Clinical
Assessing Competency for Medicines Administration: SOP
Document Control Summary
Status: New
Version: v1.0 Date: 08.12.15
Author/Owner/Title: Cathy Riley - Director of Pharmacy
Approved by: Policy and Procedures Committee Date:
Ratified: Date:
Related Trust Strategy and/or Strategic Aims
Medicines Optimisation Strategy 2013-2018: Making the Most of Medicines
Implementation Date: February 2016
Review Date: December 2018
Key Words: Medicines, Administration, Assessing, Competency, Assessment
Associated Policy or Standard Operating Procedures
Administration of Medicines in the Community Setting SOP Administration of Medicines in the In-Patient Setting SOPMedicines Code
Contents
1. Introduction .............................................................................................................. 3
2. Purpose ..................................................................................................................... 3
3. Scope ........................................................................................................................ 3
4. Body Text .................................................................................................................. 3
5. Process For Monitoring Compliance And Effectiveness ....................................... 4
6. References ................................................................................................................ 4
Appendix 1a ..........................................................................................................................5
Appendix 1b………………………………………………………………………………..18
Appendix 2 ........................................................................................................................ 26
18.02.16
18.02.16Policy and Procedures Committee
SOP: Assessing Competency for Medicines Administration, Dec 2015
Change Control – Amendment History
Version Dates Amendments
v1.0 Dec 15 SOP created from existing Medicines Code V6.10
SOP: Assessing Competency for Medicines Administration, Dec 2015
1. Introduction
This SOP is needed to ensure those who are required to administer medicines to
service users are competent to do so.
2. Purpose The Assigned Practitioner in Charge is responsible for ensuring that prescribed medicines are administered within a reasonable time, plus or minus one hour either side of the prescribed time, with regard to the efficacy of the medication, and possible risk regarding overdose.
3. Scope
Medicines must only be prepared, checked or administered to a patient by the
following categories of healthcare staff:
A Designated Practitioner
A Medical Practitioner
Authorised Pharmacy Staff
A practitioner in training, but only under the direct supervision of a Designated Practitioner.
Other Authorised Employees (e.g. Learning Disabilities)
4. Procedure
1. The Trust has developed a Competency Framework for Medicines Administration (Appendix 1). Each qualified nurse involved in administering medicines will be competency assessed:
Annually as part of appraisal process
After a medicines administration error
On local induction to each clinical area
2. Assessment will normally be conducted by the senior nurse in each clinical area, or in the cases of ward managers, by the service manager (if a nurse) or a senior nurse from the Nursing directorate. There are two competency assessments templates: for in-patient and community services respectively. If a nurse works in both settings, then both competency assessments need completing (with duplicate sections omitted as advised on the assessment). All applicable parts of the competency framework require completion for annual appraisal and during local induction.
3. After a medicines administration error, the assessor should use his/her professional judgement to identify the pertinent parts of the competency assessment framework which require completion; it will not always be necessary to complete the whole assessment. Decision to only complete parts of the competency framework should be made by the ward manager, hospital co-ordinator (duty nurse manager), modern matron or a senior nurse from the Nursing directorate; the nurse assessor should ensure that the nurse’s medicines administration competency assessment was already in date, when making this
SOP: Assessing Competency for Medicines Administration, Dec 2015
judgement (if not, the whole framework will require assessment), and take due account of any recent history of medicines administration errors. The assessor should also identify whether the medicines error also requires competency assessment of any unregistered healthcare worker providing the second check (again professional judgement is allowed to identify the relevant parts of the framework to be assessed). In all cases, incident forms should be completed, and a file note placed on each individual staff member’ file to record action taken and the outcome.
4. The second check provided by an unregistered healthcare worker
provides additional governance around medicines administration. A
competency framework is also developed for the second check function
(see Appendix 2).
