L7 NURS2035 Medication and Identification Lecture Notes PDF

Law and ethics WELCOME Darren Conlon, Sydney Campus E u n i c e Ta n , F re m a n t l e a n d B ro o m e C a m p u s e s School of Nursing and Midwifery ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land upon w...

Law and ethics WELCOME Darren Conlon, Sydney Campus E u n i c e Ta n , F re m a n t l e a n d B ro o m e C a m p u s e s School of Nursing and Midwifery ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land upon which our University sits. The University acknowledges that the Fremantle Campus is located on Wadjuk Country, the Broome Campus on Yawuru Country and the Sydney Campus on Cadigal Country. Objectives By the end of this lecture, you will be familiar with: ❑ Identification ❑ Legal aspects of medication management ❑ Task delegation Identification Identification Identification ❑ Where possible a patient must be identified as soon as possible upon arrival at a facility or hospital ❑ Correct identification of a patient promotes patient safety and prevents errors in procedures, administration of medication and diagnostic testing Identification Identification ❑ On admission, do ask patient or person responsible to state: ❑ the patient’s full name ❑ date of birth Identification Identification ❑ Do not state patient’s name and/or date of birth and then ask the patient, or their person responsible, if this information is correct ❑ No assumptions regarding identity should be made Identification Once admitted, a minimum of three identifiers must be used ❑ Full name ❑ Date of birth ❑ Medical Record Number (MRN) A hospital armband in conjunction with patient statement is the preferred method of identification Identification Allergy and adverse reaction information ❑ Must be requested from patient and recorded in patient record ❑ Existing allergy or adverse reaction information in the record should be confirmed without prompting patient for a certain response ❑ A red armband must be placed on the patient to indicate an allergy or adverse reaction ❑ The armband should have the patient details inserted in the band NOT the allergy details ❑ The red armband is to alert the nurse that allergy and alert advice must be accessed from the patient and patient notes (even if someone has written these on the red armband) Identification Allergy and adverse reaction information ❑ Existing alerts should be investigated as required ❑ New alerts should be promptly added to the record Identification Failure to confirm identification or details that leads to the incorrect patient receiving or not receiving treatment can constitute ❑ Negligence ❑ Trespass to the Person Medication Medication A nurse registration is a license ❑ License verb, to grant permission: Licence noun, the document granting that permission ❑ Permission to do something that might be harmful in the wrong hands ❑ In nursing that includes allowing the nurse to undertake invasive procedures, dispense therapeutic substances, even hold persons for short periods against their will in rare and isolated circumstances Medication Medications ❑ Classed as therapeutic substances within a list of controlled poisons ❑ NSW and WA have Poisons and Therapeutic Acts that cover substances that are harmful to varying degrees when handled incorrectly ❑ Nurses need a nursing licence to handle certain medications Medication Safe medication administration requires ❑ 5 Rights (Sometime 6, with the 6th being documentation) ❑ 3 Checks ❑ Full informed consent Medication Standard for the Uniform Scheduling of Medicines and Poisons ❑ A document by the Australian Committee for Chemicals Scheduling, a committee of the Therapeutic Goods Administration ❑ Makes recommendations to the states on the regulation of medications and poisons in Australia Medication Standard for the Uniform Scheduling of Medicines and Poisons ❑ Medicines and poisons are classified into Schedules according to the level of regulatory control over the availability of the medicine or poison, required to protect public health and safety ❑ The following schedules relate to most nursing contexts Medication Schedule 2 ❑ Medications for minor ailments. Over the counter. Advice may be given if necessary (Panadol < 24 per pack) Medication Schedule 3 ❑ Must be sold and advice given, by a pharmacist for a condition that does not need a medical diagnosis (example, Salbutamol) Medication Some poison and therapeutic schedules ❑ Require specific handling procedures Medication Schedule 4 ❑ Prescription only medications Medication Schedule 4 Appendix D or Schedule 4 Restricted (S4D / S4R) ❑ Accountable medications. Must be recorded in a ward register in a public hospital / private hospital. Open to being abused. Can cause a dependency. (benzodiazepam) Medication Schedule 8 ❑ Controlled Drug ❑ Accountable medications, must be recorded in a facility/ward register. Addictive substances (morphine, cocaine) Medication Storage of S4 medication ❑ Must be stored in a locked room or cupboard away from patient and public access ❑ Keys kept by the nurse in charge of the ward or their delegate who must be authorised person (which includes a nurse) ❑ In many modern hospitals a nurse’s ID tag will open the room and allow for monitoring of access ❑ Other facilities may have a