medicines policy for registered nursing associates working

Medicines policy for Registered Nursing Associates working within the Northern Care Alliance

Reference Number: NCADP002(19) Version: 1.2 Issue Date: 21/12/2020 of 28 It is your responsibility to check on the intranet that this printed copy is the latest version

Medicines Policy for Registered Nursing Associates working within the Northern Care Alliance

Lead Author: Grainne Lundrigan, Lead Pharmacist – Community Services

(Salford)

Additional author Sam Westwell, Director of Clinical Workforce Transformation

Division/ Department: Diagnostics and Pharmacy Group

Applies to: Bury & Rochdale Care Organisation

North Manchester Care Organisation

Oldham Care Organisation

Salford Royal Care Organisation

Approving Committee: Medicines Management Group and Pennine Acute Drugs

And Therapeutics

Date approved: 18/02/2019

Date v1.1 amendments approved

Date v1.2 amendments approved

09/06/2020

20/08/2020

Review date: 18/02/2022

Content

Contents

Section Page

1 Overview 3

2 Scope & Associated Documents 3

3 Background 3

4 What is new in this version? 4

5 Policy 4

5.1 Following qualification and registration with the NMC 4

5.2 Accountability 5

5.3 Nursing Associate scope in handling medicines 5

5.4 General information on prescribing 7

5.5 Dispensing and supply of medicines 8

5.6 Administration of medicines 8

5.7 Storage and security of medicines 9

5.8 Disposal of medicines 9

5.9 Patient education and medication counselling 10

5.10 Medicines Safety 10

6 Roles and responsibilities 11

Group arrangements:

Salford Royal NHS Foundation Trust (SRFT)

Pennine Acute Hospitals NHS Trust (PAT)



7 Monitoring document effectiveness 13

8 Abbreviations and definitions 14

9 References 14

10 Document Control Information 15

11 Equality Impact Assessment (EqIA) tool 16

12 Appendices 18



1. Overview (What is this policy about?) The Nursing Associates Medicines Policy is intended as a working document for Registered Nursing Associates involved in the administration, safe and secure storage and disposal of medicines as well as those individuals involved in the delegation of the these tasks to Registered Nursing Associates. The policy offers a framework of processes for all aspects of medicines management Registered Nursing Associates may be involved in within the Northern Care Alliance. It is a multidisciplinary document intended to be comprehensive and as inclusive as possible. If you have any concerns about the content of this document please contact the author or advise the Document Control Administrator.

If you have any concerns about the content of this document please contact the author or advise the Document Control Administrator.

2. Scope (Where will this document be used?)

This policy will be used in both the acute and community setting across all Care Organisations within the Northern Care Alliance. Currently this policy applies to adult and paediatric services as well as maternity services. This policy constitutes an important element of the Care Organisation’s risk management strategy. The policy is supported by a number of associated documents and therefore those areas are not covered extensively in the main body of the Nursing Associates Medicines Policy. This policy should be read alongside the nursing standards of proficiency and associated Trust medicines management policies as they demonstrate the synergies and differences between the Registered Nurse and Nursing Associate role. These policies include (but are not limited to): Associated Documents SRFT 163TD(C)(33) Medicines Policy MM23(08) Safe and Management of Controlled Drugs TWCG18(20) Protocol for the administration of insulin to adults with diabetes by Registered Nursing Associates in community PAT EDC018 Medicines Policy EDC017 Controlled Drugs Policy CPDI176 Adult Community Nurse Controlled Drugs Policy

3. Background (Why is this document important?)

Nursing Associate is a new role being introduced into the health and care workforce in England from 2019. It is a generic role (not defined by a field of nursing) but within the discipline of nursing. Nursing Associates are intended to bridge a gap between health and care assistants and Registered Nurses. Whilst the Nursing Associate role is new, it is particularly important that the public, health and care professionals, and employers develop an understanding of the capabilities of Nursing Associates. This policy is intended to support this.



Nursing Associates are a new profession, accountable for their practice. This policy will ensure patients who require support with medication receive this from suitably trained and competent staff. For Registered Nurses and other health and care professionals, this policy will also provide clarity on the knowledge and skills they can reasonably expect all Nursing Associates to have and this will help inform safe decisions about delegation, within the limitations laid out in this policy. The Nursing and Midwifery Council (NMC) have issued standards of proficiency for Nursing Associates. These standards represent the standards of knowledge and skills Nursing Associates require in order to be considered by the NMC as capable of safe and effective Nursing Associate practice. These standards have been designed to apply across all health and care settings. In common with all of the NMC regulatory standards and guidance, these proficiencies will be subject to periodic review. The current version of proficiencies can be found on the NMC’s website.

4. What is new in this version?

4.1 Amendments made in V1.1 from V1 Updates to scope of practice in Appendix 1 that allows Registered Nursing Associates to:

Administer medicines rectally, following additional training and competency assessment

Administer medicines via buccal and sublingual routes (except administration of buccal midazolam oromucosal solution)

Administration subcutaneous insulin within PENNINE ACUTE ADULT COMMUNITY SERVICES ONLY, following additional training and competency assessment

4.2 Amendments made in V1.2 from V1.1

Updates to scope of practice in Appendix 1 that allows Registered Nursing Associates to:

Administration subcutaneous insulin within Salford Adult Community Nursing Services, in addition to Pennine Acute Adult Community Services; following additional training and competency assessment

Minor amendments to wording in Appendices 2 and 3 to reflect above.

New protocol referenced in ‘Associated Documents’ section of ‘Scope’.