5. Process For Monitoring Compliance And Effectiveness
Annual Audit
Administration error monitoring
6. References
Medicines Code
SOP: Assessing Competency for Medicines Administration, Dec 2015
Appendix 1a - Medicines Administration Competency Framework In-patient
Name:
Date:
Designation:
Name of assessor:
Date:
Designation:
Comments:
Purpose of assessment: To assure the quality and safety of medication administration by a qualified practitioner in conjunction with standards for better health; core standards C1A, C4d, D2d, Governance D4, C11 and NPSA competence assessments. The practitioner undergoing assessment will demonstrate by practical methods a comprehensive understanding of the administration of medicines. The assessment will be completed using the following criteria:
− Completion of ward medicine round
− Administration of an intra- muscular injection − For preceptorship staff nurses over three occasions within eight
weeks of registration − For qualified nursing staff annually as part of the individual appraisal
process
− Following a medication error if deemed appropriate by the manage
SOP: Assessing Competency for Medicines Administration, Dec 2015
Prior to assessment it is the individual’s responsibility to familiarise themselves with the documents listed below prior to the assessment commencing.
Please date and sign to Assessor – Please date indicate you are familiar and sign to indicate the with the following trust individual undergoing and professional assessment is able to documents locate the documents
NMC Guidelines for the
Management of
Medicines 2007
Mental Capacity Act
British National
Formulary
Rapid Tranquillisation
Policy
IM administration
Guidelines
Oral administration
guidelines
Standard precautions
and equipment policy for
the control and
prevention of infection
The practitioner undergoing assessment will demonstrate by practical methods comprehension of the administration of medicines via oral and intra-muscular routes.
The Following criteria will be used; A Yes No COMMENTS
Confirm the Validity of the 1. Prescription;
Assure the Identity of the patient is following Trust policy, checking that the patient understands the treatment being given and consents where appropriate.
Assure all detention papers are in
SOP: Assessing Competency for Medicines Administration, Dec 2015
A Yes No COMMENTS
date and accurate
Recorded drug allergies and confirmation of such with the
patient
Assure the prescription is legible
Confirm Start date
Confirm stop date
Confirm drug dosage and strength
Confirm administration route prescribed
Prescribers signature
Specific/other instructions
Assure knowledge of safe storage
and handling of medication , I.E
security of medication, stock
ordering, rotation
2. Assure the Preparation of the dose for
oral administration, in accordance with
the guidelines for oral administration of
medication and calculate doses
accordingly
3. Assure Preparation of the dose for intra-
muscular administration in accordance
with the guidelines for IM administration
of medication
4. Assure Cross checking / double checking
of medication against prescription as per
medicines code 5. Identify Actions to be taken if the
prescription is illegible or invalid 6. Assure evidence of cross checking as
required medication, with the regular prescription, not exceeding daily dose
7. Assure the correct amount of prescribed medication has been placed in the container/ syringe
8. Demonstrate knowledge of SOP for own area for controlled drugs, Trust procedure for administration, storage, loans, wastage, and checks as per medicines code.
SOP: Assessing Competency for Medicines Administration, Dec 2015
B. Following Yes No COMMENTS administration of the
medication, the
practitioner will: 1. Ensure that the patient
has taken the drug 2. For Intra- Muscular
administration evidence that the administration site is observed for immediate adverse effects
3. Sign the medication chart in the appropriate section
4. Note the time and dose given on administration on the prescription chart if a variable dose or I/M has been prescribed
5. Demonstrate accurate / appropriate recording of medication administration on the card and within health records
6. Demonstrate accurate recording following administration of a drug under a PGD
7. Monitor the patient for any side effects and document in health records
The individual undergoing assessment will demonstrate by verbal method knowledge of medication from a current treatment card, containing at least 5 medications one of which will be administered via the intra- muscular route if applicable;
The following criteria will be used:
C. Yes NO COMMENTS 1. Brand name 2. Approved name
SOP: Assessing Competency for Medicines Administration, Dec 2015
3. Drug group 4. Drug usage
- What condition(s) is the drug prescribed for?
5. Indications - What is the drug being used for?
6. Side effects
7. Contra-indications 8. Dosage range
- oral/intramuscular
Signs of, and treatment of: Yes NO COMMENTS 9. Extrapyramidal side effects
10. Neuroleptic Malignant Syndrome 11. Overdose/self-poisoning 12. Dependency/withdrawal
Drug specific: Yes No COMMENTS
13. Dietary needs for MAOI’s
14. Blood monitoring:
Clozaril
Lithium
Anticonvulsants
15. Insulin
16. Controlled drugs
Other Yes No COMMENTS
SOP: Assessing Competency for Medicines Administration, Dec 2015
D) The practitioner undergoing the assessment (if applicable to the clinical area) will demonstrate by verbal method knowledge and understanding of rapid tranquillisation, its implementation, risks and associated benefits D1 What are the aims of rapid
tranquillisation?
