BSc NURSING (Academic year 2015/2016) MEDICINE ...

School of Nursing and Health Sciences, University of Dundee. Revised AUGUST 2015 FP 1

BScNURSING(Academicyear2015/2016)

MEDICINEADMINISTRATION

WORKBOOK(YEAR3)

STUDENT’SNAME: CLASS:SEP13

PERSONAL TUTOR’S NAME/SIGNATURE (Signature required for year 3 portfolio

oncethestudenthascompletedparts1,2and3ofthisworkbookbyMay2016):

………………………………………………………………………. DATE:

MENTOR(S)NAMES(S)andSIGNATURE(S):

……………………………………………………………………… DATE:

ToconfirmthatMentorisawareofthestudent’sparticipation/responsestothe

activitiesinpart3oftheworkbook.


CONTENTS

Introductiontoworkbook Page2

Guidanceforstudents Page3

Year3OSCE Page4

Timeframesforcompletingtheworkbook Page5

Guidanceformentorsandpersonaltutors Page6

Learningoutcomes Page7

SECTION1 Page8

SECTION2 Page19

SECTION3 Page26

REFLECTIVESTUDY Page36

INFORMATIONSOURCES Page37

PERSONALNOTES Page38


INTRODUCTIONTOWORKBOOK

Medicinesarepowerful tools in treatment that, ifused improperly,arepotentially

dangerous. The safety and handling of medicines are of great importance to the

registerednursewhoisrequiredtobeabletoaccountforamedicinefromthetime

ofordering through to theadministration toapatient. As a senior studentnurse

youmustacknowledgethe limitsofyourdevelopingprofessionalcompetenceand

obtainhelpandsupervisionfromacompetentpractitioneruntilyouhaveacquired

your registration and the requisite knowledge and skill. The Code: Professional

standardsofpracticeandbehaviorfornursesandmidwives(NMC2015)states‘The

Code containsa seriesof statements that taken together signifywhatgoodnursing

andmidwiferypractice looks like. Itputs the interestsofpatientsand serviceusers

first, is safeandeffective,andpromotes trust throughprofessionalism.”TheCode is

relevant to all aspects of practice, including medicine administration and

management. Please familiarise yourselfwith the Code, and in particular, refer to

thespecificinformationinsection18.Additionally,re‐readtheinformationfromthe

NMCStandardsforMedicinesmanagement(2010)whichyouwereintroducedtoin

year1alongwiththeNMCcircularaboutPGDs(SEP2009)(seebelow).

NMCStandardsforMedicinesManagement(2010)

Beforeproceedingwiththeactivitieswithinthisworkbook,pleaseaccessthe‘NMC

Standard for Medicines Management’ (2010). An electronic copy (pdf) of the

StandardisavailableviatheNMCwebsite,whichyoucandownloadandsavefrom

thefollowingwebsite:http://www.nmc‐uk.org/Publications/Standards/

In theStandards sectionof theNMCwebsite there is other information regarding

the supply and/or administration of medicine by student nurses and student

midwivesinrelationtoPatientGroupDirections(PGDs).Pleasereadthecircular

(SEP09)fromtheNMCthatwasdistributedaboutPatientGroupDirections(PGDs)

in relation to the student nurse’s role in the supply/administration ofmedicines.

Student nurses cannot supply and/or administer medicines under a PGD even if

underdirectsupervision(NMC2009).PGDsarespecificwritteninstructionsforthe

supply and/or administration of a licensednamedmedicine including vaccines to

specificgroupsofpatientswhomaynotbeindividuallyidentifiedbeforepresenting

thetreatment(NMC2009).


GUIDANCEFORSTUDENTS

This workbook is organised into three sections. The fullworkbook should be

completedbytheendofApril2016.

IMPORTANTINFORMATION

● The administration of intravenous drugs is a skill which is learned by

registerednurses(i.e.Post‐registrationskill);thereforestudentnursescanonly

observethisskillinpractice.

●AlthoughtheNMC(2010)statesthatstudentnursescanbeasecondsignatory

in theadministrationof controlleddrugs, localpracticesandpoliciesvary. In

some areas, 2 registered nurses must participate in the administration of

controlleddrugs;thereforestudentnurseswouldbeathirdsignatory.

● The above points are also relevant to the administration of drugs or

controlleddrugsviasyringedriversandinfusionpumps.

When completing theactivitieswithin thisworkbookyouwill be cognisantof the

professional role and the accountability role of the nurse and the professional

guidanceprovidedbytheNMC.Togainthemaximumfromtheseactivitiesyoumust

reflect beyond the mechanics of administering medicines and other prescribed

substances to the act of identifying and minimising the risk to patients, clients,

friendsandcolleagues.