5. Policy

5.1 Following qualification and registration with the NMC

Upon qualification, Nursing Associates will be deemed competent by their University body to administer medication via a variety of routes.

https://www.nmc.org.uk/standards/nursing-associates/standards-for-nursing-associates/



A further period of preceptorship and additional training, supervision and assessment of competence will be expected by the Trust before the Nursing Associate is authorised to handle and administer medicines as part of their role (for further information see Appendices 1 and 2 of this policy). Certain care settings will require additional competencies and training in order to support patients with complex care needs. Where this is identified beyond the scope of the current competencies contained within this document, Ward/Clinical Managers must highlight to the Medicines Management team along with the Learning and Development team. Where access to the electronic prescribing record system is required, only Registered Nursing Associates will be given access to record the administration process on the electronic prescribing system.

5.2 Accountability

Nursing Associates must act in the best interests of patients, putting them first and providing nursing care which is person-centred, safe and compassionate. Nursing Associates must act professionally at all times and use their knowledge and experience to make evidence based decisions and solve problems.

Nursing Associates must:

recognise and work within the limits of their competence;

keep up to date with, and follow, the law, professional guidance and other regulations relevant to their work.

Nursing Associates are accountable for their actions both to their employer and to their relevant professional body. Please also see the NMC website for further information.

5.3 Nursing Associate scope in handling medicines

Only appropriately trained, assessed and competent Nursing Associates, with the right knowledge and skills, can provide support to patients with medication and its related tasks. As laid out by the NMC; at the point of registration, Nursing Associates will be able to:

understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies

demonstrate the ability to recognise the effects of medicines, allergies, drug sensitivity, side effects, contraindications and adverse reactions

recognise the different ways by which medicines can be prescribed

To manage and administer medicines safely, Nursing Associates must be able to demonstrate the ability to:

continually assess people receiving care, knowing when and how to escalate any concerns;

undertake accurate drug calculations for a range of medications;

https://www.nmc.org.uk/standards/nursing-associates/standards-for-nursing-associates/



exercise professional accountability in ensuring the safe administration of medicines to those receiving care;

administer medication via oral, topical and inhalation routes;

administer injections, using subcutaneous and intramuscular routes and manage injection equipment as detailed in Appendix 1;

administer and monitor medications using enteral equipment;

manage and monitor effectiveness of symptom relief medication;

recognise and respond to adverse or abnormal reactions to medications, and when and how to escalate any concerns;

undertake safe storage, transportation and disposal of medicinal products.

In order to undertake the tasks associated with their profession in clinical areas, Nursing Associates are required to complete mandatory training and be signed off as competent by an approved Assessor. In addition to information contained in the body of this policy, please refer to Appendix 1 for further information on the administration of medicines by Nursing Associates. Nursing Associates must NOT be delegated tasks that involve any aspect of handling medicines until signed off as competent in that task. Until then, Nursing Associates must be adequately supervised and appropriate second checks in place via a Registered Nurse.

Medicines administration must be identified as part of the Nursing Associates role by the Ward/Clinical Manager who is prepared to support the Nursing Associates development for medicine administration. The specific training and competency assessments a Nursing Associate is required to undertake is at the decision of the Ward/Clinical manager or Lead Nurse and must be relevant and appropriate for the nature of that clinical area.

Only the following staff may assess and sign as Nursing Associate off as competent to handle and administer medicines:

A Band 6 Registered Nurses with an up to date knowledge of current practice;

A Band 5 Registered Nurses that has been qualified for 12 months, completed preceptorship and has an up to date knowledge of current practice.

Supervision must be an on-going process and the Nursing Associate’s competence to undertake the tasks associated with their profession in clinical areas should be regularly assessed (annually as a minimum).

A period of supervised practice and assessment of competence must occur when:

a Nursing Associate qualifies and has undertaken a period of preceptorship;

a Nursing Associate is new to the Northern Care Alliance;

a Nursing Associate moves to a new clinical area/Care Organisation to assume a new role;

a Nursing Associate has had a period of long term sick;

a Nursing Associate has had a period of maternity leave;



a Nursing Associate has returned to practice;

a Nursing Associate has been involved in a medication incident.

Nursing Associates must keep a portfolio of evidence to demonstrate competence and use reflective logs and certificates of attendance at training courses and updates relevant to their role. See Appendix 2 for further information relating to Assessors and required competency assessments for Nursing Associates.

5.4 General information on prescribing

All prescriptions must be written by an authorised prescriber with current UK registration. Nursing Associates are NOT legally authorised to prescribe medicines.

A Patient Group Direction (PGD) is a written instruction for the supply or administration of medicine (or medicines) where the patient may not be individually identified before presenting for treatment. Nursing Associates are NOT authorised to practice under a PGD, under current legislation.

Nursing Association are NOT authorised to administer medicines via a Nurse Discretionary Administration order.

Prescription charts should be re-written by authorised prescribers when no longer suitable for use. Nursing Associates are NOT authorised to transcribe medicines when a chart re-write is required.

Nursing Associates that identify any missing, lost or stolen prescription forms/charts must report the incident immediately to the Registered Nurse in charge for further investigation.

Prescriptions must NOT be given or accepted over the telephone.

Nursing Associates must NOT administer medicines against a faxed prescription.

Further details on prescription requirements and authorised prescribers can be found in the relevant medicines policies, for information purposes only.

