Policy for Ordering, Prescribing and Administering Medicines (POPAM)
SECTION 4
Nurses General Instructions
4.1 The NMC guidelines for the Administration of Medicines (2004) states:
“The Administration of medicines is an important aspect of the professional practice of persons whose names are on the Council’s register. It is not solely a mechanistic task to be performed in strict compliance with the written prescription of a medical practitioner, independent/supplementary prescriber. It requires thought and the exercise of professional judgement which is directed to assisting in assessing the efficacy of medicines and the identification of side effects and interactions.”
The practitioner will be satisfied that he/she:
- has an understanding of the medicine’s use for therapeutic purposes
- is able to justify any actions taken
- is prepared to be accountable for the action taken.
4.2 It is the responsibility of the ward manager to ensure that procedures in POPAM are followed by all nurses working in the ward and department.
4.3 Nurses must not write up or rewrite prescription charts (unless Nurse Prescribers acting in their own area of competence).
4.4 Under no circumstances is a nurse allowed to supply medicines directly from the ward stock when a patient is discharged. However, Dispensed From Ward (DFW) special stock may be supplied on discharge by nurses under a Protocol (with similar sections to Patient Group Directions).
4.5 Nurses must not transfer medicines from one container to another or write drug names on containers.
4.6 A nurse must not administer a medicine if he/she regards the prescription to be incorrect. Clarification must be sought from the prescriber, the pharmacist or the consultant to ensure the medicine is correctly prescribed.
4.7 All registered nurses holding a valid NMC PIN may undertake drug administration, provided the ward manager or deputy has agreed that they are competent to do so. This may include:
Bank Nurses
Agency Nurses
Nurses returning to practice
Newly qualified nurses
4.8 In the following situations a second nurse (including student nurses), doctor or pharmacist is required to check all aspects of the drug administration. Health care assistants are not allowed to check.
Administration of drugs to children under 12
Administration of controlled drugs
Administration of drugs where calculation, dilution or weight related doses are required
Administration by the intravenous route, epidural or intrathecal route is required (excluding students)
Administration by intravenous route will be checked by two nurses to ensure correct medicine, but may be administered by one nurse.
Administration by intramuscular or subcutaneous route may only involve one nurse in the process.
4.9 A record must be made of each administration and the administering nurses must be identified.
The ward manager will keep a record of initials and signatures of all current staff who may administer medicines within their ward.
4.10 For administration of continuous or intermittent infusions a record will be kept of those involved in setting up the infusion.
4.11 When such infusions are prepared on the ward, these must be prepared immediately before use and should be administered by the nurse preparing the drug.
The solution to be infused must be correctly labelled with the patient’s name..
Name and dose of the drug added.
Name of the diluent
Date and time prepared
Date and time of expiry
Time of administration
Signatures of the nurses preparing and checking the solution
Note: Batch numbers of cytotoxic drugs must be recorded on the IV infusion chart or cytotoxic chart.
4.12 When the nurse gives discharge medication to the patient:
· The TTO must be checked against the current ward prescription, in case changes have been made after the discharge prescription was written.
· The patient should understand the function, dose, frequency and any cautions of each medicine.
· On wards that have one stop dispensing schemes in operation and are permitting nurse led discharge, nurses must have completed the workbook and training associated with one stop dispensing before being allowed to do discharges at ward level (see section 21). (Workbooks & nurse led discharge policy)
4.13 Hospital inpatients with documented allergies including medicines, should wear readily distinguishable wrist bands on which all allergies should be included. See Trust’s Red Wrist Band Policy.
4.14 When patches containing medicines are prescribed, all patches of the same medicine must be removed before the new patch is put on.
4.15 Oral not IV syringes must be used, where appropriate, to administer medicines via oral and other enteral routes. See NPSA Safety Alert 19 March 07.
4.16 Medicine Waste. See Trust Medicine Waste Policy, when finalised.
4.17 Loading Doses:
Reports to the NPSA have identified potential risk when loading doses are prescribed and administered as well as when maintenance treatment is continued.
In order to alert anyone administering a loading dose all prescriptions for loading doses must include “loading dose” in the instructions on the prescription. Additional information about how to calculate and administer loading doses of a range of high risk medicines is given in the Loading Dose section within the Pharmacy homepage on the Trust intranet.
November 2011