When facing professional dilemmas, a registered nurse’s first consideration in all

actsmust be the interests and safety of patients and clients. The purpose of the

theory and practice–based learning activities are to assist you towards safe and

competent practice in the administration of medicines, calculations, controlled

drugs and other prescribed substances as a registered practitioner. This will be

accomplished through your own personal investigation and self‐directed learning

andwiththeassistanceandsupportofyourmentorduringyouryear3placements.

Completionoftheactivitieswillenableyoutofurtherdevelopyourknowledgeand

skills of calculations, administering medicines, controlled drugs and other

prescribedsubstances.SpacehasbeenprovidedattheendoftheWorkbookforyou

torecordpersonalnotestosupplementyourknowledgeandskills.


YEAR3OBJECTIVESTRUCTUREDCLINICALEXAMINATION(OSCE)

Inyear3,studentswillundertakeaMedicationsManagementOSCEwhichinvolves

demonstrating a safe and effective medicine administration procedure. By

completingtheactivities inthisworkbook, thiswillassistyouinpreparingforthe

OSCEandforfuturepractice.

TheMedicationmanagementOSCEallowsstudents todemonstrate theirability to

carryoutthisskillinpracticebyapplyingtheappropriateknowledgeanddecision‐

makinginaprofessionalmanner.Thiswillinclude:

Right patient – Introducing and checking the identity of the patient and

whetherthiscorrelateswiththewrittenprescription

Rightmedication; right route and form ‐ checking the prescription, the

prescribed medication and the route and form e.g. oral/tablets. Students

shouldcheckandquestionwhetherthereareanyerrorsordiscrepancieson

the prescription. Students should be knowledgeable of the common errors

that occur in medication management and how these can be identified

and/orprevented.Ifanerrorisidentified,studentsshouldbeknowledgeable

oftheappropriateactiontotake,e.g.contactanddiscusswiththeprescriber.

Rightdose – checking the prescribed dose ‐ is it accurate? Is this a usual

dose for apatient, e.g. according to their age,weight, clinicalhistory, renal

function,etc.?Studentsshoulduserelevantresourcesforthisandbeableto

find specific information in the British National Formulary (BNF) such as

side‐effects,indicationsandinteractions.

Right time – checking that the medication has not already been

administered and ensuring that the time of the prescribed medication is

satisfactory e.g. has the medication been prescribed at appropriate time

intervalsasindicatedintheBNF,e.g.6hourly?

Rightdocumentation–demonstratingthecorrectprocedureforrecording

when a medication has been administered, or not administered e.g. if the

medicationisoutofstock.

Professionalism – effectively communicating with the patient throughout

the procedure, ensuring patient comfort and safely disposing of used

equipment. Effectively communicating with the relevant multidisciplinary

team members if advice is sought regarding the prescription, medication,

etc.,e.g.pharmacist,prescriber.


Ifyouhaveanyquestionsabouttheworkbook,pleaseusetheDiscussionBoard

ontheYEAR3SkillsandPracticemodulesite.

Suggestedtimeframesforcompletingtheworkbook

Sections1and2oftheworkbook

TobecompletedbyFebruary2016.

Section3oftheworkbook

TobeundertakenduringyourplacementinFebruary2016andsubmittedtoyour

LTF/personaltutorbythebeginningofMay2016.

In section 3 of the workbook, you are encouraged to record and reflect on any

significant events, e.g. personal, ethical, professional, or legal dilemmas, that have

occurred during recent or previous practice placements concerning the

administration ofmedicines, controlled drugs and other prescribed substances to

patientsandclients.


GUIDANCEFORMENTORSANDPERSONALTUTORS

TheCode(2015)statesthatamentorhasadutytofacilitatestudentsofnursingto

developtheircompetence.Thisworkbookhasbeendevelopedforstudentnursesto

complete during their third year of the nursing programme (to be completed by

April 2016). The workbook aims to encourage student nurses to develop their

knowledge, understanding, experiences and competence in medicine

administration.Thisincludesdevelopingessentialskillssuchasnumeracyanddrug

calculationsinboththepracticesettingandcompletingtheenclosedactivities.Asa

mentor,weappreciateyour input tothestudents’ learningandweareaware that

questionsaboutwhatstudentscanandcan’tsooftenarise.Belowarethreeaspects

ofpracticewhichtheSchooloftenreceivesenquiriesabout.

NB. 1. Administration of intravenous drugs is apost‐registration skill, and

therefore student nurses can only observe this throughout their pre‐

registrationeducationprogramme.Thisincludesmedicinesadministeredvia

syringedriversandotherIVinfusiondevices.

NB. 2. Patient Group Directions (PGD) – the NMC (2009) circulated

information to state that student nurses cannot supply and/or administer

medicines under a PGD, even under direct supervision (see page 2 of this

workbookforfurtherinformation).

NB.3.‐Controlleddrugs–Dependingonlocalpolicy,insomeareasstudents

canbeasecondsignatory,howeverthisvariesindifferentspecialtiesand

areas(seepage3ofthisworkbookforfurtherinformation).