Salford Care Organisation Medicines Policy

Section 1 – Prescribing Standards

Salford Care Organisation Safe Management of Controlled Drugs

Sections 21-25

Pennine Acute Hospitals NHS Trust Medicines Policy

Section 3.3 Prescribing of Medicines 3.3 to 3.8

Medicines Policy for Community Staff Employed by Pennine Acute Hospitals NHS Trust

Section 3 Prescribing, 3.1 to 3.8



5.5 Dispensing and supply of medicines

For the dispensing and supply of medicines please refer to the relevant sections of the Trust’s Medicine Policies. Controlled Drugs (and certain medicines liable to misuse) are subject to additional security measures therefore for the dispensing and supply/collection of controlled drugs please refer to the relevant sections of the Trust’s Controlled Drugs policy. Nursing Associates must NOT be involved in the preparation of pre-packed (‘over-labelled’) medicines for supply or administration. Nursing Associates must NOT transfer controlled drugs between wards out of hours.


Section 2 – Dispensing and Supply of medicines


Section 8 to 10

Pennine Acute Hospitals NHS Trust Medicines Policy

Section 3.9 Dispensing and issues of medicines

Pennine Acute Hospitals NHS Trust Controlled Drugs Policy

Section 3.8 Controlled Drug Discharges Section 3.9 Patients Own Medicines

Pennine Acute Hospital NHS Trust Adult Community Nurse Controlled Drugs Policy

Section 3.2 Transportation

5.6 Administration of medicines

Medicines may be administered by Nursing Associates providing that the individual has demonstrated the necessary level of knowledge, skill and competence and that the medicine is within the scope of their clinical practice. A summary of the medicines Nursing Associate may administer are summarised in appendix 1. Nursing Associates must NOT delegate the administration of medicines to another member of staff, including another Nursing Associate/Trainee Nursing Associate or student nurse. Nursing Associates must NOT provide a second independent check for administration, where the administrator is: another Nursing Associate; Trainee Nursing Associate; Student Nurse; Operating Department Practitioner; Assistant Practitioner; Radiographer; Allied Healthcare Professional or an unregistered member of staff (e.g. Care Support Worker). Nursing Associates must NOT assess patients for suitability be enrolled in a ‘Self-administration of medicines’ scheme or supervise patients that self-administer their own medicines under a ‘self-administration of medicines’ scheme. Nursing Associates must NOT be involved in any aspect of the covert administration of medicines.



For the general principles, requirements and guidance on the administration of medicines, including controlled drugs, please refer to the relevant sections of the Trust’s Medicines Policies.


Section 3 – Administration of medicines


Section 25 to 27

Pennine Acute Hospital Trust - Procedure for the administration of prescribed medicines to inpatients


Section 3.21 Administration of Medicines 3.21 to 3.34


Section 3.1 Administration

In addition to these policies, Nursing Associates must follow any local procedures or guidance, relevant to their clinical area.

5.7 Storage and security of medicines

For the safe and secure storage requirements of medicines in clinical areas, including controlled drugs, please refer to the relevant sections of the Trust’s Medicines Policies.


Section 4 – Storage and Security of medicines


Section 12 to 20

Pennine Acute Hospital NHS Trust Medicines Policy

Section 3.10 Security of medicines in clinical areas Section 3.14 Receipt and Records Section 3.17 – Storage of medicines on the ward or department

Pennine Acute Hospital NHS Trust Controlled Drugs Policy

Section 3.2 to 3.97


Section 3.16 Storage of medicines Section 3.12 Use of Medicines by Community Services and Clinics Section 3.14.2 Delivery of Medicines by Suppliers.

Pennine Acute Hospital Trust Adult Community Nurse Controlled Drugs Policy

Section 3.3 Storage Section 3.4 Recording Section 3.6 Loss or Theft of Controlled Drugs


5.8 Disposal of medicines

For the safe and appropriate disposal of medicines, including controlled drugs, please refer to the relevant sections of the Trust’s Medicines Policies.




Section 5 – Disposal of medicines


Section 28 to 32

Pennine Acute Hospital NHS Trust Medicines Policy

Section 3.23 Disposal of medicines

Pennine Acute Hospital NHS Trust Controlled Drugs Policy

Section 3.10 Disposal and Destruction


Section 3.19 Disposal of medicines


Section 3.5 Destruction


5.9 Patient education and medication counselling

Nursing Associates are NOT authorised to provide patient education around their medicines or provide medication counselling. Any patient education or medication counselling required by the patient, including changes to medication regimes, must be referred to the Registered Nurse or a member of the Pharmacy Team. Nursing Associates are NOT authorised to prepare or hand over discharge medicines (TTOs) to patients (and/or their carers, where appropriate) at the point of discharge.

5.10 Medicines safety

Medicines Safety errors: dealing with incidents involving medicines An incident report should be completed when there is an occurrence which may/has resulted in an injury, ill health to any person, damage / loss to property, equipment or environment. The registered nurse in charge must be informed immediately following a medication error/suspected medication error. An incident report should be completed in any circumstance when a medication error occurs. Where serious incident / injury or death has occurred or there was potential for serious incident / injury or death, the matter must be immediately reported to the Senior Manager on duty. Malfunction of medicinal devices Stop using the device. Inform the registered nurse in charge immediately. Suspected prescribing, dispensing or administration errors



Apparent discrepancies in any aspect of medication handling must be reported to the Registered Nurse in charge, who in turn will take appropriate action, following the relevant Trust Medicines Policy. Nursing Associates suspected of involvement in a medication error / discrepancy must be reported to the appropriate line manager immediately if they have not self-reported. Suspected adverse drug reactions (ADR) If a patient has suffered a suspected ADR to a medicine then the Registered Nurse in charge must be informed immediately, who in turn will take appropriate action, following the relevant section of the Trust Medicines Policy. If a patient has suffered a suspected ADR to a medicine, then consideration should be given as to whether this should be reported via the yellow card scheme – guidance on reporting via the yellow card scheme is available in BNFs and also electronically at http://yellowcard.mhra.gov.uk/ Reporting can be carried out by Nursing Associates. Medicines and Healthcare Products Regulatory Agency (MHRA) alerts – for information The MHRA issues alerts on medicinal products. These are cascaded to the Pharmacy Departments. Where appropriate, the Pharmacy Department will issue advice based on the alert, detailing action to be taken. The advice will be cascaded to the appropriate senior clinical staff. Nursing Associates must be aware of advice issued from the Pharmacy Department based on alerts.