D2 When should the use of
I/M administration be considered?
D3 What are the 3 main
agents associated for use within rapid tranquilisation?
D4 What is the suggested
scheme of monitoring for a patient following parenteral administration of medication following Rapid tranquilisation?
SOP: Assessing Competency for Medicines Administration, Dec 2015
E) Drug Calculations- answer all of the questions
Formulation- What you need X What you’ve got
What it’s in
Show your calculations Write your answer in the box
Calculations are provided at the competency assessment, and will change at
each session
SOP: Assessing Competency for Medicines Administration, Dec 2015
Additional Comments
______________________ _______________ _______________________________ Name Date Signature
______________________ _______________ _______________________________ Name of assessor Date Signature A copy of this document must be retained in the Individual’s personnel file
SOP: Assessing Competency for Medicines Administration, Dec 2015
Medicines Competency Framework
Procedural Note
Purpose of the Assessment:
This assessment framework aims to ensure both the quality and safety of
medicines administration by all first level registered nurses working within South
Staffordshire and Shropshire NHS Foundation Trust continues. The framework
has been developed in conjunction with Standards for Better Health Document
and links directly to the following core standards: C1A, C4D, D2D, Governance
D4, C11 and the National Patient Safety Agency (NPSA) Competency
Assessments.
By undertaking the assessment the practitioner will demonstrate, by practical application, a comprehensive understanding of the administration of medicines.
Frequency of the Assessment: This assessment must be conducted annually for all registered nurses and must
form part of each registered nurses annual appraisal. Where a medicine error
has occurred within the clinical practice setting a re assessment must be carried
out within a timely manner. The assessment must also be conducted when a
registered nurse is inducted in to a new clinical environment. Where an
assessment has been conducted following a medicine error or induction, it does
not need to be completed for a further year unless the manager considers this to
be necessary.
Prior to Conducting the Assessment: Prior to the assessment being conducted the assessor will discuss the assessment purpose with the individual undergoing assessment. This will be documented within the individuals Clinical Supervision records and should form part of the individuals Annual Appraisal. This will ensure that the individual is clear about the rationale for the assessment being undertaken. It is the responsibility of the assessor to provide the individual with a copy of the
Medicines Competency Assessment Document prior to the assessment being
SOP: Assessing Competency for Medicines Administration, Dec 2015
conducted. This must exclude any Drug Calculation questions. Drug calculation
questions are an unseen component of the assessment and therefore must only
be issued during the assessment and marked by the assessor at the end of the
assessment process.
It is the individuals’ responsibility to ensure that they are familiar with all of the
documents outlined within the Competency Framework prior to the assessment.
Whilst some clinical areas hold paper copies of Trust policies and procedures,
the most up to date copies are always accessible on the Trusts intranet. It is
reasonable therefore to expect the individual to demonstrate competency in
accessing these documents electronically.
Assessment Process: The assessment should form part of the individuals’ daily clinical practices, and
should take place in their own clinical area. There may be occasion’s where
particular components of the assessment cannot be carried out in the individuals
area of practice e.g. administration of a depot injection. Where it is deemed
necessary and appropriate for the individual to be assessed as competent in this
SOP: Assessing Competency for Medicines Administration, Dec 2015
area, there will need to be a process of negotiation for this part of the
assessment to be assessed in another clinical area within the Trust.
Through negotiation the assessor and the individual undergoing assessment will
select which medicines round they will be assessed on.
Whilst conducting the assessment the assessor must be confident that the
individual is practicing in a safe and competent manner, in line with Trust
Medicines Code (C/YEL/MM/03) and with due regard for Nursing and Midwifery
Council Standards for Medicines Administration (NMC, 2007).
Where and individual is deemed as demonstrating unsafe practice at any time
during the practical assessment the assessor must stop the assessment
immediately to ensure that the highest level of client and staff safety is
maintained. Where an assessment is stopped the assessor must inform the
individual of the reasons for this. This will result in the individual being awarded a
fail for their assessment and they will not be allowed to administer or witness any
further medicines administration within any clinical area.