LEARNINGOUTCOMES

Followingcompletionofthisworkbook,thestudentwillbeableto:

1 Demonstratecompetenceindrugcalculations.

2 Criticallydiscusstheroleofthenurseinthepreventionofmedicationerrors.

3 Critically discuss the professional, legal, ethical, and safety issues

surrounding drug administration in preparation for becoming a competent

registeredpractitioner.

4 Demonstrate how to correctly locate information on medications, such as

side‐effects, interactions, indications and contra‐indications in the British

NationalFormulary(BNF).


SECTION1DRUGCALCULATIONS

Instructions

Pleasecompletethefollowingcalculationswithinsection1ofthisworkbook.Should

youhavedifficultywith these,pleasereviewdrugcalculationsbyreadingsomeof

thebooksinthelibrary,oraccessingsomeoftheresourceslistedattheendofthe

workbook.

Inadditiontothecalculationsinthisworkbook,further‘self‐directedstudy’fordrugcalculationrevisionsisavailableat:http://www.nursingnumeracy.info/

If youhave specificdifficulties inbasicnumeracy,please refer to ‘theUniversity’s

AcademicSkillsUnit:http://www.dundee.ac.uk/asc/programmes/

Section1

This section is sub divided into four parts. Part A includes general

arithmetic/mathematics,PartB involvesoraldrugadministration,PartCinvolves

drugsgivenbyinjection,andPartDinvolvesintravenousinfusioncalculations.


PartA:Calculations

GoodPracticeinCalculations

Nursesneedtoachievecompetenceinnumeracyskillstoensuresafenursingpractice

(Starkings & Krause 2013). When dealing with calculations, especially complex

calculations,alwayswritethesedownfirst,andthenuseacalculatortocheck(Wright,

2011).

Thefollowingstepswillensuretheriskoferrorsisminimisedindrugcalculations:

Alwayswritedownyourcalculations

Useacalculatortocheckcalculations

Alwaysgetsomeoneelsetoindependentlycheckyourcalculation

Seekadvice,e.g.Pharmacist,fornewordifficultproblems

Takeyourtimeandavoidbeingdisturbed

Read prescriptions carefully, checking factors such as numbers, dose, always

questionabbreviationsorillegibleinformation

Make an approximate estimation as to what the answer should be before

performingthecalculationinearnest.Comparethiswiththeresult

Ifinanydoubtdonotadministerthedrug.Seekassistance

Alwaysquestionwhethertheanswermakessense,e.g.willyouhavetouselotsof

tabletsorvialstoadministerthedose?

SUGGESTEDREADING

STARKINGS,S.&KRAUSE,L.2013.Passingcalculationstestsfornursingstudents,

2ndedition.London:Sage/LearningMatters

WRIGHT,K., 2011.Drug calculations fornurses: context forpractice.Basingstoke:

PalgraveMacmillan.


Multiplication

1 560x2.25=

Division

2 68.86÷100=

Fractions:writethefollowingintheirsimplestform

3 a)25/75=b)7/56=c)375/1000=

Conversions

4 a)1kilogram= grams

b)1gram = milligrams

c)1milligram= micrograms

d)1litre = millilitres

5 a)Change0.78gramstomilligrams=

b)Change294microgramstomilligrams =

6 a)Change2.4litrestomillilitres=

b)Change965millilitrestolitres=


Convert

7 a)0.055gtomg=

b)0.45gtomg=

Decimalsandpercentages

Writethefollowingasfractionsintheirsimplestform

8 a)0.125=

b)15%=

c)37½%=

d)0.02=

Divide.Calculatethevalueofeachfractiontothenearestwholenumber.

9 a)95

3 =

b)225

4 =

Multiply.Simplifywherepossible.

10 a)2x5

36 =

b)5x12

87 =

c)9x4

109 =


PartB:Oralmedication

Formula for tablets, capsules: what you want divided by what you have got

(tablets, capsules) e.g. if you want 10mg and the stock strength of the tablets is

10mg,then1tabletwouldbegiven.

Volume(amounttogive)= Strengthrequired

Stockstrength

Formula for liquidmedication: what you want divided by what you have got,

timesthevolumeoffluidthatthedrugstockstrengthisin,e.g.ifyouwant40mgand

thestockstrengthoftheliquidmedicationis20mg/ml,then2mlwouldbegiven.

Volume(amounttogive)= StrengthrequiredxVolumeoffluid

Stockstrength

1 ApatientisorderedRanitidine150mgorally.Youhave75mgtabletsinstock.

Howmanytabletsshouldyougive?

2 OralDigoxin125microgramsisordered.Youhave0.125mginstock.

Howmanytabletsshouldyougive?

