MMComp4–V02–Issue1

RatifiedMMC-Sept2016–IssuedOct16Review-July2019

ManagementandAdministrationofAnti-CoagulantMedicationCompetencyAssessment

ForRegisteredNursesBand5andaboveTobecompleted3yearly

EmployeeNameJobTitle

PlaceofWork

AssessorNameDateofAssessment

Knowledge

PerformanceCriteria / AssessmentMethod / MeetsStandard
() / DoesNotMeetStandard
() / Comments
1.1Thenursecandescribethetherapeuticuseofanti-coagulantmedication;oralanticoagulants,includingNoveloralanticoagulants(NOACS)andlow-molecularweightsubcutaneousheparins. / VerbalDuringInterview
1.2ThenursehasanunderstandingofInternationalNormalisedRatio(INR);therapeuticrangeandtheimpactofanti-coagulantsuponINRlevels. / VerbalDuringInterview
1.3ThenursecanstatenormaldosageofeachmedicinetobeadministeredandrelatethistoINRresults.ThenursecandescribetheimportanceofcheckingINRresults / Verbal
MedicationRound
1.3ThenursecanstatethemostcommondruginteractionswithWarfarinincludingherbaldrugs,cranberryjuiceetc
ReftoBNF / VerbalDuringInterview
MedicationRound
1.4A)Thenursecanstatethemajorcautions/sideeffectsandsignstomonitorwhilstindividualsarereceivinganti-coagulanttherapy;including,bruising,yellowingofskin/eyes(jaundice)andbloodinstools/urine.
B)Thenursecandescribewhattodoifaboveevident. / Verbal
DuringInterview
MedicationRound
Verbal
1.5Thenursecandescribetheneedforthemedicationinthecontextoftheserviceuser’scareplanincludinganyrequirementsofconsenttotreatment
DuringInterview
MedicationRound

2AdministrationofOralAnti-Coagulants

PerformanceCriteria / AssessmentMethod / MeetsStandard
() / DoesNotMeetStandard
() / Comments
2.1Thenurseidentifiestheserviceusercorrectly / ObservationDuringMedicationRound
2.2Thenursecheckstheserviceuser’sallergystatus–withparticularattentiontoWarfarinallergy / ObservationDuringMedicationRound
2.3Thenursechecksthattheserviceuserisnotexperiencinganyadverseeffectsthatmaysuggestthedoseiswithheldprthetreatmentisdiscontinued.Ifthisissuspectedthenursemustdiscusswithamemberofthemedicalteam / ObservationDuringMedicationRound
2.4Thenursechecksthatthemedicationhasnotalreadybeenadministeredtothepatient;checkingprescriptionsheetandwithpatientifpossible. / ObservationDuringMedicationRound
2.5Thenursechecksthattheprescriptionislegibleandvalid / ObservationDuringMedicationRound
2.6Thenurseidentifiesthenameofthemedication / ObservationDuringMedicationRound
2.7Thenursechecksthetimeofadministrationofmedication / ObservationDuringMedicationRound
PerformanceCriteria / AssessmentMethod / MeetsStandard
() / DoesNotMeetStandard
() / Comments
2.8Thenursecheckstherouteofadministrationofmedication / ObservationDuringMedicationRound
2.9Thenursechecksthedoseofeachmedication
NB–ForpatientswithanINRthatisnotwithinrangeorrequiresfrequentINRchecksduetoinstabilityorhasnotreachedatherapeuticdose;sochangesdosagesonaregularbasis;theprescriptionsheetmustbecrossreferencedtoanticoagulantchart,toensurecorrectdoseisadministered.
IftheserviceuserisstablethenthemedicationdosewillbewrittenontheKardexaswithanyothermedication
TheINRresultmustbewithintargetrangefortheserviceuser.ThenursemustalwaysconsultwiththedoctoriftheINRrangeisouroftargetrangeasthedosemayneedtobewithheldortreatmentdiscontinued / ObservationDuringMedicationRound
2.10Thenursecheckstheexpirydateofeachmedication / ObservationDuringMedicationRound
2.11Thenursepreparesthedosagecorrectlywhenadministeringanti-coagulantmedication
NB–Warfarinisavailableinthreestrengthsoftabletswhicharecolourcodedasfollows(theshadesofcolourmayverydependantonthemanufacturers.Somepharmacydepartmentsdonotstock5mgtablets)
1mg=Brown
3mg=Blue / ObservationDuringMedicationRound
2.12Thenursemakesaclear,accurateandimmediaterecordofallmedicationadministered,intentionallywithheldorrefusedbytheserviceuser / Observation