6. Roles & responsibilities

It is the responsibility of all Nursing Associates and Northern Care Alliance employees who are involved in any aspects of medicines management including prescribing, dispensing or administering medicines, to follow this policy and all associated medicines policies. The Medicines Management Group will ensure that the policy is reviewed and amended as required. The Medicines Management Group will evaluate the results of regular audits of compliance and make recommendations for improvement and report to the Clinical Effectiveness Committee. Divisional Directors of Nursing It is the responsibility of the Divisional Directors of Nursing to ensure that:

Systems are in place to ensure compliance of these competencies Assistant Directors of Nursing It is the responsibility of the Assistant Directors of Nursing to:

http://yellowcard.mhra.gov.uk/



Support Ward/Clinical Managers to ensure Registered Nursing Associate achieve the appropriate competencies;

Support Ward/Clinical Managers in the assessment process and assist as required to establish any performance/development plans with individuals who fail to achieve competency;

Support Ward/Clinical Managers post incident to review medication errors as required; action plan to prevent reoccurrence;

Monitor incident reporting statistics and work in conjunction with Ward/Clinical Managers to ensure compliance and development to minimise re-occurrence

Feedback to the Medicines Safety Group any medicines management practice issues/themes/trends arising that may contribute to risk of harm to patients.

Ward/Clinical Managers and Matrons It is the responsibility of the Ward/Clinical Manager and Matrons to ensure that:

Registered Nurses and Assessors are supported when supervising and observing Nursing Associates to carry out medicine administration and associated medicine-related tasks;

All Registered Nursing Associate within their team achieve the competencies in the area of practice and competencies are maintained on an on-going basis;

All Registered Nursing Associates complete competency assessments within the required time frame;

Systems are in place to maintain up-to-date access to the relevant Trust Medicine Policies and associated guidance/policies;

Medication incidents are monitored, that practice is safe and all remedial actions are taken to minimise reoccurrence;

Staff performance is monitored and action planned as required.

Registered Nurses: It is the responsibility of the Registered Nurses to:

Supervise and observe Nursing Associates at all times when administering medication until they have completed the appropriate Medicines Management Competency Assessments and required mandatory training;

Delegate tasks appropriately to Nursing Associates that demonstrate the relevant competency to safely perform the task;

Ensure medication incidents are reported, that practice is safe in their clinical area and all remedial actions are taken to minimise reoccurrence;

Registered Nursing Associates: It is the responsibility of the Registered Nursing Associate to ensure that they practice in accordance with the standards for administration of medication as set out by the NMC and Trust



policy. Each Registered Nursing Associate is accountable for their actions and omissions when administering medication. Registered Nursing Associate should:

Complete the competencies relevant to the area of practice and remain updated within the timescales;

Follow a process for the administration of medicines to ensure the safety and wellbeing of the patient;

Report promptly any concerns or errors to a Registered Nurse and in line with relevant Trust policy;

Have a working knowledge of the Trust’s Medicines policy and associate medicine-related documents and act accordingly to maintain their skills and competency in order to administer medication safely;

Follow NMC guidance in relation to Medication administration;

Work within their scope of practice and ensure they seek guidance prior to administering medication that has specific training requirements or where concerns arise.

Mentors and Assessors and Preceptors Mentors and Assessors and Preceptors are required to:

Act as role models and support learners in achieving the competencies;

Supervise and observe Nursing Associates at all times when administering medication until they have completed the appropriate Medicines Management Competency Assessments and required mandatory training;

Appropriately escalate any concerns regarding practice of the Nursing Associates in an appropriate timeframe.

Learning & Development It is the responsibility of Learning and Development to:

Review medication competencies in line with changes to Medicine policy and national guidance/Patient Safety alerts, and to cascade any amendments following discussion with the Medicines Management Group;

Ensure Nursing Associates receive appropriate training during preceptorship and that on-going training and support is available post-registration for further development.

7. Monitoring document effectiveness

The Medicines Policy is given formal approval by the Salford and Pennine Medicines Management Groups and is subject to review every two years. The Medicines Management Groups are responsible for ensuring dissemination and appropriate implementation of the Policy.



Any comments, suggestions and proposals for amendment should be forwarded to the Director of Pharmacy, Salford Care Organisation or Director of Pharmacy, Pennine Care Organisation. The Medicines Management Group is responsible for ensuring that the effectiveness of the Policy is monitored, assessed and reviewed. This will be achieved through:

Rolling prescription audit as part of the Clinical Care Records Audit

Review of medication-related adverse incident reports

Nursing Assessment and Accreditation System

Safe and Secure Handling of Medicines Audit

Controlled Drugs Audit

Discharge Medicines Audit (where applicable to the Trust)

Medicines management risk register and action plan

Where there is evidence of non-compliance with the policy, an adverse incident report (DATIX) should be submitted.

8. Abbreviations and definitions

8.1 ADR Adverse Drug Reaction MHRA Medicines and Healthcare products Regulatory Agency

NMC Nursing and Midwifery Council

9. References

Nursing and Midwifery Council (NMC) Standards of proficiency for nursing associates (https://www.nmc.org.uk/standards/standards-for-nursing-associates/standards-of-proficiency-for-nursing-associates/).

