetherate indropsper
minute.
4 1.5Lof fluid is prescribed to runover10hours.The giving set delivers20
drops/ml.Calculatetherateindropsperminute.
5 Apatientistohavetheremaining300mlofdextrose5%runthroughin50
minute.Thegivingsetdelivers20drops/ml.Calculatetherateindropsper
minute.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 19
6 Apatienthastwointravenouslinesinserted.Onelineisrunningat45ml/hr,
theotherat30ml/hr.Whatvolumeoffluidwouldthispatientreceiveina24
hourperiod?
7 At 21.00hrs on a Monday, one litre of dextrose 5% is set up to run at
50ml/hr.Whenwillthebagbefinished?
8 Apatientistoreceivehalfalitreofdextrose5%byintravenousinfusion.A
bag is set up at 08.00hrs running at 60ml/hr. After 5 hours the rate is
increased to 80 ml/hr. At what time will the intravenous infusion be
completed?
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 20
SECTION2
PREVENTINGMEDICATIONERRORS
Morethan2.5millionmedicationsareprescribedperdaytopatientsinhospitaland
thecommunity.Mostmedicationsareusedsafelyandeffectively,howevererrorscan
occur,whichcancompromisepatients’safety(NationalPatientSafetyAgency2007).
“Becausenursespredominantlyadministerdrugs,theyareoftenthelastpotential
barrierbetweenamedicationerrorandseriousharmtoapatient,withdrugerrors
frequentlyfeaturinginprofessionalmisconductcases”(Boyd2013,p7).
Activity1:Themedicationprocessgenerallyinvolvesfourstages,i.e.prescribing,
dispensing,administrationandmonitoring.Medicationerrorscanoccuratanyof
thesestages.Usingtheheadingsbelowandoverleaf,considertheroleofthenurse
inpreventingmedicationerrorsandlistthekeyreasonswhysucherrorsmayoccur
andhowthenursecanpreventthese.Youmayfinditusefultoaccessandreadone
ormoreofthereferenceslistedattheendofsection2.
Prescribingerrors:
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 21
Dispensingerrors:
Administrationerrors:
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 22
Monitoringerrors:
Activity2
UsingtheBritishNationalformulary(BNF),identifyfromthelistofextractsbelow
whetherthereareanyerrorsintheprescriptions.Ifanerrorisidentified,what
wouldyoudo?
a) John,aged50yearsisprescribedoralCefuroxime125mgtabletstwice
daily.
b) Mary,aged4yearsisprescribedNitrofurantoinoralsuspension
(concentrationis25mg/5ml).Mary’sweightisrecordedas20kg.The
prescriptionindicatesthatsheshouldbegiven60mgeverysixhours.
c) Larry,aged60yearsisprescribedNystatinoralsuspension100000units
oncedaily.
d) Jane,aged15monthsisprescribedaSalbutamolnebulizer.The
prescriptionstates‘2.5mgtobegivenasrequiredupto8timesdaily.’
e) Anne,aged68yearsisprescribedSimvastatin20mgviaintramuscular
injectiontwicedaily.
f) Tom,aged56yearsisprescribedGabapentincapsules(oral)300mgonce
dailyondayone,then300mgtwicedailyonday2,then300mg3timesa
dayondaythree.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 23
Activity3:Apossiblereasonwhyamedicationerrormayoccurisbecausesomedrug
namesaresimilar,e.g.OxycontinandOxybutynin.UsingtheBNF,lookupboththese
medicationsandlistthefollowingforeach:
Oxycontin
Indications
Cautions
Contra‐indications
Side‐effects
Doses(adultandchildren)
Routes/preparation
Oxybutynin
Indications
Cautions
Contra‐indications
Side‐effects
Doses(adultandchildren)
Routes/preparation
IfthepatientshouldhavebeenprescribedOxybutynin,butwasmistakenly
prescribedOxycontin,whatmighttheconsequencesbeforthepatient?
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 24
Activity4:Abbreviationsonprescriptionsmayleadtomedicationerrors(Boyd
2013).Belowisalistofabbreviationsthatrelatetoroutesofadministration.
ITH;SC;IV;IM:O;INH;NEB:TOP;INTERDERM.
Whatdoeseachoftheseabbreviationsmean?
Whymighttheseabbreviationsleadtomedicationerrors?