medication dispensing machine ❑ Emergency or anaesthesia trolleys are exempt from locked storage Medication Storage of S4 D/R medication ❑ Stored separately from all other medications ❑ Must be stored in a locked room or cupboard away from patient and public access ❑ No other goods should be stored in the same place (e.g. cash, ward keys) ❑ S4 key must only be carried by a staff member authorised to handle these medications Medication Storage of S4 and S4D/R medication ❑ Must be checked and counted by 2 authorised staff members (in a public / private hospital, 1 must be a RN), at least once every shift and recorded in a dedicated S4D/R register Medication Storage of S8 medication ❑ Stored separately from all other medications and behind 2 locked doors (approved drug safe) at all times ❑ No other goods should be stored in the same place (e.g. cash, keys) ❑ S8 key must be carried by an RN Medication Storage of S8 medication ❑ Must be checked and counted by 2 nurses, 1 must be an RN and recorded in a dedicated S8 register ❑ Good professional practice means the count should happen at the beginning and end of each shift, even if legislation or regulation does not adhere to this strict regime. Medication S4 and S8 storage cupboard key/s ❑ A S4 / S8 cupboard / Safe key must be carried by an ‘authorized person’ ❑ S8 key and S4 key can be kept together but with no other ward keys and if so, must be carried by an RN Medication Self administered medications ❑ Stored in a secure bedside storage that is inaccessible to other patients or visitors e.g. locked bedside drawer to which the patient may hold the key> however, in many places the key is kept by nurse, who opens drawer and supervises patient taking medications and then signs chart. Medication When storing medications ❑ All medications should be stored in their original packs or containers as received from Pharmacy Medication Adverse medication events ❑ Form part of quality improvement programs, and facilities should have a system in place ❑ All disciplines should be encouraged to report incidents, or near miss incidents ❑ ‘No blame’ reporting of errors ❑ Open disclosure Medication orders Medication orders Medication orders must ❑ Use a patient medication chart (area health logo) either paper or electronic ❑ Record allergies and adverse drug reactions ❑ Be clear, legible and unambiguous. Block capitals if necessary ❑ Record patient full name, DOB, MRN (medical record number) and address ❑ Record age and weight if a paediatric patient Medication orders Medication orders must include ❑ Name of medication in full, no abbreviations. Generic name if possible ❑ Strength of medication ❑ Form of medication ❑ Dose, route, and frequency ❑ Date of cessation, total number of doses, or set time period for administration Medication orders Medication orders must include ❑ Signature and date ❑ Each individual medication order must be written in a separate box ❑ Each medication order must also be signed Medication orders Where a medication is not given on certain days ❑ The prescriber must cross out those days on the medication chart to prevent errors Medication orders To cease a medication order ❑ The doctor must draw a line across the area of the chart where administration is recorded (after the last entry) and sign and date adjacent to this line ❑ For an electronic chart, the doctor must cancel the order using their login Medication orders Fax and email orders ❑ Written orders must be attached to the patient record until attended and transcribed by the prescriber Medication orders Telephone and verbal orders ❑ Should be discouraged ❑ But where essential, the medication chart should contain a specific section that promotes safe practice ❑ The phone order must be repeated to 2 nurses on the phone ❑ Must be attended and signed by prescriber within 24 hours Medication orders Telephone and verbal orders should include ❑ Date prescribed ❑ name of doctor giving verbal order ❑ The 5 / 6 rights, patient and their medication chart, medication, time medicine is to be administered, route, dose ❑ Details of two nurses to confirm that verbal order was heard and checked by TWO persons and also repeated back to doctor ❑ Time medication was administered Medication orders Telephone orders ❑ The telephone order MUST be signed, or otherwise confirmed in writing, within 24 hours Non-RN scope of practice and medications Non-RN scope of practice and medications The Assistant in Nursing ❑ Provides direct patient care ❑ Supports the nursing team in the delivery of nursing care under guidance of the RN ❑ Practices in accordance with state guidelines, the terms of their employment and facility policy and procedure ❑ Remains accountable to the RN in the exercise of their duties ❑ But is also responsible for their own actions Non-RN scope of practice and medications The Assistant in Nursing ❑ Can assist with certain medication under delegation (aged care only) ❑ Must have completed the relevant Cert IV unit in medication knowledge ❑ Can act as second check for accountable medications if there is no other more senior staff member (aged care only) Non-RN scope of practice and medications The enrolled nurse ❑ Is an associate to the registered nurse who demonstrates competence in the provision of patient-centred