Mandatory Competency Assessment for Medicines Management (Not Injectable Medicines) for Registered Practitioners
‘IN HOSPITAL’
Document Author / Authorised SignatureWritten by: Lead Pharmacist/Lead Technician
Medicines Use and Safety Team,
Pharmacy Department
Date: September 2015 / Authorised by: Head of Practice Education and Development
Date: September 2015
Effective Date: October 2015 / Review Date: October 2017
Approval at: Clinical Competency Group and Mandatory Training Group / Date Approved: September 2015
DOCUMENT HISTORY
(Procedural document version numbering convention will follow the following format. Whole numbers for approved versions, e.g. 1.0, 2.0, 3.0 etc. With decimals being used to represent the current working draft version, e.g. 1.1, 1.2, 1.3, 1.4 etc. For example, when writing a procedural document for the first time – the initial draft will be version 0.1)
Date of Issue / Version No. / Date Approved / Person Responsible for Change / Nature of Change / Ratification / Approval
October 2015 / 1.0 / September 2015 / Clinical Competency Group/Mandatory Training Group
March 2016 / 1.1 / Donna Baker / Frequency amended to reflect the annual assessment component of the Medicines Policy
‘Nursing staff in the best interests of their patients must know the therapeutic uses of the medicine to be administered, normal dosage, side effects, precautions and contraindications. They must have considered the dosage, method of administration, route and timing of the administration in context of the patient’s condition, co-existing therapies and meals’ (NMC, Standards for Medicines Management 2010).
The core mandatory assessment requirements for Medicines Management ‘IN HOSPITAL’ are applicable to the following practitioners:
NEW REGISTERED PRACTITIONERS OR EXISTING PRACTITIONERS WHERE MEDICINES MANAGEMENT IS NEW TO THEIR ROLE ARE TO COMPLETE ALL THE REQUIRED ELEMENTS BELOW PRIOR TO UNDERTAKING MEDICINES MANAGEMENT UNSUPERVISED.
EXISTING REGISTERED PRACTITIONERS WHERE MEDICINES MANAGEMENT IS PART OF THEIR ROLE ARE TO COMPLETE THE REQUIRED ELEMENTS ON AN ANNUAL BASIS.
REQUIRED ELEMENTS:
1. Ward based ‘IN HOSPITAL’ Competency Assessment for Medicines Management (this document)
2. E Learning Training Tracker Module for Medicines Management
a) Clinical Medicines Scenarios – 100%
b) Maths and Medicines Calculations - 100%
IF REQUIRED
3. Electronic Prescribing and Medicines Administration system (EPMA) training commonly referred to as “JAC” Medicines Management system, if in use on the ward.
4. Electronic Medicines Storage Cabinet training (e.g. Omnicell and MDG Cabinet) if the electronic medicines storage cabinet is in use on the ward.
Learning outcome 1Safely & Effectively Administer Medicines (not injectable medicines) / Registered practitioners (RP) to be observed undertaking administration of medicines to 4 different patients covering a minimum of 4 different formulations
1. Observed administration of medicines (not injectable medicines)
1.1 Using the electronic or paper drug chart the RP must satisfy the assessor that: / 1
patient / 2 / 3 / 4 / Assessed as competent
Signature
· the correct drug chart is being used for the correct patient
· the whole drug chart has been checked (to identify prn, stat doses & range of doses) e.g.to check if once only doses have, or have not been administered e.g. methotrexate, or to ensure that prn medicines e.g. paracetamol, are administered within recommended maximum dose/dose range
· the patient’s allergies have been considered
· the patient’s weight has been considered (if necessary)
· identify if other drug /recording charts are being used for that patient e.g. warfarin, insulin
· identify which medicines are to administered at that time
1.2 The assessor witnesses the RP with the patient: / 1
patient / 2 / 3 / 4 / Assessed as competent
Signature
· asks the patient to confirm identity (wrist band and verbally) full name & DOB (or according to Patient Identification policy)
· asks the patient about allergies or sensitivities
· explains details of medicines to be administered
· obtains patient consent
1.3 The assessor witnesses the RP selecting the medicine for administration (the medicine label must correspond to the prescription) / 1
patient / 2 / 3 / 4 / Assessed as competent
Signature
· the correct medicine
· the correct strength and dose
· the correct formulation
· the correct frequency/time
· the correct route
· the medicine has a valid expiry date
1.4 RP is able to demonstrate /explain where to obtain information about a medicine e.g. dose, contraindications, side effects, how to prepare the medicine, route, drug interactions and obtaining stock RP to include the following: / Assessed as competent
Signature
· Intranet- Medusa & Electronic Medicines Compendium (EMC)
· medicine pack insert
· in date BNF/ web BNF
· JAC clinical information on
· ward pharmacy team
· on call pharmacist (out of hours)
· bed manager (out of hours)
1.5 RP is able to demonstrate completion of administration of medicine/s : / 1
patient / 2 / 3 / 4 / Assessed as competent
Signature
· observes the patient taking/using the medication
· documents administration on JAC/Paper prescription
· orders a specific medicine using ‘resupply orders’
· can explain process when delaying or omitting a prescribed medicine
· demonstrates disposal of equipment/waste medicines
1.6 RP is witnessed administering a selection of formulations during assessment; tick preparations/routes assessed
*mandatory / 1
patient / 2 / 3 / 4 / Assessed as competent
