L3 Medicines Management - Administration of Medication PDF September 2021

Medicines Management / Administration of Medication Component 11  Administration of Medication - Component 11 Objectives Understand the purpose of JRCALC guidelines Discuss the LAS medicines management policy and the subjects wi...

Medicines Management / Administration of Medication Component 11  Administration of Medication - Component 11 Objectives Understand the purpose of JRCALC guidelines Discuss the LAS medicines management policy and the subjects within it Types of aids available to assist a patient administer their own medications Infection Prevention control © Department of Clinical Education & Standards 2  Administration of Medication - Component 11 JRCALC The guidelines have evolved from locally-derived protocols for each individual ambulance service to systematically- developed national clinical practice guidelines based on current best evidence. They are an important part of clinical risk management and ensure uniformity in the delivery of high quality patient care. As such, they form the basis for UK training and education and are an essential resource © Department of Clinical Education & Standards 3 Administration of Medication - Component 11 What is a medicine? Any substance which, when taken into, or applied to the body has an effect on the composition or function of the body, or microbes within it. © Department of Clinical Education & Standards 4  Administration of Medication - Component 11 Legislation and Guidelines Medicines Act 1968. Medicines and Healthcare Products Regulatory Agency (MHRA). Misuse of Drugs Act 1971. Prescription Only Medicines (Human Use) Order 1997. Joint Royal Colleges Ambulance Liaison Committee (JRCALC) UK Ambulance Services Clinical Practice Guidelines. Control of Substances Hazardous to Health 2002. Health and Safety at work Act 1974. Human Medicines Regulations 2012 Schedules: 16, 17, 19. © Department of Clinical Education & Standards 5 Administration of Medication - Component 11 London Ambulance Service Medicines Management Policies and Procedures TP/008 Policy and Procedure for the safe and secure handling of medicines by LAS Staff All policies and procedures can be found on the pulse. https://thepulseweb.lond-amb.nhs.uk/policies- procedures/trust-policies/ © Department of Clinical Education & Standards 6  Administration of Medication - Component 11 Other Policies and Procedures OP/014 Managing the Conveyance of Patients Policy and Procedure OP/031 Policy for Consent to Examination or Treatment Patient Report Form User Guide © Department of Clinical Education & Standards 7  Administration of Medication - Component 11 The LAS forms LA4 – Patient Report Form LA290 – Drug Usage Form (Paramedic Drugs Pack) LA291 – Drug Usage Form (General Drugs Pack) Ref.OP/002 © Department of Clinical Education & Standards 8  Administration of Medication - Component 11 Classification of Drugs Medicines act 1968 General-sales-list medicines (GSL). Medication that does not require a prescription or the supervision of a pharmacist. Pharmacy medicines (P). Can only be sold under the supervision of a pharmacist. © Department of Clinical Education & Standards 9  Administration of Medication - Component 11 Classification of Drugs Medicines act 1968 Prescription-only medicines (POM). Require a prescription from a doctor , non-medical prescriber or an appropriate practitioner. Many of the drugs given by ambulance crews are POM. © Department of Clinical Education & Standards 10  Administration of Medication - Component 11 Misuse of Drugs Act 1971 Class A drugs. E.g. cocaine and morphine. Class B drugs. E.g. Amphetamine and Codeine. Class C drugs. E.g. Diazepam and Lorazepam. © Department of Clinical Education & Standards 11  Administration of Medication - Component 11 Misuse of Drugs Act 1971 Controlled drugs are subject to specific conditions. The regulations classify these controlled drugs into 5 schedules. Ranging for the strictest controls in Schedule 1 to those that have limited risk of abuse in Schedule 5 © Department of Clinical Education & Standards 12  Administration of Medication - Component 11 Human Medicines Regulations 2012 Schedule 19 Administration of certain drugs in an emergency Anyone - incorporates AAP/EMT/EAC staff (IF WITHIN SCOPE OF PRACTICE) Not IV administration © Department of Clinical Education & Standards 13  Administration of Medication - Component 11 Parenteral and Non-parenteral routes of administration Parenteral: Routes that require the skin or mucous membranes to be broken Non – Parenteral: Routes where the skin or mucous is not broken. Relies on passive absorption. © Department of Clinical Education & Standards 14 Administration of Medication - Component 11 Parenteral Routes Intramuscular (IM). Subcutaneous (SC). Intra-osseous (IO). Intravenous (IV). External jugular vein (EJV). © Department of Clinical Education & Standards 15 Administration of Medication - Component 11 Non-Parenteral Routes Inhaled (INH) Nebulisation (NE) Oral (OR) Sub-lingual (SL) Buccal Intranasal Rectal (PR) Transdermal © Department of Clinical Education & Standards 16  Administration of Medication - Component 11 Drug Administration Routes for AAP’s EACs and Paramedics Route INH NE OR SL Buccal Intra IM SC PR IV IO nasal Paramedic EAC AAP © Department of Clinical Education & Standards 17  Administration of Medication - Component 11 Responsibilities - TP/008 The responsibilities of individual LAS staff no matter what their rank / grade in the LAS in relation to drugs are as follows: Receiving, checking, recording and storage of stock as appropriate; The safe and legal possession of any drug that is in their possession as a result of their duties; Completing all paperwork accordingly; Ref.OP/002 © Department of Clinical Education & Standards 18  Administration of Medication - Component 11 Responsibilities - TP/008 Recording accurately in the patient’s clinical record the amount of drug administered; Explicit legal obligation to report any discrepancies. Ref.OP/002 © Department of Clinical Education & Standards 19  Administration of Medication - Component 11 Reporting Adverse Effects Any adverse/near miss or untoward event that occurs as a result of drug administration. Needs to be documented on the patient report form/ePCR Reported using Datix Incident Reporting. Ref.OP/002 © Department of Clinical Education & Standards 20  Administration of Medication - Component 11 Discrepancies All discrepancies are to be reported to either a Clinical Team Manager, Station Support Manager, Location Group Manager, Incident Response Officer, Emergency Operations Centre. No matter how minor To be recorded on Datix Ref.OP/002 © Department of Clinical Education & Standards 21 Administration of Medication - Component 11 Reporting Lost or Stolen Drugs To be reported to EOC Reported at the local police station The incident reported on Datix Ref.OP/002 & OP/030 © Department of Clinical Education & Standards 22  Administration of Medication - Component 11 When Things Go Wrong Don’t hide errors! Tell: Your crewmate The clinician you hand over to A Clinical Team Manager or IRO Clinical Hub The on-call team [email protected] © Department of Clinical Education & Standards 23  Administration of Medication - Component 11 When Things Go Wrong Don’t hide errors! Document: Patient Report Form/ePCR DATIX Duty of Candour © Department of Clinical Education & Standards 24 Administration of Medication - Component 11 Keeping Things Secure G1653 12/6/18 1234 00000000000 000000000 x G1 6 5 3 ADM Adrenaline 1:1000 500mcg 1 IM 1 3 00 1 © Department of Clinical Education & Standards 25 Administration of Medication - Component 11 Documentation: Patient Report Form © Department of Clinical Education & Standards 26  Administration of Medication - Component 11 Documentation: Patient Report Form The dose of a drug administered must be recorded in milligrams (mg) or micrograms (mcg). The volume that constituted one dose must also be written. © Department of Clinical Education & Standards 27 Administration of Medication - Component 11 Documentation: Patient Report Form © Department of Clinical Education & Standards 28 Administration of Medication - Component 11 Documentation: Patient Report Form Document who has administered the drug. © Department of Clinical Education & Standards 29 Administration of Medication - Component 11 Closing the loop PATIENT 1 DRUG PACK NO. DATE CAD NO. PRF NO. PERSONNEL NO. DRUG QTY BATCH NOS. AND EXPIRY DATES Diazepam 5mg Expiry Expiry Expiry rectal stesolid 3 X X X Batch No. Batch No. Batch No. Diazepam 2.5mg Expiry Expiry rectal stesolid 2 X X Batch No. Batch No. © Department of Clinical Education & Standards 30 Administration of Medication - Component 11 The Importance of Documentation The accurate documentation of medication administered forms part of the patients on going care. To be able to link the patient to a particular batch number should the need arise. © Department of Clinical Education & Standards 31 Traceability London Ambulance Service NHS Trust 32  Closing the loop Example of an MHRA alert Logistics know what batch numbers we buy and which pack they go into. Drug pack number starts with a: P for paramedic drugs packs G for the general drugs pack. London Ambulance Service NHS Trust 33  Administration of Medication - Component 11 Medicines Safety Guard against loss or theft Prevent misuse Prevent tampering Good medicines management means better, safer patient care ! © Department of Clinical Education & Standards 34  Administration of Medication - Component 11 Controlled Drugs Must be stored in a “controlled drugs”(CD) safe. YOU Can witness the withdrawing and return of controlled drugs Witness the administration and disposal of controlled drugs With your signature! © Department of Clinical Education & Standards 35 Administration of Medication - Component 11 Controlled Drugs © Department of Clinical Education & Standards 36  Administration of Medication - Component 11 The Withdrawing of Station Based Drugs Appropriately qualified members of staff will be able to use the New Digital Medicines Tracking System. It works through the use of scanning software accessed through iPads fixed to the wall to record the signing in and out of general and paramedic drug packs and station based drugs including: Aspirin, GTN, Salbutamol, Glucose 40% Oral Gel, Paracetamol and Ibuprofen © Department of Clinical Education & Standards 37 Administration of Medication - Component 11 Electronic Recording System © Department of Clinical Education & Standards 38 Administration of Medication - Component 11 Presentation of Drugs © Department of Clinical Education & Standards 39 Administration of Medication - Component 11 Brand and Generic name Brand Name Generic name © Department of Clinical Education & Standards 40  Administration of Medication - Component 11 Infection Protection and Control Why is this important when administering drugs? Patient Healthcare Provider Friends/family Organisation Organisation Economy © Department of Clinical Education & Standards 41  Administration of Medication - Component 11 Safety Checks Before administering any drug Check the patient is not allergic to the drug. Attitude – is the drug indicated? Check it is the right drug. Confirm with senior clinician that Check the strength of the drug. the patient has capacity to understand the need for the Check that the packaging is intact. medication and that they give consent treatment Check the clarity of the fluid. Check the expiry date. © Department of Clinical Education & Standards 42 Administration of Medication - Component 11 Drugs Administration Cross Check (DACC) The DACC is to ensure that any drug that is to be administered meets the following. The Right Patient The Right Drug The Right Dose The Right Route © Department of Clinical Education & Standards 43 Administration of Medication - Component 11 Drugs Administration Cross Check (DACC) The role of the Assistant Ambulance Practitioner is vital in making sure that drug safety checks are completed and cross checking of the drug is confirmed before administration to a patient © Department of Clinical Education & Standards 44 Administration of Medication - Component 11 45 Administration of Medication - Component 11 Drugs Administration Cross Check (DACC) © Department of Clinical Education & Standards 46  Administration of Medication - Component 11 Aids to assist a patient to administer their own medication Tablet boxes Spacer for nebuliser Oral syringes Tablet cutters © Department of Clinical Education & Standards 47 Administration of Medication - Component 11 Any Questions? © Department of Clinical Education & Standards 48