3 Bearinginmindthatthenumberoftabletsgivenatanyonetimeshouldbeas

fewaspossible.Whichtabletswouldyougiveinthefollowingsituations?

a. OralWarfarin9mgisprescribed.Youhave0.5mg,1mg,2mgand5mg,

strengthsinstock.

b. OralVerapamil320mg is prescribed.Youhave40mg,80mg,120mg,

and160mgstrengthsinstock.

c. Oral Sulpiride 400mg is prescribed. You have 100mg, 200mg, and

400mgstrengthsinstock.

4 An oral medication solution contains Furosemide 10mg/ml. How many

milligramsofFurosemidearein3mlofthesolution?


5 AsolutioncontainsMorphineHydrochloride2mg/ml.Howmanymilligrams

ofMorphineHydrochloridearein7mlofthesolution?

6 A suspension contains Erythromycin 250mg/5ml.Howmanymilligramsof

Erythromycinarein20mlofthesuspension?

7 35mg Chlorpromazine Syrup has been prescribed. You have 25mg/5ml of

ChlorpromazineSyrupinstock.Whatvolumewouldyougive?

8 30mg of Fluoxetine has been prescribed. You have 20mg/5ml solution in

stock.Whatvolumewouldyougive?

9 8mgofDiazepamhasbeenprescribed.Youhave5mg/mlsolutioninstock.

Whatvolumewouldyougive?

10 ApatientisreceivingCiprofloxacinsuspension100mg.Theconcentrationof

thesuspensionis250mg/5ml.Howmanymlwillthepatientreceive?

11 Stockdiazepamis5mgtablets.Howmanywouldyouadministerifpatientis

prescribed12.5mg?

12 Morphine2.5mg isprescribed.The stock solution contains10mg/ml.What

volumewouldberequired?

13 Suspension contains phenytoin 125mg/5ml. How many milligrams of

phenytoinareinthefollowing?

a)20ml b)30ml c)40ml

14 StockBenperidol is 250micrograms. 1mg is prescribed.Howmany tablets

wouldberequired?

15 Zuclopenthixolissuppliedinthefollowingstrengths‐2mg,10mg&25mg

What combination of tablets would be required for the following

prescriptions?

a)6mg b)18mg c)37mg


16 Chlorpromazinesyrupcontains25mg/5ml.Howmanymilligramsareinthe

following?


17 Chlorpromazine syrup contains 100mg/5ml. What volume is required for

120mg?

18 Haloperidol tablets are supplied in the following strengths – 1.5mg, 5mg,

10mg & 20mg. What combination of tablets would be required for the

followingprescriptions?

a)3mg b)8mg c)11.5mg d)16.5mg e)25mg

19 Clozapinetabletsaresuppliedinthefollowingstrengths–25mg&100mg.

What combination of tablets would be required for the following

prescriptions?

a)12.5mg b)37.5mg c)150mg d)225mg e)450mg

20 ThestocksolutioncontainsFluoxetine20mg/5ml.Howmanymilligramsof

fluoxetineareinthefollowing?


21 ThestocktabletsavailableareLofepramine70mg.Howmanytabletswould

youdispensetoapatientprescribed210mg?

22 Quetiapine is supplied in the following strengths ‐ 25mg, 100mg,150mg&

200mg. What combination of tablets would be required for the following

prescriptions?

a)75mg b)450mg c)375mg d)175mg

23 StockThyroxinecontains25microgramsand50micrograms.Thepatientis

prescribed125micrograms.Whatwouldyoudispense?

24 Stock Procyclidine is 5mg tablets. What would you dispense to patient

prescribed?

a)2.5mg b)12.5mg c)15mg


PartC:Injections

1 Digoxin ampoules in the stock cupboard contain 500 micrograms in 2ml.

Whatvolumeisneededtogive350micrograms?

2 A patient is prescribed Flucloxacillin 250mg. Stock vials contain 1gram in

10mlafterdilution.Calculatethevolumerequired.

3 A patient is prescribed 6,500units of Heparin subcutaneously. Stock vials

contain5,000unitspermlHeparin.Calculatethevolumerequired.

4 Naloxone0.6mgistobegiventoapatientduringanemergency.Stockvials

contain0.4mg/2ml.Whatvolumeshouldbedrawnupforinjection?

5 Vancomycin 500mg is prescribed. Stock vials contain 1g in 10ml once

diluted.Whatvolumeisrequired?

6 Benzylpenicillin800mg isprescribed.Stockvials contain1.2g in6ml.What

volumeisrequired?

7 Atropine0.5mgisprescribed.Stockvialscontain0.6mg/ml.Whatvolumeis

required?

8 Clindamycin1.2gisprescribed.Stockvialscontain150mg/1ml.Whatvolume

isrequired?

9 Heparin1,750unitsisprescribed.Stockvialscontain1,000unitsperml.What

volumeisrequired?

10 Pethidine 60mg is prescribed. Stock vials contain 100mg in 2ml. What

volumeisrequired?