Signature
· Oral tablet
· Dispersible tablets*
· Liquid- oral syringe/spoon/medicine measure*
· Inhalers*
· Cream/ointment
· Eye drops/ointment*
· Rectal – suppositories
· Vaginal - pessaries
· patch
· Nebules*
· Sublingual
· Others please state:
1.7 RP to explain what action to take if they are unable to administer a prescribed medicine to include: / Assessed as competent
Signature
· if a patient is unable to swallow (determine reason e.g. size of table, refer for SALT assessment, refer to doctor for review form of medication)
· if a medicine is not available(contact pharmacy, bed manager- out of hours ,prescriber) there should be NO delay, especially with critical medicines)
· patient unable to tolerate
· nurse unable to give by prescribed route (contact prescriber without delay)
1.8 RP is witnessed administering a subcutaneous injection (tick boxes 1.1 – 1.8) / 1
patient / 2 / 3 / 4 / Assessed as competent
Signature
· demonstrates ability to select appropriate equipment with rationale for us
· prepares the medicine for injection appropriately
· identifies correct patient, explains procedure, checks any contraindications, potential side effects and obtains valid consent
· demonstrates ability to ensure correct administration technique of the medicine via the subcutaneous route in the prescribed site
· demonstrates understanding of the anatomy and physiology of sites used for injection technique
1.9 RP is witnessed administering an intramuscular injection / 1
patient / 2 / 3 / 4 / Assessed as competent
Signature
· demonstrates ability to select appropriate equipment with rationale for use
· prepares the medicine for injection appropriately
· identifies correct patient, explains procedure, checks any contraindications, potential side effects and obtains valid consent
·
· demonstrates ability to ensure correct administration technique of a medicine via the intramuscular route in the prescribed site safely
· demonstrates understanding of the anatomy and physiology of sites used for injection technique
1.10 RP to demonstrate the correct procedure for administering Controlled Drugs ( including appropriate record keeping) / Assessed as competent
Signature
· preparation and administration (must be carried out by two RPs )
· how to ensure security of the CD cupboard
· how to complete a stock balance
· use of electronic medicines storage cabinet for ‘supplementary restock’ and ‘cycle counts’( if in use on ward)
1.11 RP to demonstrate correct process to follow when administering and documenting Oxygen therapy / 1
patient / 2 / 3 / 4 / Assessed as competent
Signature
· flow rate and duration
· appropriate percentage according to patient’s saturation rate
· appropriate device used
· correct documentation
· what action to take if oxygen not prescribed and patient requires oxygen
1.12 RP to demonstrate/explain how to prescribe/administer Homely Remedies on JAC or paper prescription chart / Assessed as competent
Signature
· which medicines can be given( paracetamol, Gaviscon Advance, simple linctus, senna, lactulose and aqueous cream)
· check for contraindications
· correct procedure for administering medicines
· length of time these medicines can be administered before review (24hours)
1.14 RP to explain the use of a Patient Group Direction (PGD) and records required / Assessed as competent
Signature
· explains when are they used
· explains who can use them
· explains appropriate recording/documentation
1.15 RP to explain the process to initiate and monitor a patient on the Self Administration of Medicines Scheme (SAM) the following should be mentioned: / Assessed as competent
Signature
· patient assessment
· SAM levels
· consent
· only medicines reconciled(checked by pharmacy)can be used
· medicines not suitable to self-administer
· key security
· Medicines Information Card/JAC administration chart
· where to store medicines
· nurse responsibility for monitoring patient (mention deteriorating patient and withdrawal from scheme)
Learning outcome 2
Medicines Safety
2.0 Medication errors and patient safety
2.1 RP to define the following: / Assessed as competent
Signature
· Medication errors: are incidents in which there has been an error in prescribing, dispensing, preparing, administering or monitoring, regardless of whether harm has occurred
· Near miss: are incidents that did not cause harm but which are judged to have had the potential to cause harm
2.2 RP to explain what process to follow upon discovery of a medication error (including near miss)
· complete incident on electronic incident report ‘Datix’
· the ‘Management of medication related incidents’ protocol (see Intranet)must be followed
2.3 RP to explain how they would manage the following: / Assessed as competent
Signature
· Adverse drug reaction(preventable and non-preventable)(MHRA- Yellow Card Scheme)
· a missed dose
· a patient sensitive to prescribed medicine (e.g. upset stomach)
· no stock of the first dose antibiotic
· incorrect stock balance of a Controlled Drug
· a patient has been given two doses of Paracetamol within 1 hour by a colleague
· a discovery of a ‘near miss’
· you have given a medicine to the wrong patient
Learning outcome 3
Order, Receive, Store, Transfer and Dispose of Medicines
3.1 RP is able to demonstrate/explain the process for ordering, receiving and storage of urgent medicines used on the ward including : cardiac arrest, anaphylaxis, intubation boxes. / Assessed as competent
Signature
· which packs are stocked on your ward?