3AdministrationofInjectableHeparins(e.g.TinzaparinSodium)

PerformanceCriteria / AssessmentMethod / MeetsStandard
() / DoesNotMeetStandard
() / Comments
3.1Thenurseidentifiestheserviceusercorrectly / ObservationDuringMedicationRound
3.2Thenursecheckstheserviceuser’sallergystatus / ObservationDuringMedicationRound
3.3Thenursechecksthattheserviceuserisnotexperiencinganyadverseeffectsthatmaysuggestthedoseiswithheldorthetreatmentisdiscontinued.Ifthisissuspectedthenursemustdiscusswithamemberofthemedicalteam / ObservationDuringMedicationRound
3.4Thenursechecksthatthemedicationhasnotalreadybeenadministered / ObservationDuringMedicationRound
3.5Thenursechecksthattheprescriptionislegibleandvalid / ObservationDuringMedicationRound
3.6Thenurseidentifiesthenameofthemedication / ObservationDuringMedicationRound
3.7Thenursechecksthetimeofadministrationofmedication / ObservationDuringMedication
Round
3.8Thenursecheckstherouteofadministrationofmedication / ObservationDuringMedicationRound
3.9Thenursechecksthedoseofthemedication,ensuringarecentweighthasbeenused. / ObservationDuringMedicationRound
3.10Thenursecheckstheexpirydateofeachmedication / ObservationDuringMedicationRound
3.11Thenursepreparesthedosagecorrectlywhenadministeringanti-coagulantmedication / ObservationDuringMedicationRound
3.12Beforeadministeringmedicationthenursecheckstheyhavethecorrectpatient;Thenurseensuresthattheserviceuserunderstandstheprocedureandobtainsconsent. / ObservationDuringMedicationRound
Theinjectionwillbeadministeredtotheserviceuserbyacompetentnursefollowingprocedurebelow;
3.13Whereadministeringthefulldosefromthepre-loadedsyringesintendedforsubcutaneousadministrationthereisnoneedtoexpeltheairfromthesyringeasthisactsasa‘pocket’beneaththeskin / ObservationDuringMedicationRound
3.14Fordoseslessthanafullsyringeallairshouldbeexpelledalongwiththeexcessvolumeofthesolutionleavingthevolumerequiredinthesyringe.Thereisnoneedtore-introducetheairbubbleintothesyringe / ObservationDuringMedicationRound
3.14Thenursewillbecompetentinadministeringinjectionsandbeabletoidentifyandlocatetheappropriatesubcutaneoussiteas / Discussionobservation
perpolicy;PPT03AdministrationofSubcutaneousinjections
3.15Theinjectionshouldbeinjectedsubcutaneouslyintotheabdomensincethisisthethickestsubcutaneouspad,whichreducestheriskofpuncturingtheunderlyingmuscle.
(Acircumferenceof1incharoundthenaval/bellybuttonmustbeavoided)
RefertoPPT03AdministrationofSubcutaneousinjections / ObservationDuringMedicationRound
3.16Serviceuserswillbeobservedfor10minutespostinjectionforpossibleanaphylaxisorcomplications. / ObservationDuringMedicationRound
3.17Thenursemakeaclear,accurateandimmediaterecordofallmedicationadministered,intentionallywithheldorrefusedbytheserviceuser / ObservationDuringMedicationRound
3.18Thenursecandescribeanddemonstratesafedisposaloftheequipmentusedinadministration / ObservationDuringMedicationRound
VerbalVerbalObservation
Documentation
3.19Thenursewilldocumentinprogressnotesand“Yellowmonitoringbook”,asrequiredandensurethatAllpatientshaveacomprehensivecare/treatmentandmonitoringplan;alllongtermmonitoringarrangementswillbecommunicatedtostaff/carer/patientontransferordischarge.
AssessorsComments:
Signature: / Date:
NursesComments:
Signature: / Date:

ActionPlan

Action / DatetobeAchieved / DateofRe-assessment / Outcome / Signature

CertificateofCompletion

Thisistocertifythat

Hassuccessfullycompletedthe

ManagementandAdministrationofAnti-CoagulantMedicationCompetencyAssessment

SignatureofAssessorDate