11 Haloperidol10mgisprescribed.Stockvialscontain5mg/ml.Whatvolumeis

required?

12 Zuclopenthixol acetate 50mg is prescribed. Stock vials contain 50mg/2ml.

whatvolumeisrequired?


13 IntramuscularProcyclidinehydrochlorideissuppliedin2mlampoules.Each

2ml ampoule contains a concentration of 5mg in 1ml. The patient is

prescribed5mg.Howmanymlwouldyoudrawup?

14 How many ml would you draw up for the following antipsychotic depot

injections?

Depixolcontains20mg/ml

a)10mg b)24mg c)30mg d)36mg

DepixolConc.contains100mg/ml

a)130mg b)60mg c)220mg

DepixolLowVolumecontains200mg/ml

a)160mg b)240mg c)120mg

ClopixolConc.contains500mg/ml

a)600mg b)200mg c)550mg d)450mg

Fluphenazinedecanoatecontains25mg/ml

a)12.5mg b)6.25mg c)75mg


PartD:IntravenousInfusion

Thisformulacanbeusedforcalculatingintravenousinfusionsdriprates(dropsper

minute)whenaninfusionpumpisnotavailable.Youwillneedtofindoutfromthe

infusion giving set packagehowmanydrops are equivalent to1ml.Most infusion

giving sets are designed for 20 drops perml in adult areas. Paediatric areasmay

havemoredropspermlasthedropswillbemuchsmaller,e.g.60dropsperml.

Formula:dropspermltimesvolumedividedbytimeinminutes.

Drops/mlxVolume

Timeinminutes=Dropsperminute

Example,Volume=100mlsxDropsperml=20=2000.Divide2000bythetimein

minutes that the infusion has been prescribed. Time = 1 hour (60 minutes).

Therefore2000/60=33.3,thereforethedropsperminutewillbe33drops.

1 150ml of Hartmann’s solution is prescribed to run over 6 hours. The

Microdropadministrationsetdelivers60dropspermillilitre(ml).Calculate

thedriprateindropsperminute.

2 500mlofdextrose5%isprescribedtorunover8hours.Theadministration

dripsetdelivers20dropsperml.Calculatetherateindropsperminute.

3 750ml of sodium chloride 0.9% is prescribed to run over 9 hours. The

administrationsetdelivers20dropsperml.Calculatetherate indropsper

minute.

4 1.5Lof fluid is prescribed to runover10hours.The giving set delivers20

drops/ml.Calculatetherateindropsperminute.

5 Apatientistohavetheremaining300mlofdextrose5%runthroughin50

minute.Thegivingsetdelivers20drops/ml.Calculatetherateindropsper

minute.


6 Apatienthastwointravenouslinesinserted.Onelineisrunningat45ml/hr,

theotherat30ml/hr.Whatvolumeoffluidwouldthispatientreceiveina24

hourperiod?

7 At 21.00hrs on a Monday, one litre of dextrose 5% is set up to run at

50ml/hr.Whenwillthebagbefinished?

8 Apatientistoreceivehalfalitreofdextrose5%byintravenousinfusion.A

bag is set up at 08.00hrs running at 60ml/hr. After 5 hours the rate is

increased to 80 ml/hr. At what time will the intravenous infusion be

completed?


SECTION2

PREVENTINGMEDICATIONERRORS

Morethan2.5millionmedicationsareprescribedperdaytopatientsinhospitaland

thecommunity.Mostmedicationsareusedsafelyandeffectively,howevererrorscan

occur,whichcancompromisepatients’safety(NationalPatientSafetyAgency2007).

“Becausenursespredominantlyadministerdrugs,theyareoftenthelastpotential

barrierbetweenamedicationerrorandseriousharmtoapatient,withdrugerrors

frequentlyfeaturinginprofessionalmisconductcases”(Boyd2013,p7).

Activity1:Themedicationprocessgenerallyinvolvesfourstages,i.e.prescribing,

dispensing,administrationandmonitoring.Medicationerrorscanoccuratanyof

thesestages.Usingtheheadingsbelowandoverleaf,considertheroleofthenurse

inpreventingmedicationerrorsandlistthekeyreasonswhysucherrorsmayoccur

andhowthenursecanpreventthese.Youmayfinditusefultoaccessandreadone

ormoreofthereferenceslistedattheendofsection2.