Greater Manchester Guidance for Organisations in respect of Medicines Management and Administration by Nursing Associates, Greater Manchester Combined Authority.

Medicines Policy, Salford Royal NHS Foundation Trust, Issue 14, May 2017, Selwa Elrouby (Medicines Management Pharmacist) et al.

Medicines Policy, The Pennine Acute Hospitals NHS Trust, Version 7, October 2017, Philippa Jones (Chief Pharmacist).

Medicines Management Competencies, Northumberland, Tyne and Wear NHS Foundation Trust (https://www.ntw.nhs.uk/about/policies/medicine-management-competency-assessment/) accessed Feb 2019

https://www.nmc.org.uk/standards/standards-for-nursing-associates/standards-of-proficiency-for-nursing-associates/

https://www.nmc.org.uk/standards/standards-for-nursing-associates/standards-of-proficiency-for-nursing-associates/

https://www.ntw.nhs.uk/about/policies/medicine-management-competency-assessment/

https://www.ntw.nhs.uk/about/policies/medicine-management-competency-assessment/



10. Document Control Information

Lead Author: Grainne Lundrigan, Lead Pharmacist - Community Services

Lead author contact details:

0161 206 1027 [email protected]

Consultation List the persons or groups who have contributed to this policy. (please state which Care Organisation)

Name of person or group Role / Department / Committee (Care Org) Date

Key Stakeholders, including Director of Clinical Workforce Transformation, Learning and Development, Senior Pharmacy team, Senior Nursing team and Lead Nurses.

NCA wide Feb 2019

Endorsement List the persons or groups who have seen given their support to this policy. (please state which Care Organisation)

Name of person or group Role / Department / Committee (Care Org) Date

NCA Nursing Associate Task and Finish Group

NCA

Feb 2019 and June 2020 and July 2020

Sam Westwell

Director of Clinical Workforce Transformation Northern Care Alliance

Salford Care Organisation

Feb 2019 and June 2020 and

August 2020

Richard Cooper Medicines Management Group, Salford Care

Organisation 09/06/2020 20/08/2020

Philippa Jones Pennine Acute Drugs & Therapeutics,

Pennine Acute 09/06/2020

Keywords / phrases: Nursing Associate, medicines, controlled drugs, PGD, allergy, administration, storage, disposal, drugs,

Communication plan:

Dissemination via the Divisional Directors of Nursing, Assistant Directors of Nursing and Lead Nurses

Document review arrangements:

This document will be reviewed by the author, or a nominated person, at least once every three years or earlier should a change in legislation, best practice or other change in circumstance dictate.

This section will be completed following committee approval

Policy Approval V1: Name of Approving Committee: Medicines Management Group, Salford Care Organisation Pennine Acute Drugs & Therapeutics, Pennine Acute

Chairperson: Dr Richard Cooper (MMG Chair, Salford), Lindsay Harper (Director of Pharmacy, NCA), Philippa Jones (PADAT)

Approval date 18/02/19

Formal Committee decision: approved

Date amendments approved: V1.1

09/06/2020

Formal committee decision Medicines Management Group

Date amendments approved: V1.2

20/08/2020

Formal committee decision Medicines Management Group

mailto:[email protected]



11. Equality Impact Assessment (EqIA) tool Legislation requires that our documents consider the potential to affect groups differently, and eliminate or minimise this where possible. This process helps to reduce health inequalities by identifying where steps can be taken to ensure the same access, experience and outcomes are achieved across all groups of people. This may require you to do things differently for some groups to reduce any potential differences.

1a) Have you undertaken any consultation/ involvement with service users, staff or other groups in relation to this document? If yes, specify what.

Yes, consultation with key stakeholders

1b) Have any amendments been made as a result? If yes, specify what.

No

2) Does this policy have the potential to affect any of the groups listed below differently? This may be linked to access, how the process/procedure is experienced, and/or intended outcomes. Prompts for consideration are provided, but are not an exhaustive list.

Protected Group Yes No Unsure

Age (e.g. are specific age groups excluded? Would the same process affect

age groups in different ways?) X

Sex (e.g. is gender neutral language used in the way the policy or

information leaflet is written?) X

Race (e.g. any specific needs identified for certain groups such as dress,

diet, individual care needs? Are interpretation and translation services required and do staff know how to book these?)

X

Religion & Belief (e.g. Jehovah Witness stance on blood transfusions;

dietary needs that may conflict with medication offered.) X

Sexual orientation (e.g. is inclusive language used? Are there different

access/prevalence rates?) X

Pregnancy & Maternity (e.g. are procedures suitable for pregnant and/or

breastfeeding women?) X

Marital status/civil partnership (e.g. would there be any difference

because the individual is/is not married/in a civil partnership?) X

Gender Reassignment (e.g. are there particular tests related to gender? Is

confidentiality of the patient or staff member maintained?) X

Human Rights (e.g. does it uphold the principles of Fairness, Respect,

Equality, Dignity and Autonomy?) X

Carers (e.g. is sufficient notice built in so can take time off work to attend

appointment?) X

Socio/economic (e.g. would there be any requirement or expectation that

may not be able to be met by those on low or limited income, such as costs incurred?)

X

Disability (e.g. are information/questionnaires/consent forms available in

different formats upon request? Are waiting areas suitable?) Includes hearing and/or visual impairments, physical disability, neurodevelopmental impairments e.g. autism, mental health conditions, and long term conditions e.g. cancer.