Activity5:AccessinginformationintheBNF
WhileitmayseemstraightforwardtoaccessinformationintheBNF,somestudents
havehaddifficultyfindingspecificinformationinthepaper‐basedcopies.Although
anelectronicversionisavailableonline,ingeneral,thepaper‐basedversionisused
inclinicalareas.Partoftheyear3OSCEinvolveslookingupspecificinformationfor
patientsonaspectssuchassideeffects,indicationsandinteractionsbetween
differentmedicines,thereforeitisimportanttopracticethisskill.Pleasewatchthis
shortvideocliphttps://www.youtube.com/watch?v=cW60Em0AKiAandthen
answerthequestionsbelow.
1. Whatarethedrugslistedinsection5usedtotreat?
2. What does a black triangle symbol mean when it is next to a drug
name?
3. Name3commondrugsthatWarfarininteractswith?
4. What does the black dot mean when it is next to a drug in the
interactionssection?
5. LookupCo‐Amoxiclav –what type ofmedication is this andwhat is
usedfor?
6. Name3mainsideeffectsofCo‐Amoxiclav.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 25
7. Look up the cautions, contraindications and side effects of
Amitriptyline Hydrochloride. What does the statement “see notes
above”mean?
8. LookupSalbutamol–whatdifferentways(forms)areavailabletogive
thismedication?Arethedosesthesameregardlessoftheform?
9. Whatdoesthe‘Cautions’sectionmeanintheBNF?
10. WhatcounsellinginstructionsaregivenaboutAcarbose?
References:
Boyd,C.,2013.Medicinemanagementskillsfornurses:studentsurvivalskills.West
Sussex:Wiley‐Blackwell.
NationalPatientSafetyAgency.2007.Safetyindoses:improvingtheuseof
medicationsintheNHS.
http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=60117&..
(accessed091013).
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 26
SECTION3
Readthefollowingscenariosandanswertheaccompanyingquestions.
SCENARIO1
Wilfred is an 85 year old resident of a nursing home. He has dementia. He has
developed a chest infection and has become toxic and confused, refusing his
antibiotics.Thenursesfearthatwithouttheantibioticshewillnotsurvivethenight.
He has no family and there is no access to immediate medical or psychiatric
assessment.Theyareprettysurethathewilldrinkacupoftea.
ShouldthenursesputtheantibioticsintoWilfred’stea?
Please discuss this fully taking into consideration the professional, legal,
ethicalandsafetyissuespertinenttothissituation.
SCENARIO2
JohnandMaryhavebeenmarried for20years.Maryhasapsychiatric illnessbut
does not like taking her medication, so John disguises it by putting it into her
pudding each day. As a result hermood and behaviour have stabilised. She now
believes that she is better andwhen the community psychiatric nurse visits, she
refusestreatment.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 27
ShouldthenurseconsiderhavingMarysectioned–orcolludewithJohnsoshe
canstayathome?
Please discuss this fully taking into consideration the professional, legal,
ethicalandsafetyissuespertinenttothissituation.
SCENARIO3
Ethelaged64hasbeendischargedfromhospitalfollowingapulmonaryembolus.
HeronlydrugondischargewasWarfarin–shewasgivena7dayssupplyof1mg,
3mg,5mgtablets.Dailybloodsinthewarddictatedthedosefortheday.
WhatinformationdoesEthelneedtoknowbeforesheisdischargedtoensure
shecantakehermedicationsafely?
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 28
YouvisitEthelthedayfollowingdischargetoassesshowsheismanaging.Shetells
youshehadabitofastomachupsetandaheadacheandhasbeen taking “Alka–
Seltzar” four timesaday forherstomachupsetand“Anadin” four timesaday for
herheadache.SheboughtboththeseprescriptionsfromTesco.
Whatarethesignificantingredientsinthesepreparations?
Alka–Seltzar–
Anadin–
ArethesemedicationssafetotakewithherWarfarin?
SCENARIO4
Robertisan83yearoldwholivesaloneathome.Hehasrecentlybeendischarged
from the local hospital with the followingmedication for atrial fibrillation, heart
failureandahiatushernia:
Digoxin250micrograms,oncedaily
Furosemide40mg,oncedaily
Omeprazole20mg,oncedaily
Hewas fit andwell when first discharged but over the past 3weeks he has lost
weight,feelsnauseatedandisnotkeentodrink.Hishome–careworkerhasensured
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 29
that he has had hismedication but is nowworriedbecausehe is looking terrible
today.