Prescribingerrors:


Dispensingerrors:

Administrationerrors:


Monitoringerrors:

Activity2

UsingtheBritishNationalformulary(BNF),identifyfromthelistofextractsbelow

whetherthereareanyerrorsintheprescriptions.Ifanerrorisidentified,what

wouldyoudo?

a) John,aged50yearsisprescribedoralCefuroxime125mgtabletstwice

daily.

b) Mary,aged4yearsisprescribedNitrofurantoinoralsuspension

(concentrationis25mg/5ml).Mary’sweightisrecordedas20kg.The

prescriptionindicatesthatsheshouldbegiven60mgeverysixhours.

c) Larry,aged60yearsisprescribedNystatinoralsuspension100000units

oncedaily.

d) Jane,aged15monthsisprescribedaSalbutamolnebulizer.The

prescriptionstates‘2.5mgtobegivenasrequiredupto8timesdaily.’

e) Anne,aged68yearsisprescribedSimvastatin20mgviaintramuscular

injectiontwicedaily.

f) Tom,aged56yearsisprescribedGabapentincapsules(oral)300mgonce

dailyondayone,then300mgtwicedailyonday2,then300mg3timesa

dayondaythree.


Activity3:Apossiblereasonwhyamedicationerrormayoccurisbecausesomedrug

namesaresimilar,e.g.OxycontinandOxybutynin.UsingtheBNF,lookupboththese

medicationsandlistthefollowingforeach:

Oxycontin

Indications

Cautions

Contra‐indications

Side‐effects

Doses(adultandchildren)

Routes/preparation

Oxybutynin

Indications

Cautions

Contra‐indications

Side‐effects

Doses(adultandchildren)

Routes/preparation

IfthepatientshouldhavebeenprescribedOxybutynin,butwasmistakenly

prescribedOxycontin,whatmighttheconsequencesbeforthepatient?


Activity4:Abbreviationsonprescriptionsmayleadtomedicationerrors(Boyd

2013).Belowisalistofabbreviationsthatrelatetoroutesofadministration.

ITH;SC;IV;IM:O;INH;NEB:TOP;INTERDERM.

Whatdoeseachoftheseabbreviationsmean?

Whymighttheseabbreviationsleadtomedicationerrors?

Activity5:AccessinginformationintheBNF

WhileitmayseemstraightforwardtoaccessinformationintheBNF,somestudents

havehaddifficultyfindingspecificinformationinthepaper‐basedcopies.Although

anelectronicversionisavailableonline,ingeneral,thepaper‐basedversionisused

inclinicalareas.Partoftheyear3OSCEinvolveslookingupspecificinformationfor

patientsonaspectssuchassideeffects,indicationsandinteractionsbetween

differentmedicines,thereforeitisimportanttopracticethisskill.Pleasewatchthis

shortvideocliphttps://www.youtube.com/watch?v=cW60Em0AKiAandthen

answerthequestionsbelow.

1. Whatarethedrugslistedinsection5usedtotreat?

2. What does a black triangle symbol mean when it is next to a drug

name?

3. Name3commondrugsthatWarfarininteractswith?

4. What does the black dot mean when it is next to a drug in the

interactionssection?

5. LookupCo‐Amoxiclav –what type ofmedication is this andwhat is

usedfor?

6. Name3mainsideeffectsofCo‐Amoxiclav.


7. Look up the cautions, contraindications and side effects of

Amitriptyline Hydrochloride. What does the statement “see notes

above”mean?

8. LookupSalbutamol–whatdifferentways(forms)areavailabletogive

thismedication?Arethedosesthesameregardlessoftheform?

9. Whatdoesthe‘Cautions’sectionmeanintheBNF?

10. WhatcounsellinginstructionsaregivenaboutAcarbose?

References:

Boyd,C.,2013.Medicinemanagementskillsfornurses:studentsurvivalskills.West

Sussex:Wiley‐Blackwell.

NationalPatientSafetyAgency.2007.Safetyindoses:improvingtheuseof

medicationsintheNHS.

http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=60117&..

(accessed091013).


SECTION3

Readthefollowingscenariosandanswertheaccompanyingquestions.

SCENARIO1

Wilfred is an 85 year old resident of a nursing home. He has dementia. He has

developed a chest infection and has become toxic and confused, refusing his

antibiotics.Thenursesfearthatwithouttheantibioticshewillnotsurvivethenight.

He has no family and there is no access to immediate medical or psychiatric

assessment.Theyareprettysurethathewilldrinkacupoftea.

ShouldthenursesputtheantibioticsintoWilfred’stea?

Please discuss this fully taking into consideration the professional, legal,

ethicalandsafetyissuespertinenttothissituation.

SCENARIO2

JohnandMaryhavebeenmarried for20years.Maryhasapsychiatric illnessbut

does not like taking her medication, so John disguises it by putting it into her

pudding each day. As a result hermood and behaviour have stabilised. She now

believes that she is better andwhen the community psychiatric nurse visits, she

refusestreatment.


ShouldthenurseconsiderhavingMarysectioned–orcolludewithJohnsoshe

canstayathome?

Please discuss this fully taking into consideration the professional, legal,

ethicalandsafetyissuespertinenttothissituation.

SCENARIO3

Ethelaged64hasbeendischargedfromhospitalfollowingapulmonaryembolus.