X



Are there any adjustments that need to be made to ensure that people with disabilities have the same access to and outcomes from the service or employment activities as those without disabilities? (e.g. allow extra time for appointments, allow advocates to be

present in the room, having access to visual aids, removing requirement to wait in unsuitable environments, etc.)

X

3) Where you have identified that there are potential differences, what steps have you taken to mitigate these? n/a

4) Where you have identified adjustments would need to be made for those with disabilities, what action has been taken? n/a

Will this policy require a full impact assessment? No (a full impact assessment will be required if you are unsure of the potential to affect a group differently, or

if you believe there is a potential for it to affect a group differently and do not know how to mitigate

against this - Please contact the Inclusion and Equality team for advice on [email protected]) Author: Grainne Lundrigan Date: 19/02/2019 - no changes to body of policy since 2019 Sign off from Equality Champion: Tara Hewitt Date: 05/03/2019

mailto:[email protected]



12. Appendices

Appendix 1 The Nursing Associates scope of practice regarding the administration of medicines

Single administration Act as a second independent check

Yes No Yes No

Intravenous route (including fluids) Intrathecal route Intra-arterial route Intra-articular route Total Parenteral Nutrition

Enteral routes:

Key G Green – administration via this route is authorised

A

Amber - administration via this route is authorised, following additional training and successful competency assessment

R Red - administration via this route is NOT authorised

Oral

G Administration via this route IS authorised

R

Exceptions:

Warfarin and acenocoumarol – NOT authorised to administer

Oral anticancer agents (cytotoxic chemotherapy or targeted treatments for cancer) - NOT authorised to administer

Chlordiazepoxide – NOT authorised to administer

Oral methotrexate – NOT authorised to administer

A Controlled Drugs – authorised to act as a second independent check, following additional training and successful competency assessment.

Swallowing difficulties requiring the manipulation of solid dosage forms (tablets and capsules) for oral administration

A

Administration via this route is authorised, following additional training and successful competency assessment

Medicine Administration via a PEG/PEGJ/PEJ/RIG/RIG-J feeding tube in adults

A Administration via this route is authorised, following additional training and successful competency assessment

Medicine Administration via an NG feeding tube in adults A


Medicine Administration via an A Administration via this route is authorised in adult



NJ feeding tube in adults patients, following additional training and successful competency assessment

Administer oral unlicensed/’off-label’/clinical trial/black triangle medicines


‘When required’ (PRN) oral medicines

G

Administration via this route IS authorised provided the indication for the medicine is clearly stated on the prescription chart, along with the dosing frequency and recommended maximum dose.

A

Exceptions:

Where a patient is deemed to not have capacity around their medicines. Administration of PRN medicines in this instance should remain a task for the Registered Nurse.

Subcutaneous route (including fluids)

R Administration via this route NOT authorised

A

Exceptions: Administration of subcutaneous Low Molecular Weight Heparins; providing the dose is prophylactic or, in the case of treatment dose, can be administered from a full syringe without the need to expel part of the dose, following additional training and competency assessment May act as a Second Independent check for subcutaneous controlled drugs, following additional training and successful competency assessment. Administration of subcutaneous insulin within PENNINE ACUTE ADULT COMMUNITY NURSING SERVICES and SALFORD ADULT COMMUNITY NURSING SERVICES only, following additional training and competency assessment Note, for insulin administration at Salford, refer to the Protocol for the administration of insulin to adults with diabetes in by Registered Nursing Associates in the community via the Trust intranet

Intramuscular route into the deltoid muscle

G Administration via intramuscular injection into the deltoid muscle is authorised, following additional training and successful competency assessment

R

Vaccines - NOT authorised to administer Paediatric intramuscular injection – NOT authorised to administer Gluteal muscle - NOT authorised to administer Deep intramuscular injection (e.g. Depot injection) -



NOT authorised to administer

Inhalation route (including inhalers and nebulisers)

A

Administration via this route is authorised, following additional training and successful competency assessment Note for inhaled nebuliser medication, only for the following - sodium chloride 0.9%, salbutamol and ipratropium

Administration and management of oxygen A


Topical skin preparation (including creams, lotions and ointments)


Topical eye drops and eye ointments


Ear drops or ear sprays G Administration via this route IS authorised

Buccal and sublingual


R Administration of buccal midazolam oromucosal solution is NOT authorised

Mouthwashes or rinses G Administration via this route IS authorised

Transdermal patches G

Administration via this route IS authorised

A

Exclusions: Controlled Drugs – authorised to act as a second independent check, following additional training and competency assessment.

Vaginal route R Administration via this route is NOT authorised

Rectal route G Administration via this route IS authorised

All identified instances of administration that deviate from this policy should be reported as a Trust incident and investigated accordingly.



Appendix 2

Medicines Management Competency Assessments Introduction Nursing Associates are accountable for their actions and omissions and, in administering medication, must exercise professional judgement; applying knowledge and skills in the best interests of patient safety. Nursing Associates must work within their scope of practice and competence. Nursing Associates must immediately refer back to a Registered Nurse if faced with a situation outside of their scope of practice and competence. Staff in charge of wards and departments are responsible for ensuring that Nursing Associates working in their clinical area have received appropriate training; have been assessed as competent to undertake the tasks required as part of their professional role and that Nursing Associates follow the medicine policies relevant to their clinical area. Purpose The Medicines Management Competency Assessments (in conjunction with Trust Medicines Policies and Nursing Associates Medicines Policy) are designed to ensure that Nursing Associates demonstrate adherence to the principles of medicines management, compliance with standards for medicines management and can demonstrate competence in safe medicines management. By achieving competence, Nursing Associates will be able to demonstrate that they have the skills and knowledge required to:

Order, store and dispose of medicines

Safely handle and administer medicines within their scope of practice

Recognise and manage adverse effects, side effects, cautions and contraindications

Deal with medication errors Scope

Medicines administration must be identified as part of the Nursing Associates role by the Ward/Clinical Manager, who is prepared to support the Nursing Associates development for medicine administration. The specific training and Medicines Management Competency Assessments a Nursing Associate is required to undertake is at the decision of the Ward/Clinical manager or Lead Nurse, and must be relevant and appropriate for the nature of that clinical area.