When youvisit you findhim inbed. He is frail, has poor skin turgor and is very
drowsy.Hisfamilyhavegatheredroundastheythinkheisabouttodie.
WhatarethesideeffectsofthemedicationRobertistaking?
Digoxin–
Omeprazole–
Furosemide–
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 30
Shouldhome–careworkersbegiventheresponsibilityofensuringpatients
taketheirmedication?
Howdonursesmonitorpatientsfordigoxintoxicity?
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 31
SCENARIO5
MrsDaleyhasbeeninhospitalfor5daysandislookingforwardtoavisitfromher
twograndchildrenaged5and7years.AftertheirvisitMrsDaleyurgentlysummons
the nurses to report that the 2 “painkillers” in the pot on her locker have gone
missing and that she is extremely worried that one of her grandchildren has
swallowedthem.
1. Whatareyourviewsonthissituation?
2. Explaintheimplicationsfor:
i. patients
ii. registerednurses
iii.studentnurses
iv. doctors
v. pharmacists
vi. relatives/visitors
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 32
SCENARIO6
Staff Nurse Care arrives on duty late to discover that she is the only 1st level
registerednurseondutywith2ndlevelregisterednurses,studentnursesandhealth
care assistants. To catch up with the outstanding patient care she decides to
completethe08.00and10.00o’clockmedicineroundstogether.Sheasksa3rdyear
studenttoassistheranda1styearstudenttoactasa“runner”betweenthemand
thepatient.
The medicine round is completed by 09.45 hr and, after discussion with the
students, StaffNurseCaredecides this shouldbecome standardpractice for these
two daily medicine rounds as they always occur at a busy time and are never
completedontime.
1. Whatareyourviewsonthissituation?
2. Explaintheimplicationsfor:
i. patients
ii. registerednurses
iii.studentnurses
iv. doctors
v. pharmacists
vi. relatives/visitors
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 33
SCENARIO7
ThedoctorhasprescribedAmoxycillincapsules500milligrams,peroralroute,three
timesdailyat0800hrs1200hrsand1800hrs.
The followingdayhe changes theprescription times to0800hrs1400hours and
2000hours,howeverheonlyputsacrossthroughthe1200hrsand1800hrstimes
and ticks off the new times of 1400 hrs and 2000 hrs. The doctor initials these
changes.
Whyisthisnotanacceptableprescriptionandwhatneedstobedonebefore
thenurseadministersthepatient’snextdose?
SCENARIO8
YouaretheStaffNurse inchargeoftheward.Thenursewhoisadministeringthe
medicinesreports toyouthatshehasgiventhewrongmedicationtoaclientwho
hasasimilarnameastheclientwhoshouldhavereceivedthemedication.
Discusswhatyouwoulddo.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 34
SCENARIO9
Aclientinformsyouthatwhilstinthetoilethewitnessedanotherclientspittingout
theirmedicationdownthesink.
AstheStaffNurseinchargeofthewarddiscusswhatyouwoulddo.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 35
SCENARIO10
Dillon is a 3 year old boy who is requiring treatment for an infected insect bite
(cellulitis)onhisright forearm.Heisbeingtreatedasaninpatient.3daysintohis
treatment there is no change in the distribution of the cellulitis. The nurses are
havinggreatdifficultyinadministeringthedrugsorallyandconsiderthatheisnot
receivingallofthemedication.Dillonweighs17kg.
Dillonisreceivingthefollowingmedication:
Flucloxacillin 125mg liquidoral 4timesperday
Phenoxymethylpenicillin 125mg liquidoral 4timesperday
Howimportantisdocumentationinthiscase?
ArethedosescorrectforDillon’sweight?
WhatvolumeofliquidofeachdrugwillDillonreceive?
When and how should oral Phenoxymethylpenicillin and Flucloxacillin be
administeredtogainmaximumbenefitfromthedrug?
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 36
SCENARIO11
Emmaisa4yearoldgirlwhohasCysticFibrosis.Emmaliveswithbothparentsand
hermotheris6weekspregnant.Shehasnoothersiblings.Emmahasbeenadmitted
intohospitalforthetreatmentofherfirstchestinfection.Thishasrequiredstarting
many new treatments some of which her parents are unfamiliar with including
intravenousandinhaledantibiotics.