HeronlydrugondischargewasWarfarin–shewasgivena7dayssupplyof1mg,

3mg,5mgtablets.Dailybloodsinthewarddictatedthedosefortheday.

WhatinformationdoesEthelneedtoknowbeforesheisdischargedtoensure

shecantakehermedicationsafely?


YouvisitEthelthedayfollowingdischargetoassesshowsheismanaging.Shetells

youshehadabitofastomachupsetandaheadacheandhasbeen taking “Alka–

Seltzar” four timesaday forherstomachupsetand“Anadin” four timesaday for

herheadache.SheboughtboththeseprescriptionsfromTesco.

Whatarethesignificantingredientsinthesepreparations?

Alka–Seltzar–

Anadin–

ArethesemedicationssafetotakewithherWarfarin?

SCENARIO4

Robertisan83yearoldwholivesaloneathome.Hehasrecentlybeendischarged

from the local hospital with the followingmedication for atrial fibrillation, heart

failureandahiatushernia:

Digoxin250micrograms,oncedaily

Furosemide40mg,oncedaily

Omeprazole20mg,oncedaily

Hewas fit andwell when first discharged but over the past 3weeks he has lost

weight,feelsnauseatedandisnotkeentodrink.Hishome–careworkerhasensured


that he has had hismedication but is nowworriedbecausehe is looking terrible

today.

When youvisit you findhim inbed. He is frail, has poor skin turgor and is very

drowsy.Hisfamilyhavegatheredroundastheythinkheisabouttodie.

WhatarethesideeffectsofthemedicationRobertistaking?

Digoxin–

Omeprazole–

Furosemide–


Shouldhome–careworkersbegiventheresponsibilityofensuringpatients

taketheirmedication?

Howdonursesmonitorpatientsfordigoxintoxicity?


SCENARIO5

MrsDaleyhasbeeninhospitalfor5daysandislookingforwardtoavisitfromher

twograndchildrenaged5and7years.AftertheirvisitMrsDaleyurgentlysummons

the nurses to report that the 2 “painkillers” in the pot on her locker have gone

missing and that she is extremely worried that one of her grandchildren has

swallowedthem.

1. Whatareyourviewsonthissituation?

2. Explaintheimplicationsfor:

i. patients

ii. registerednurses

iii.studentnurses

iv. doctors

v. pharmacists

vi. relatives/visitors


SCENARIO6

Staff Nurse Care arrives on duty late to discover that she is the only 1st level

registerednurseondutywith2ndlevelregisterednurses,studentnursesandhealth

care assistants. To catch up with the outstanding patient care she decides to

completethe08.00and10.00o’clockmedicineroundstogether.Sheasksa3rdyear

studenttoassistheranda1styearstudenttoactasa“runner”betweenthemand

thepatient.

The medicine round is completed by 09.45 hr and, after discussion with the

students, StaffNurseCaredecides this shouldbecome standardpractice for these

two daily medicine rounds as they always occur at a busy time and are never

completedontime.

1. Whatareyourviewsonthissituation?

2. Explaintheimplicationsfor:

i. patients

ii. registerednurses

iii.studentnurses

iv. doctors

v. pharmacists

vi. relatives/visitors


SCENARIO7

ThedoctorhasprescribedAmoxycillincapsules500milligrams,peroralroute,three

timesdailyat0800hrs1200hrsand1800hrs.

The followingdayhe changes theprescription times to0800hrs1400hours and

2000hours,howeverheonlyputsacrossthroughthe1200hrsand1800hrstimes

and ticks off the new times of 1400 hrs and 2000 hrs. The doctor initials these

changes.

Whyisthisnotanacceptableprescriptionandwhatneedstobedonebefore

thenurseadministersthepatient’snextdose?

SCENARIO8

YouaretheStaffNurse inchargeoftheward.Thenursewhoisadministeringthe

medicinesreports toyouthatshehasgiventhewrongmedicationtoaclientwho

hasasimilarnameastheclientwhoshouldhavereceivedthemedication.

Discusswhatyouwoulddo.


SCENARIO9

Aclientinformsyouthatwhilstinthetoilethewitnessedanotherclientspittingout

theirmedicationdownthesink.

AstheStaffNurseinchargeofthewarddiscusswhatyouwoulddo.


SCENARIO10

Dillon is a 3 year old boy who is requiring treatment for an infected insect bite

(cellulitis)onhisright forearm.Heisbeingtreatedasaninpatient.3daysintohis

treatment there is no change in the distribution of the cellulitis. The nurses are

havinggreatdifficultyinadministeringthedrugsorallyandconsiderthatheisnot

receivingallofthemedication.Dillonweighs17kg.

Dillonisreceivingthefollowingmedication:

Flucloxacillin 125mg liquidoral 4timesperday

Phenoxymethylpenicillin 125mg liquidoral 4timesperday

Howimportantisdocumentationinthiscase?