· when are they used?
· where are they stored?
· how are they ordered?
3.2 RP can demonstrate/explain the correct process for ordering, receiving and storage of ward stock medicines / Assessed as competent
Signature
· urgent medicines for cardiac arrest , anaphylaxis, extravasation, intubation and neonatal resuscitation boxes
· order a ward stock item for Top Up and Non Top up wards ( use stock item request form or green stock profile order folder)
· request a new stock item by using the ‘New Stock Request’ form
· receiving medicines on to a ward including signing transportation of medicines register
· ‘returning’, ‘supplementary re -stock ‘and ‘cycle count’ for medicines using the electronic medicines storage cabinet, if in use on ward
· storage of the following ward stock:
Intravenous fluids - should be stored off the floor in their original containers in a designated area/electronic medicines storage cabinet
medicines for internal use
medicines for external use
diagnostic reagents
medical gases
3.3 RP to explain the correct storage and documentation requirements for refrigerated medicines: / Assessed as competent
Signature
· demonstrate/explain daily temperature monitoring and recording (using an electronic max/min thermometer to maintain temp between 2-8 0C or electronic display on automated fridges) or web monitoring (electronic medicines storage cabinet)
· action to be taken following disconnection of electrical supply or refrigerator breakdown
· action following the discovery of medicines that have not been stored in recommended conditions
3.4 RP can demonstrate the process for ordering, receiving and storage of named patient medicines / Assessed as competent
Signature
· ordering medicines for named patients
· receiving medicines in secure green pharmacy bag, checking and signing transportation of medicines register
· storage of the following:
insulin
unopened eye drops
dosette box (patient’s own medicines)
oral tablets
3.5 RP can demonstrate/explain correct procedures for dealing with the following: / Assessed as competent
Signature
· Expired medicines
· Lost/missing medicines
· Returns to pharmacy
· Disposal of medicines (see Trust Waste Policy)
· Medicines on death of a patient
3.6 RP can demonstrate the process for ordering, receiving, returning and storage of Controlled Drugs to include: / Assessed as competent
Signature
· ordering a Controlled Drug for stock
· receiving stock Controlled Drugs
· storing and stock checking process for Controlled Drugs
· returning Controlled drugs to Pharmacy including documentation
· how to obtain supplies of Controlled drugs out of hours
· explain the process for dealing with discrepancies in ward stock levels of Controlled Drugs
· why a Controlled Drugs record book needs to be used on the ward (include requirements for documentation)
· how to manage patient’s own Controlled Drugs brought into the hospital
· process for managing Controlled Drugs when a ward or clinical area is closed or transferred to another clinical area
Learning outcome 4
Managing Discharge and Transfer of Medicines
4.1 Registered practitioners can explain the procedure for managing medicines for discharge (TTOs)including timescales / Assessed as competent
Signature
· check the medicines: right drug, right patient, right strength, right route, right time (including any medicines stored in the fridge or electronic medicine storage cabinet or Controlled Drugs cupboard)and sufficient quantity(14 days)
· patient assessed on knowledge and ability to self-medicate on discharge
· patient receives appropriate information (e.g. copy of discharge summary, treatment cards) regarding their discharge medicines
· patient given follow up appointments for monitoring of high risk medicines (e.g. warfarin)
· appropriate discharge paperwork is completed
· RP can explain how to arrange discharge medicines for a patient out of hours
4.2 Registered practitioners can demonstrate/explain the procedure for patients being discharged on Controlled Drugs. (the following should be mentioned) / Assessed as competent
Signature
· CD prescription sent to Pharmacy
· sign out of the CD record book any medicines belonging to patient to be used for discharge
· patient counselled on discharge medicines
· If discharge is to be delayed then CDs should be entered into the CD register and locked in electronic medicine storage cabinet or CD cupboard as appropriate, until patient is discharged e.g. overnight
4.3 Registered practitioners can demonstrate/ explain the procedure for the transfer of patient’s medicines to another ward area / Assessed as competent
Signature
· check and place all patient medicines from patient’s own lockable bedside cabinet into a ‘My Medicines’ Green bag
· check for medicines stored elsewhere e.g. in fridge or electronic medicine storage cabinet or CD cupboard that are needed for patient on next ward
4.4 Registered practitioners can demonstrate the process for issuing TTO packs from wards and clinics (see also section 1.3) / Assessed as competent
Signature
· after checking the patient’s identity, date of birth and address, assemble appropriate TTO medicines pack/s according to the (electronic) prescription
· insert patient name in the space provided on the label and complete date of issue (if using an ‘over the counter’ pack this step can be omitted)
· insert administration instructions if not already present on the label according to the prescription
· obtain second check from another RP
· complete appropriate paperwork
· complete identity checks, sensitivities and allergies before issuing the medicine
· Give the patient full verbal instructions on taking the medicine and make patient aware of information leaflet inside the pack.
· If paper prescription is used, place the pink copy of the triplicate form with GP’s letter and give to the patient.
· Send completed paper prescription to Pharmacy for filing
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