Where a Nursing Associate administers medicines as part of their role:

Medicines Management Competencies MMCA.001 to MMCA.003 are relevant to all Registered Nursing Associates working in a clinical setting.



Medicines Management Competencies MMCA.004 to MMCA.11, MMCA.14, MMCA.15, MMCA.16, MMCA.17 and MMCA.18 are relevant to all Registered Nursing Associate working in a clinical setting where administration via these routes/specialist techniques occurs. Medicines Management Competency MMCA.012 is relevant to Registered Nursing Associate required to independently check and witness the administration of controlled drugs, and witness 24 hour controlled drug balance checks, in their clinical setting. Medicines Management Competency MMCA.013 is relevant to Registered Nursing Associate required to administer intramuscular injection. Medicines Management Competency MMCA.019 is relevant to Registered Nursing Associate required to administer subcutaneous insulin whilst working within Pennine Acute Adult Community Services. Medicines Management Competency MMCA.020 is relevant to Registered Nursing Associate required to administer subcutaneous insulin whilst working within Salford’s Adult Community Nursing Services Assessment Process The Medicines Management Competency Assessments should be used to assess and document individual levels of competence associated with the management and administration of medicines. All Nursing Associates handling and administering medicines must be assessed as competent at least once every 12 months, however consideration needs to be given for Nursing Associates that:

have newly qualified and undertaken a period of preceptorship;

are new to the Northern Care Alliance;

have had a period of long term sick;

have had a period of maternity leave;

have moved to a new clinical area/Care organisation to assume a new role;

have returned to practice;

have been involved in a medication incident.

Medicines Management Competency Assessments may be carried out by a Band 6 Registered Nurse with an up to date knowledge of current practice; or a Band 5 Registered Nurses that has been qualified for 12 months, completed preceptorship and has an up to date knowledge of current practice. A Registered Nurse undertaking the role will be known as the Assessor. The observation assessment is to be satisfactorily completed for Nursing Associates prior to their involvement in the administration of medication; for re-assessment and yearly competency assessments. Note, where Nursing Associates are undertaking their competency assessments for the first time or are being re-assessed, the Nursing Associate may not be the primary or sole signatory for medicine administration. During a period of supervision, the Registered Nurse supervising will be overall responsible / accountable.



Failure to demonstrate competency Where a Nursing Associate fails to demonstrate competency in any element of a required competency, they should be given support and advice from their Assessor/mentor to support the individual to achieve the competencies and enable best practice, prior to any further assessments being taken. The Assessor must ensure any action required to improve practice/knowledge of the Nursing Associate is discussed and identified within an appropriate action plan. This includes making reference to a date of re-assessment, appropriate to the identified area for improvement. Where a member of staff has self-reported a disability, it is important that they have any reasonable adjustments in place and this is reviewed prior to any re-assessment. The Nursing Associate will be given further opportunity to demonstrate competency within an agreed timeframe.

The Medicines Management Competency Assessments can be taken up to a maximum of THREE times. If the Nursing Associate continues to fail to demonstrate competency, the Assessor/Ward Manager should meet with the Clinical Educator within Learning & Development and the individual, to discuss the action plan and next steps. Action plans should be updated along with any other required documentation.

Where necessary, performance issues must be addressed by the Ward/Clinical Manager or Lead Nurse in line with the relevant Trust’s disciplinary policies and procedures. Assessment Guidelines The Nursing Associate undertaking the competency assessment must have read the Trust Medicines Policies relevant to their area of practice and have completed the mandatory Medicines Management training packages. The Nursing Associate must be assessed on their ability to administer medicines safely and knowledgeably to a group of patients. The assessment must be carried out as follows:

The Nursing Associate undertaking the competency assessment has their medicine-related knowledge on the subject assessed through a series of formal questions, prior to and during clinical practice.

The Nursing Associate undertaking the competency assessment must correctly prepare and safely administer the medicine via the appropriate route, without assistance. The Assessor continually observes and only intervenes for matters of safety. Note any required second independent checks should be in place via a Registered Nurse, where necessary and Trust policy dictates.

The Nursing Associate must be deemed competent in all aspects of the competency assessment criteria in order to pass the assessment. If the Nursing Associate is not competent in any aspect of the assessment criteria, this must be reassessed as detailed above. Competency must be assessed for each individual route of administration authorised within this policy. The assessor must deem the Nursing Associate competent to administer by the assessed route.