ArethedosescorrectforDillon’sweight?

WhatvolumeofliquidofeachdrugwillDillonreceive?

When and how should oral Phenoxymethylpenicillin and Flucloxacillin be

administeredtogainmaximumbenefitfromthedrug?


SCENARIO11

Emmaisa4yearoldgirlwhohasCysticFibrosis.Emmaliveswithbothparentsand

hermotheris6weekspregnant.Shehasnoothersiblings.Emmahasbeenadmitted

intohospitalforthetreatmentofherfirstchestinfection.Thishasrequiredstarting

many new treatments some of which her parents are unfamiliar with including

intravenousandinhaledantibiotics.

Please consider the following prescription and apply the principles of

accountabilitytoprescribingpractice.

InhaledColistin1millionunits(MU)tobeadministeredat0800and2000hrs.

IsthisthecorrectdosageofthedrugfortheageofEmma?

IsthisthecorrectdosageofthedrugfortheageofEmma?

Is this medication licensed for use in children? Can you discuss the

implicationsifadrugisnotlicensedforuseinchildren?

Identifytheprecautions,informationandequipmentrequiredforthecorrect

administration of inhaled Colistin at home and does this differ from

administrationinhospital?


SCENARIO12

You are the nurse holding the drug cupboard keys, one of your colleagues

approachesyouandasksforthedrugkeysasshehasa“splittingheadache”andis

goingtotakesomeparacetamolfromthecupboard.

Isthisacceptable?

Ifyouthinkthisisnotacceptable,considerthereasonswhy.

Whatwouldyoudointhissituation?


REFLECTIVESTUDY

Toenableyoutoreflectcriticallyonyourinvolvementinmedicineadministrationit

isnecessary foryoutorecordan incident inwhichyouhavebeen involved.Usea

modelofreflectiontohelpstructureyourreflection,e.g.Marks‐MaranandRose.

Instructions

1 Selectarecentexperienceinwhichyouwereinvolvedintheadministrationof

anewmedicationoramedicationthatyouarenotfamiliarwith.Thiscanbean

oralmedicationoraninjection.

2 Describe the selected experience including the checking of the prescription,

route of administration used, the name of the medication, the dose of the

medication,thetimeofadministration,andyourroleinthesequenceofevents

fromidentifyingthemedicationtocompletionoftheadministration.

3 What were your thoughts and feelings regarding the administration of this

medication?

4 Howdoyouthinkthepatientfelttaking/receivingthismedication?

5 Wasacalculationrequiredbeforethemedicationwasadministered?Ifso,was

thisstraightforwardorcomplex?

6 Was the medication administration procedure straightforward, e.g. were all

the steps carried out according to the NMC Standards for Medicines

Management?

7 Werethereanypossibleissues,e.g.professionalorethical?

8 Describethelearningthathastakenplacefromthisactivitywhichyouwillbe

abletouseinfuturemedicineadministration.

Pleaseenterthisreflectivesummaryintoyouryear3Portfolio.


INFORMATIONSOURCES

BAXTERHEALTHCARE.,2009.Goodpracticefordrugcalculations.

http://www.baxterhealthcare.co.uk/downloads/healthcare_professionals/therapie

s/pharmacy_services/ps_calc_guide.pdf(accessed160913)

BOYD,C.,2013.Medicinemanagementskillsfornurses:studentsurvivalskills.

WestSussex:Wiley‐Blackwell.

DOUGHERTY,L.andLISTER,S.E.,eds.2015.TheRoyalMarsdenHospitalmanual

ofclinicalnursingprocedures.9thed.Oxford:Blackwell.

HAMBRIDGE, K., 2011. Needlestick and sharps injuries in the nursing student

population.NursingStandard,25(27),pp.38–45.

NATIONALPATIENTSAFETYAGENCY.2007.Safetyindoses:improvingtheuseof

medicationsintheNHS.

http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=60117&..

(accessed09/10/13).NURSINGANDMIDWIFERYCOUNCIL,2010.StandardsforMedicinesManagementhttp://www.nmc‐uk.org/Publications/Standards/

NURSING AND MIDWIFERY COUNCIL, 2015.

http://www.nmc.org.uk/standards/code/

NURSINGANDMIDWIFERYCOUNCIL,2009.Guidanceonprofessional conduct for

studentsofnursingandmidwifery.London:NMC.

http://www.nmc‐uk.org/Documents/Guidance/NMC‐Guidance‐on‐professional‐

conduct‐for‐nursing‐and‐midwifery‐students.PDF

STARKINGS,S.&KRAUSE,L.2013.Passingcalculationstestsfornursingstudents,

2ndedition.London:Sage/LearningMatters.

WRIGHT,K., 2011.Drug calculations fornurses: context forpractice.Basingstoke:

PalgraveMacmillan.


PERSONALNOTES

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