Where an incident of this type occurs further advice should be sought from Cathy
Riley (Chief Pharmacist) or Michelle Lycett-Smith (Non-Medical Prescribing Lead).
This action will need to be documented in the individuals Supervision Record. This
will allow further CPD needs to be explored.
Drug Calculations: This component of the assessment is unseen prior to the assessment being
conducted. The assessor must provide Drug Calculation questions only at the
time of the assessment. It is acceptable for the individual to use a calculator and
SOP: Assessing Competency for Medicines Administration, Dec 2015
they must show their mathematical workings out on the assessment document.
The most recent BNF should also be made available for the individual to use as a
resource should they require it.
It is expected that a score of 100% should be achieved with the Drug
Calculations. Where a score below 100% is achieved this will be deemed as a
fail and the individual will not be allowed to administer or witness any further
medicines administration within any clinical setting.
Where an incident of this type occurs further advice should be sought from Cathy
Riley (Chief Pharmacist) or Michelle Lycett-Smith (Non-Medical Prescribing Lead).
This action will need to be documented in the individuals Supervision Record. This
will allow the further CPD needs to be explored.
Successful Completion: Following successful completion of Medicines Administration Competency, the
assessor will inform the individual of the outcome. Where this has formed part of
an annual assessment a record of successful completion will be made in the
individual’s annual appraisal document.
Where successful completion has occurred following a medicine error the
individual will be allowed to administer and/or witness medicines administration in
line with Trust Policy and Procedure. An entry of successful completion of the
assessment must be made in the individuals Clinical Supervision record.
Nurses Employed to Work Across In-patient and Community Settings:
The in-patient competency framework will be the key assessment undertaken, but in addition the community competency assessment framework will also be
SOP: Assessing Competency for Medicines Administration, Dec 2015
undertaken (using the community card and authorised documents relating to medicines), with omission of any duplicated sections on the community assessment:
if depot administration has already been assessed as part of the in-patient
assessment, criteria A12, A14, A15, A16, A17, A18 A19 may be omitted
from the community assessment with “refer to in-patient assessment”
recorded
criteria C1-C4 and criteria D17 & D18 may be omitted from the community
assessment with “refer to in-patient assessment” recorded
Criteria E (drug calculations) may be omitted from the community
assessment with “refer to in-patient assessment” recorded
Reference:
Medicines Code: Policies and Procedures to Manage the Clinical Risks Associated with the use of Medicines. (C/YEL/mm/03).November 2007.
Nursing and Midwifery Council (2007). Standards for Medicines Management. London, NMC.
SOP: Assessing Competency for Medicines Administration, Dec 2015
Appendix 1b- Medicines Administration Competency Framework Community Practitioners
Name: Date: Designation: Name of assessor: Date: Designation:
Comments:
Purpose of assessment:
To assure the quality and safety of medication administration by a qualified practitioner in conjunction with standards for better health; core standards C1A, C4d.
D2d, Governance D4, C11 and NPSA competence assessments. The practitioner undergoing assessment will demonstrate by practical methods a comprehensive understanding of the administration of medicines. The assessment will be completed using the following criteria:
Administration of an intra-muscular injection where possible For preceptorship staff nurses over three occasions within eight weeks of registration For qualified nursing staff annually as part of the individual appraisal process
Following a medication error The supply and/or administration of a patient group direction.
SOP: Assessing Competency for Medicines Administration, Dec 2015
Prior to assessment it is the individual's responsibility to familiarise themselves with the documents listed below prior to the assessment commencing.
Please date and sign to Assessor - Please date and indicate you are familiar sign to indicate the with the following trust individual undergoing and professional assessment is able to documents locate the documents
Medicines Code
NMC Guidelines for the
Management of Medicines
(2010)
Mental Capacity Act
British National Formulary
IM administration
Guidelines
PGD administration
guidelines
Standard precautions and
equipment policy for the
control and prevention of
infection
The practitioner undergoing assessment will demonstrate by practical methods a comprehensive understanding of the administration of medicines via intra-muscular routes and/or the supply and/or administration of oral medicines via a patient Group Direction (PGD)
SOP: Assessing Competency for Medicines Administration, Dec 2015
The following criteria will be used to assess competence for the administration of a depot injection:
A. Confirm the validity of the prescription:
Yes No COMMENTS
1. Assure the identity of the patient is established
following Trust policy, checking that the patient
understands the treatment being given and consents
where appropriate.
