Faculty of Education, Health & Sciences School of Health Advanced Diploma in Nursing Studies Programme Administration of Medicines Policy for Student Nurses Originator(s): Programme Team Applicable To: Students on the BSc (Hons) Nursing Adult and Mental Health Approved by: Programme Management Team Practice Partnership Group Ratified by: Richelle Duffy Assistant Subject Head Equality Impact Assessment N/A Implementation from: 30th April 2010 Review date: 30th April 2013 Administration of medicines policy – final version 1st April 2010, reviewed 30th April 2011 BJP Page 1 INTRODUCTION Nurses, during training, need to be prepared to begin to take on their professional responsibilities at the conclusion of that training period. The Nursing and Midwifery Council (2008a pg2) in their Standards for medicines management identify that “The administration of medicines is an important aspect of the professional practice of persons whose name is on the Nursing and Midwifery Councils register.” The safe and secure handling of medicines is a complex process underpinned by legal, professional and employer frameworks and requiring extensive knowledge and skill in its delivery. The NMC Code (2008b) identifies that registered nurses are personally accountable for their actions and omissions in practice and must always be able to justify their decisions. This over arching statement will necessitate that during the administration of medicines patients/clients must be treated and cared for in such a way as to maintain their: safety continuity of treatment and care respect and dignity contact with appropriate staff, relatives and carers confidentiality of information on a need to know basis POLICY AIM(S) To set the standards, for safe practice in the management and administration of medications, for student nurses. The aims of this policy are to ensure that: 1. patients/clients needs are safeguarded 2. the clinical accountabilities of the mentor and student nurse in respect of the administration of medicines are transparent 3. learning opportunities for student nurses are explored, utilized and monitored appropriately RATIONALE Medications are now available for administration in many different formulations and via multiple routes. Independent and supplementary prescribers not only exert their professional judgement in their choice of medication for their patients/clients but are guided through a range of laws and policies issued via government agencies eg Medicines Act (1968) Misuse of Drugs Act (1971), National Institute for Clinical Excellence (NICE). Whilst the route of administration will depend on availability, cost, speed and mode of action, the condition being treated and the recipients ability and/or tolerance of the route chosen. Consequently students have to be aware that the administration of medicines ‘is not solely a mechanistic task to be performed in strict compliance with the written prescription of an independent or supplementary Administration of medicines policy – final version 1st April 2010, reviewed 30th April 2011 BJP Page 2 prescriber. It requires thought and the exercise of professional judgement.’ (NMC 2008a pg2) The NMC (2008c) in the standards to support learning and assessment in practice, identify that mentors are responsible and accountable for: organizing and co-coordinating student learning activities in practice. supervising students in learning situations and providing them with constructive feedback on their achievements. setting and monitoring achievement of realistic learning objectives The University of Derby Advanced Diploma in Nursing Programme encourages clinical environments to explore and develop, within acceptable parameters such as laid out in this policy, suitable learning opportunities for student nurses placed with them. Students will throughout their training undergo three summative assessments on numeracy, drug calculations and the administration of medicines Individual Trusts may also have their own policies on the issues relating to the administration of medicines and their management, these must also be considered and adhered to. Mentors need therefore to be able to ensure that the well being of patient/clients during any medicines administration together with their employment requirements are addressed, whilst there responsibilities towards student nurses are also acknowledged. Student nurses also need to be aware of the NMC (2009) guide to practice which whilst carrying similar care requirements to that of the registered nurse specifically identifies that students recognize and stay within the limits of their competence. APPLICATION OF POLICY Students are prepared from the first theory module on the administration of oral medicines, with instruction in the administration of intramuscular and subcutaneous injections occurring later in the first year of training. Throughout the three year programme these skills are revisited periodically and other routes of medicines administration explored eg topical, eye, ear. Appreciation of the wider professional and legislative frameworks that support the administration of medicines are introduced and explored throughout the three year programme. Students competence in the numerical and administrative aspects of medicines administration is also summatively assessed during the first year and subsequent years of the programme. A specific assessment in third year, focuses on patient group direction (PGD). Students, if judged to be competent by the registrant, may actively participate in the administration of the following medication, providing these are subject to a patient specific direction (PSD). Administration of medicines policy – final version 1st April 2010, reviewed 30th April 2011 BJP Page 3 Oral Topical Transdermal Instillation of eye drops/ointment Instillation of ear drops/ointments Intramuscular injections Subcutaneous injections The NMC (2009 pg2) clearly identify that ‘student nurses CANNOT supply and/or administer under a patient group direction(PGD), but that they would be expected to understand the principles and should be involved in the process.’: Students and registrants are advised that: During training students are NOT able, nor should they be expected, to administer medications out with those specifically identified above, which ALL MUST be subject to a patient specific direction. A registered nurse / midwife should supervise the student with the administration of medications at all times If the student administers any medication it must be signed for by both the student and the Registered nurse. As the registered nurse / midwife remains accountable for all administrations. In learning environments where staff other than registered nurses / midwives administer medication the student may observe but not administer medications. If the registered nurse / midwife does not feel able to take responsibility for a student to administer medications then the student should not partake. The student and mentor should explore alternative learning opportunities. All students should be aware of the NMC Code - Standards of conduct, performance and ethics for nurses and midwives (2008b); NMC Standards for medicine management (2008a) and the NMC Guidance on professional conduct for nursing and midwifery students (2009). Therefore if at any time a student does not feel prepared to participate in medication administration the onus is with the student to decline. If a clinical learning environment’s local policy prohibits student’s involvement in medication administration the students should not be involved. The student and mentor should explore alternative learning opportunities. Students and registrants are reminded that the scope of situations encompassed within the administration of medicines is potentially wide. Consequently they are referred to the definition of what a medicinal product is taken from the NMC (2008a pg3) Standards for medicine management. “Any substance or combination of substances presented for treating or preventing disease in human beings or in animals. Any substance or combination of substances which may be administered to human beings or animals with a view to making a Administration of medicines policy – final version 1st April 2010, reviewed 30th April 2011 BJP Page 4 medical diagnosis or to restoring, correcting or modifying physiological functions in human beings or animals.” Controlled Drugs Students may participate, in most instances*, with the checking and administration of controlled drugs under the supervision of a registered nurse. The student nurse’s signature must always be countersigned by the registrant. However, please check with individual Trust policy. * see NMC (2008a) Standards for medicines management (standard 8) Subcutaneous and Intravenous infusions Student nurses may observe and assist practitioners i.e. as assistant in delivery of aseptic care, with the insertion of cannulae for the administration of any infusions. At NO point in their training may students insert such cannulae themselves. Standard 20 of the medicines management (NMC 2008a pg9) identifies that ‘whenever possible two registrants should check medication to be administered intravenously, one of whom should also be the registrant who then administers the IV medication.’ Student nurses can, if deemed competent and in line with local policies, and under the supervision of a registrant ‘run through’ infusion giving sets for registrants to connect. Student nurses can, if deemed competent and in line with local policies , and having carried out the relevant checks under the supervision of a registrant, and with the registrant in attendance at all times, change infusion bags. NB: during the branch programme students on the adult branch will undergo a summative assessment in a practice environment on the monitoring and assessment of patients/clients receiving intravenous fluids Blood transfusions Whilst blood is not classified as a medicinal product some blood components are eg clotting factors, albumin and antibodies. However guidance by the National Patient Safety Agency (2006) identifies that all staff involved in blood transfusion should undergo formal competency assessment on a three yearly basis. Consequently student nurses MUST NOT be actively involved in any aspect of either the collection or establishment of blood transfusions. MONITORING POLICY Students are reminded that their conduct, skills and professionalism, which include an ability to adhere to policy requirements and recognize ones own limitations, are part of the formative and summative assessment processes for each clinical placement. University staff will monitor adherence to policy requirements. This will occur when visiting students in placement areas and through interactions with mentors. It is also Administration of medicines policy – final version 1st April 2010, reviewed 30th April 2011 BJP Page 5 maintained through formal and informal interactions with students eg during tutorials, discussion groups and via written work. Compliance with this policy will be monitored by both, the University and Trusts, through reports of any incidents. POTENTIAL REPERCUSSIONS Failure to comply with this policy will be regarded seriously and steps may be taken to invoke disciplinary measures. Administration of medicines policy – final version 1st April 2010, reviewed 30th April 2011 BJP Page 6 REFERENCES National Patient Safety Agency (NPSA) (2006)Right Patient Right Blood (Safer practice notice 14) [online] available at http://www.nrls.npsa.nhs.uk/resources/?entryid45=59805 NMC (2008a) Standards for medicines management. London. NMC NMC (2008b)The Code: Standards of conduct performance and ethics for nurses and midwives. London. NMC NMC (2008c) Standards to support learning and assessment in Practice. London. NMC NMC (2009) Guidance on professional conduct for nursing and midwifery students. London. NMC NMC (2009) Supply &/or administration of medicine by student nurses and student midwives in relation to Patient Group Directions (PGDs) NMC circular 05/2009 Accessed online at: http://www.nmc-uk.org/aArticle.aspx?ArticleID=3552 Administration of medicines policy – final version 1st April 2010, reviewed 30th April 2011 BJP Page 7