care ❑ Core not minimum EN practice requires the EN to work under the direction and supervision of the registered nurse ❑ The EN is responsible for their own actions Non-RN scope of practice and medications The Enrolled Nurse ❑ Can administer medication within limitations of role (e.g., can administer S4D/R medications but cannot administer S8) ❑ Can act as second check for S8 ❑ Cannot carry the S8 medication storage keys Non-RN scope of practice and medications The Enrolled Nurse ❑ Since the introduction of the National Scheme, there are no endorsements for administration of medicines by enrolled nurses ❑ The National Board changed this to recognise the growing number of enrolled nurses, including all new graduates, who have the required education to administer medicines Non-RN scope of practice and medications The Enrolled Nurse ❑ In the interest of public protection, it is essential that enrolled nurses must only administer medicines if they have completed the relevant medicine administration education units ❑ Graduates from Board-approved enrolled nurse courses from the Approved programs of study from 2008 (NSW) / April 2021 (WA) onwards have completed relevant medicine administration units, covered as part of the curriculum Non-RN scope of practice and medications The Enrolled Nurse ❑ Those enrolled nurses who did not have the requisite education and competence to administer medicines were required to identify themselves to AHPRA and have the notation: ‘Does not hold Board-approved qualification in administration of medicines’ placed on their registration ❑ This notation will remain in place until the enrolled nurse provides evidence of having completed a Board-approved administration of medicines unit Non-RN scope of practice and medications Administering intravenous (IV) medicines ❑ Enrolled nurses without a notation may not be able to administer intravenous (IV) medicines ❑ Therefore, an enrolled nurse may lack a notation but may also not have completed the required education ❑ An enrolled nurse who does not have a notation on their registration can expand their scope of practice to include certain intravenous medicines administration after successful completion of a relevant course Task delegation Task delegation The NMBA Decision-making framework (the DMF) ❑ An evidence-based contemporary document that is to be used in conjunction with standards for practice, policies, regulations and legislation related to nursing or midwifery. Task delegation Purpose of the decision-making framework ❑ The purpose of the DMF is to guide decision-making relating to scope of practice and delegation and to promote decisionmaking which is: ❑ consistent ❑ safe ❑ person-centred/woman-centred, and ❑ evidence-based. Task delegation Decision-making framework for nursing and midwifery ❑ 1. The primary motivation for any decision about a care activity is to meet people’s health needs or to enhance health outcomes. Task delegation Decision-making framework for nursing and midwifery ❑ 2. Nurses are responsible for making professional judgements about when an activity is beyond their scope of practice and for initiating consultation with, or referral to, other members of the healthcare team. Task delegation Decision-making framework for nursing and midwifery ❑ 3. Expansion to scope of practice occurs when a nurse assumes responsibility for an activity that is currently outside the nurses’ scope of practice, or where an employer seeks to initiate a change, because of evaluations of services and a desire to improve access to, or efficiency of, services to groups of people. Task delegation Decision-making framework for nursing and midwifery ❑ 4. Registered nurses (the delegator) are accountable for making decisions about who is the most appropriate health professional or health worker to delegate to (delegatee) to perform an activity that is in the nursing plan of care. Task delegation Decision-making framework for nursing and midwifery ❑ 5. Nursing practice decisions are best made in a collaborative context of planning, risk management, and evaluation. Questions Please bring any questions you have about this lecture to your weekly tutorial References Government of Western Australia Department of Health. (2020). Medicines Handling Policy. Medicines-Handling-Policy.pdf (health.wa.gov.au) Government of Western Australia Department of Health. (2020). Guideline on administration and record keeping for Schedule 4 Restricted and Schedule 8 medicines. Guideline-on-administration-and-record-keeping-for-S4-Restricted-and-S8-medicines.pdf (health.wa.gov.au) Nursing and Midwifery Board of Australia. (2020). Decision-making framework for nursing and midwifery. Retrieved from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/frameworks.aspx Nursing and Midwifery Board of Australia. (2016). Registered nurse standards for practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-forpractice.aspx The medicines and poison act 2014 (WA). The Medicine and Poison Regulation 2016 (WA). Savage, P., Knight, B., & Knight, C. (2011) "Can I do that? Is it legal?" The Australian nurse's cry for help. Journal of Nursing Law, 14(2), 68-76. doi10.1891/1073-7472.14.2.68 Staunton, P.J., & Chiarella, M. (2020). Law for nurses and midwives (9th ed.). Elsevier.