2. Where relevant assure all detention papers are in date
and accurate.
3. Confirms recorded drug allergies, sensitivities with the
client.
4. Assure the prescription is legible.
5. Confirm start date.
6. Confirm stop date.
7. Confirm drug dosage and strength.
8. Confirm administration route prescribed.
9. Prescriber’s signature.
10. Specific/other instructions.
11. Assure knowledge of safe storage, handling and
transporting of medication, stock ordering, stock
rotation and destruction of medicines.
12. Assure preparation of the dose for intra-muscular
administration in accordance with the guidelines for IM
administration of medication.
13. Assure cross checking/double checking of medication
against prescription as per medicines code prior to
leaving base.
14. Identify actions to be taken if the prescription is illegible
or invalid.
15. Assure the correct amount of prescribed medication
has been placed in the syringe.
SOP: Assessing Competency for Medicines Administration, Dec 2015
Following administration of depot
medication, the practitioner will: Yes No COMMENTS
16. For intra-muscular administration evidence
that the administration site is observed for
immediate adverse effects.
17. Sign the medication chart in the appropriate
section.
18. Demonstrate accurate/appropriate recording
of time and date of medication
administration on the card and within health
records.
19. Monitor the patient for any side effects and
document in health records.
B. The following criteria will be used to assess
competence for the supply and/or Yes No COMMENTS administration of a PGD: 1. Assures the identity of the patient following
Trust policy, checking that the patient understands the treatment being given and consents where appropriate.
2. Has considered the use of non-pharmacological approaches before using a PGD.
3. Assures that the PGD chosen is in date and operational.
4. Makes an accurate assessment of the patient checks and adheres to all information included in the PGD, with particular attention to all inclusive and exclusive criteria.
5. Assures double checking of medication as per medicine code.
6. Assures the correct amount of prescribed medicine is supplied and/or administered.
7. Demonstrates knowledge of the Trust procedure for administration, storage, waste and checks as per medicine code. Following administration of the
medication: Yes No COMMENTS 8. Ensure the patient has taken the drug.
9. Sign the medication chart in the appropriate
section. 10. Note the time and dose and PGD No. on
the medicine card.
SOP: Assessing Competency for Medicines Administration, Dec 2015
11. Demonstrate accurate/appropriate
recording of medication administration in the client’s health records.
12. Monitor the client for any side effects and
document in their health records.
C.
Signs of, and treatment of: Yes No COMMENTS
1. Extrapyramidal side effects.
2. Neuroleptic malignant syndrome.
3. Overdose/self-poisoning.
4. Dependency/withdrawal.
SOP: Assessing Competency for Medicines Administration, Dec 2015
D) The individual undergoing assessment will demonstrate by verbal method knowledge of one medication from a current treatment card, being administered via the intra-muscular route if applicable; and one medication available for administration and/or supply via a PGD.
D. Yes
No
COMMENTS
The following criteria will be used:
1. Brand name
2. Approved name
3. Drug group
4. Drug usage:
What condition(s) is the drug
licensed?
5. Indications:
What is the drug being used for?
6. Side effects.
7. Contra-indications
8. Dosage range:
Oral/intramuscular
The following criteria will be used: Yes No COMMENTS
9. Brand name
10. Approved name
11. Drug group
12. Drug usage:
What condition(s) is the drug
licensed?
13. Indications:
What is the drug being used for?
14. Side effects
15. Contra-indications
16. Dosage range:
Oral/intramuscular
Drug specific: Yes No COMMENTS
SOP: Assessing Competency for
Medicines Administration, Dec 2015
17. Dietary needs for MAOI’s
18. Blood monitoring: Clozaril Lithium
SOP: Assessing Competency for Medicines Administration, Dec 2015
E) Drug Calculations – answer all of the questions
A pass rate of 100% is required. You are encouraged to use the most up-to-date BNF and can use a calculator. You must
show your workings out. Formulation – what you need x what you’ve got
what it’s in
Show your calculations
Write your answer in the box
Calculations are provided at the competency assessment, and will change at each session
Name: ……………………………………. Date:……/..…/…. Signature: …………………………………………….. Name of assessor ……………………… Date:…../…../… Signature ……………….…………………….. A copy of this document must be retained in the Individual’s personnel file
SOP: Assessing Competency for Medicines Administration, Dec 2015
Appendix 2 he role of the unregistered support worker (including Assistant Practitioners)
in the witnessing and second checking of medicines by a 1st
level registered nurse:
Rationale
All medicines that are administered by 1st
level Registered Nurses (RN) directly employed by South Staffordshire and Shropshire NHS Foundation Trust (SSSFT) or who are supplied via National Health Service Professionals (NHSP) or a nursing agency are required to have a second checker to witness all aspects of the administration of medicines. This is explicit within the current Medicine Code.