Please consider the following prescription and apply the principles of
accountabilitytoprescribingpractice.
InhaledColistin1millionunits(MU)tobeadministeredat0800and2000hrs.
IsthisthecorrectdosageofthedrugfortheageofEmma?
IsthisthecorrectdosageofthedrugfortheageofEmma?
Is this medication licensed for use in children? Can you discuss the
implicationsifadrugisnotlicensedforuseinchildren?
Identifytheprecautions,informationandequipmentrequiredforthecorrect
administration of inhaled Colistin at home and does this differ from
administrationinhospital?
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 37
SCENARIO12
You are the nurse holding the drug cupboard keys, one of your colleagues
approachesyouandasksforthedrugkeysasshehasa“splittingheadache”andis
goingtotakesomeparacetamolfromthecupboard.
Isthisacceptable?
Ifyouthinkthisisnotacceptable,considerthereasonswhy.
Whatwouldyoudointhissituation?
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 38
REFLECTIVESTUDY
Toenableyoutoreflectcriticallyonyourinvolvementinmedicineadministrationit
isnecessary foryoutorecordan incident inwhichyouhavebeen involved.Usea
modelofreflectiontohelpstructureyourreflection,e.g.Marks‐MaranandRose.
Instructions
1 Selectarecentexperienceinwhichyouwereinvolvedintheadministrationof
anewmedicationoramedicationthatyouarenotfamiliarwith.Thiscanbean
oralmedicationoraninjection.
2 Describe the selected experience including the checking of the prescription,
route of administration used, the name of the medication, the dose of the
medication,thetimeofadministration,andyourroleinthesequenceofevents
fromidentifyingthemedicationtocompletionoftheadministration.
3 What were your thoughts and feelings regarding the administration of this
medication?
4 Howdoyouthinkthepatientfelttaking/receivingthismedication?
5 Wasacalculationrequiredbeforethemedicationwasadministered?Ifso,was
thisstraightforwardorcomplex?
6 Was the medication administration procedure straightforward, e.g. were all
the steps carried out according to the NMC Standards for Medicines
Management?
7 Werethereanypossibleissues,e.g.professionalorethical?
8 Describethelearningthathastakenplacefromthisactivitywhichyouwillbe
abletouseinfuturemedicineadministration.
Pleaseenterthisreflectivesummaryintoyouryear3Portfolio.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 39
INFORMATIONSOURCES
BAXTERHEALTHCARE.,2009.Goodpracticefordrugcalculations.
http://www.baxterhealthcare.co.uk/downloads/healthcare_professionals/therapie
s/pharmacy_services/ps_calc_guide.pdf(accessed160913)
BOYD,C.,2013.Medicinemanagementskillsfornurses:studentsurvivalskills.
WestSussex:Wiley‐Blackwell.
DOUGHERTY,L.andLISTER,S.E.,eds.2015.TheRoyalMarsdenHospitalmanual
ofclinicalnursingprocedures.9thed.Oxford:Blackwell.
HAMBRIDGE, K., 2011. Needlestick and sharps injuries in the nursing student
population.NursingStandard,25(27),pp.38–45.
NATIONALPATIENTSAFETYAGENCY.2007.Safetyindoses:improvingtheuseof
medicationsintheNHS.
http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=60117&..
(accessed09/10/13).NURSINGANDMIDWIFERYCOUNCIL,2010.StandardsforMedicinesManagementhttp://www.nmc‐uk.org/Publications/Standards/
NURSING AND MIDWIFERY COUNCIL, 2015.
http://www.nmc.org.uk/standards/code/
NURSINGANDMIDWIFERYCOUNCIL,2009.Guidanceonprofessional conduct for
studentsofnursingandmidwifery.London:NMC.
http://www.nmc‐uk.org/Documents/Guidance/NMC‐Guidance‐on‐professional‐
conduct‐for‐nursing‐and‐midwifery‐students.PDF
STARKINGS,S.&KRAUSE,L.2013.Passingcalculationstestsfornursingstudents,
2ndedition.London:Sage/LearningMatters.
WRIGHT,K., 2011.Drug calculations fornurses: context forpractice.Basingstoke:
PalgraveMacmillan.
School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 40
PERSONALNOTES