The observed assessment of practice must be completed as follows:

Medicines Management Competency Assessment

Number of required assessments

Newly qualified

New to the Care Organisation

New to the clinical area

Returning to practice from more than 12 months absence in the same clinical area

Annual re-assessment

Returning to practice with less than 12 months absence in the same clinical area

MMCA.001 - Core Medicines Knowledge

1 assessment 1 assessment

MMCA.002 - Security of medicines 1 observation of practice

1 observation of practice

MMCA.003 - Oral medicines 3 medicine rounds, covering various shift patterns

1 medicine round observations of practice

MMCA.004 - Non Controlled Drug Transdermal patches

3 medicine rounds, covering various shift patterns


MMCA.005 - Topical Nasal preparations



MMCA.006 - Topical Eye preparations



MMCA.007 - Topical Ear preparations



MMCA.008 - Topical Skin preparations



MMCA.009 - Administration of medicines via a PEG/PEJ/PEGJ/RIG/RIG-J feeding tube

10 observations of practice


MMCA.010 - Administration of medicines with swallowing difficulties



MMCA.011 - Low molecular weight subcutaneous heparins



MMCA.012 - Second independent check for Controlled Drugs



MMCA.013 - Administration of intramuscular injection, intramuscularly



MMCA.014 - Inhaled Nebuliser Medication



MMCA.015 – Rectal Administration 3 medicine rounds, covering various shift patterns


MMCA.016 – Administration of medicines via an NJ feeding tube





in adults

MMCA.017 – Administration of medicines via an NG tube in adults



MMCA.018 – Administration of buccal/sublingual preparations



MMCA.019 – Administration of subcutaneous insulin within Pennine Acute Adult Community Services

3 observations of practice 1 observation of practice

MMCA.020 – Administration of subcutaneous insulin within Salford Adult Nursing Community Services

10 observations of practice 5 observation of practice

The dates of the assessment and name and signature of the Assessor must be recorded on the relevant Medicines Management Competency Assessment form. Copies of the completed forms should be held on file locally. The Assessor must inform Learning and Development of the satisfactory full completion of the Competency Assessment, in order for the Nursing Associates records to be updated. Ward/Clinical managers may feel that Medicines Management Competency Assessments should be carried out more frequently throughout the year in their area, or that a greater number of competency assessments should be observed, in order to maintain competence.



Appendix 3

Medicines Management Competency Assessment forms

Copies available via Learning and Development MMCA.001 Core Medicine Administration Competency

MMCA.002 Safe and Secure Storage of Medicines

MMCA.003 Oral Administration

MMCA.004 Non Controlled Drug Transdermal Patches

MMCA.005 Topical Nasal Preparations

MMCA.006 Topical Eye Preparations

MMCA.007 Topical Ear Preparations

MMCA.008 Topical Skin Preparations

MMCA.009 Administration of medicines via a PEG/PEJ/PEGJ/RIG/RIG-J Feeding Tube in adults

MMCA.010 Administration of medicines via oral route with swallowing difficulties

MMCA.011 Administration of Low Molecular Weight Subcutaneous Heparins

MMCA.012 Second Independent check in the administration of Controlled Drugs

MMCA.013 Administration of intramuscular injections

MMCA.014 Administration of inhaled nebuliser medication

MMCA.015 Rectal Administration

MMCA.016 Administration of medicines via an NJ feeding tube in adults

MMCA.017 Administration of medicines via an NG tube in adults

MMCA.018 Administration of buccal/sublingual preparations

MMCA.019 Administration of subcutaneous insulin within Pennine Adult Community Services

MMCA.020 Administration of subcutaneous insulin within Salford’s Adult Community Nursing Services



Appendix 4

When required (PRN) medication Medication that is not required by a patient on a regular basis is sometimes referred to as a ‘when required’ (PRN) medication. ‘When required’ (PRN) medication is administered when a patient presents with a defined intermittent or short-term condition i.e. not given as a regular daily dose or at specific times e.g. medication rounds. Due to the varying dosage requirements of these medicines, many factors need to be considered to ensure their safe use. Note, where a patient lacks capacity around their medicines, the Nursing Associate must NOT be involved in the administration of PRN medication; this would remain a task for the Registered Nurse. Prescribing and care planning It is important Nursing Associates are provided with clear and precise instructions to ensure PRN medication is administered as intended by the prescriber. The prescriber should ensure the following information is on the prescription chart:

name of drug

route of drug

dose of drug

frequency of drug

minimum time interval between doses

maximum number of doses in 24 hours

what the drug is for and expected outcome (good practice)

date for review (good practice practice)

The PRN medication should be administered at the request of the patient or when the Nursing Associate observes the need, therefore a specific care plan for administering PRN medication must be documented in the patient’s clinical records. Care plan details of ‘when required’ medicines should include:

A clear treatment and outcome plan

What the medication is being used for

If the patient is able to ask for the medication or if they need prompting or observing for signs of need

Symptoms to look out for and when to offer

When a medication is prescribed at a variable dose (e.g. 1-2 tablets), the care plan should include information on how a decision is made on the dose to administer (e.g. 1 or 2 tablets)

When the PRN medicines should be reviewed or monitored



How long the patient is expected to need the PRN medicine, where appropriate

Where there is more than one option available (e.g. multiple painkillers), it should be made clear when it is appropriate to use each one.

Administration Administration must be in line with the relevant Trust policy and the guidance contained within the Nursing Associate Medicines Policy. Where a PRN dose is unclear, clarification should be sought from the Registered Nurse and where appropriate, the prescriber, before administration. If Nursing Associates are unsure of the quantity to administer, the Registered Nurse should be consulted for clarification. Monitoring When a PRN medication is in use, the patient should be monitored and reviewed regularly to ensure use is still appropriate. The following observations may indicate a review is required and the Registered Nurse should be consulted for further advice:

The patient appears to be experiencing side effects

The resident appears to derive no benefit from the medication

The resident’s condition has deteriorated

The resident is requesting the PRN medication more frequently

The resident rarely requests or regularly declines the PRN medication

To determine the on-going clinical need the prescriber/medical team must regularly review ‘PRN’ medication - the medication could be stopped or it may be necessary to alter this to a regular daily dose. The outcome of the review should be documented in the care plan. The patient should be monitored in case symptoms re-occur and requires further review from Registered Nurse / prescriber.