It is acknowledged within SSSFT that unregistered support workers (this includes all Assistant Practitioners) have a significant role to play in
supporting 1st
level RNs in this process.
At the current time there are some services that support unregistered support workers to be involved in the witnessing and second checking of medicines administration and others that do not. The purpose of this approach is to ensure that all unregistered support workers are trained and deemed
competent by a 1st
level RN in the witnessing and second checking of
medicines by a 1st
level RN. This will ensure compliance with the Medicine Code and increase patient safety.
Scope
The purpose of this process is to ensure that any unregistered support worker who is involved in the witnessing and second checking process for the administration of medicines has been assessed and deemed as competent to
do so by a 1st
level RN.
This applies to all clients within any in patient setting across SSSFT, including community based bedded units e.g. Castle Lodge, Park House.
Each unregistered support worker will have undertaken appropriate theoretical and practical training on medicines management for unregistered support workers provided and delivered by SSSFT. This must be undertaken on:
• Induction to SSSFT • Three yearly as part of mandatory training • Following the unregistered support worker being involved in a
medicine error
The unregistered support worker must be further assessed as competent by a
1st
level registered nurse before undertaking any involvement in the witnessing of medication administration and this will be achieved through a competency framework document.
SOP: Assessing Competency for Medicines Administration, Dec 2015
The unregistered support worker must agree to adhere strictly to the contents of this document and to the Medicines Code and must report any further training and development needs that they may have to their clinical supervisor or direct line manager as soon as these are highlighted.
Each unregistered support worker must have Medicines Management included in their annual appraisal, and this must be linked directly to a KSF indicator.
1st
Level RNs are responsible for the assessment of the unregistered support workers competence. Where an unregistered support worker has been unable to achieve successful completion of the assessment and competency framework this must be discussed with them individually and clearly documented on a supervision form, a copy of which must be included in the individuals personnel file. In addition it is considered as Best Practice to offer the individual with a copy for their own records. Where this has occurred, the 1
st Level RN must contact the Senior Nurse for Medicines Management
to discuss this in more detail.
An action plan to support their ongoing professional development must be
drawn up between the 1st
Level registered nurse and the unregistered support worker.
Principles
It is intended that these changes to the current Medicines Code will allow unregistered support workers to further develop their clinical skills and knowledge. In addition it will support ongoing clinical governance and risk management in the safe administration and management of medicines for clients receiving in patient care.
2. Impact
Currently unregistered support workers are not registered or regulated by a professional regulatory body as are registered nurses or other health care professionals e.g. physiotherapists, occupational therapists. It is therefore imperative that a structured and robust competency framework exists to ensure that any unregistered support worker involved in the witnessing and second checking of medicines is assessed and deemed competent to do so by a
1st
level RN.
In order to ensure that competence is maintained, each individual will need to undergo further theoretical training on a three yearly basis as part of their mandatory training.
3. Risk Management Issues
In order ensure that risks are reduced and effectively managed:
• All unregistered support workers will receive both theoretical and
practical training in medicines management.
• Unregistered support workers will have an understanding of their roles and responsibilities in respect of medicines management.
SOP: Assessing Competency for Medicines Administration, Dec 2015
• All unregistered staff will have an increased awareness of the importance of medicines management and how SSSFT are committed to minimise the risks associated with medicines use.
• Where an unregistered support worker identifies unsafe standards of
practice from a 1st
level RN they must report this to a senior manager as soon as possible.
SOP: Assessing Competency for Medicines Administration, Dec 2015
Medicines Administration Competency
Framework For Unregistered support workers and Assistant
Practitioners Name of unregistered
practitioner: Date:
Designation:
Name of
assessor: Date:
Designation:
Comments:
Purpose of assessment: To ensure that all unregistered support workers are educated and trained to assist 1
st Level
Registered Nurses in the safe witnessing and dispensing of prescribed medicines to clients.
The unregistered support worker undergoing assessment will demonstrate by practical methods a comprehensive understanding of the checking and witnessing of medicines within the clinical practice setting, with an understanding that they will not be used as “runners” in the administration of any medicines. The assessment will be completed using the following criteria:
• Upon induction • Annually as part of annual appraisal processes • Observation, witnessing and checking of a 1
st Level RN completing
a ward medicine round and where appropriate the administration of an intra-muscular injection.
• Following a medication error if an unregistered practitioner was involved in the checking and administration of a medicine.
SOP: Assessing Competency for Medicines Administration, Dec 2015
Prior to assessment it is the individual's responsibility to familiarise themselves with the documents listed below prior to the assessment commencing.
Please date and sign to Assessor - Please date and sign indicate that you are familiar to indicate the individual with the following Trust and undergoing assessment is able national documents. to locate the documents
Medicines Code
British National Formulary
Standard precautions and equipment policy for the control and prevention of infection
The unregistered practitioner undergoing assessment will demonstrate by practical methods comprehension of the witnessing and second checking of administration of medicines via oral and where appropriate intra- muscular routes. The Following criteria will be used;
Yes No Comments
Confirm the Validity of the Prescription;
• Checks with the 1st
Level RN to assure that the Identity of the patient has been achieved following Trust policy and
observes the 1st
level RN establish that the patient understands the treatment being given and consents where appropriate.
SOP: Assessing Competency for Medicines Administration, Dec 2015
Yes No Comments
• Witnesses and checks with the
1st
Level Registered nurse (RN) to ensure that any Mental Health Act detention papers are in date and accurate.
• Witnesses and checks with the
1st
Level RN for any recorded drug allergies and confirms this with the patient
• Checks the prescription sheet
with the 1st
Level RN to ensure the prescription is legible
• The 1st
Level RN confirms the following with the unregistered care worker who will then check and confirm accuracy:
• Start date • Stop date • Drug dosage and strength • Administration route prescribed • Prescribers signature • Specific/other instructions • Any information relevant to
the safe storage and handling of medication , I.E security of medication, stock ordering, rotation and storage.
The 1st
Level RN will outline the process
for the preparation of the dose for oral administration, in accordance with the guidelines for oral administration of medication and calculate doses accordingly; the unregistered support worker checks and confirms accuracy. The 1
st Level RN will outline the process
for the preparation of the dose for intra-muscular administration in accordance with the guidelines for IM administration of medication; the unregistered support worker checks and confirms accuracy. The 1
st level RN will assure cross
checking / double checking of medication against prescription as per medicines code with the unregistered support worker who will confirm accuracy.
SOP: Assessing Competency for Medicines Administration, Dec 2015
The 1st
level RN will identify and explain actions to be taken if the prescription is illegible or invalid The 1
st level RN will assure evidence
of cross checking as required medication, with the regular prescription, not exceeding daily dose. The unregistered support worker checks and confirms accuracy. The 1
st level RN will assure the correct
amount of prescribed medication has been placed in the container/ syringe. The unregistered support worker checks and confirms accuracy.
Following administration of the Yes No Comments medication, the unregistered
practitioner will:
Where appropriate support the 1st
level RN observe that the patient has taken
the drug.
Observe the 1st
level RN sign the medication chart in the appropriate
section, noting for any omissions and
identify this.
Observe the1st level RN record the
time and dose given on administration
on the prescription chart if a variable
dose or I/M has been prescribed
Where appropriate and under
supervision support the 1st
Level RN in monitoring the patient for any side
effects and document in health records
The practitioner undergoing the assessment will demonstrate by verbal method knowledge and understanding of their role as a witness and second checker in a medication round and can identify: The risks associated with using runners being used within a medication round?
Three risks associated with omissions of regular medicines
The principles of safe administration of medicines to patients e.g. the right patient; the correct dose; correct time; correct route; correct form i.e. tablet/liquid
Additional Comments Name Date Signature Name of assessor Date Signature
Please file one completed copy in Personnel File