This assignment will discuss relevant issues surrounding the subject of safe administration of medicines. The assignment will outline both legal and professional standards that have been set out by government and professional bodies for nurses and other health care professionals to follow whilst administering medicines. It will then go onto analyse actual and potential problems that may occur when a professional is trying to achieve these standards. This assignment will be supported by literature findings. The conclusion will reflect what is written.

The administration of drugs could be defined as the way in which drugs are selected, obtained, delivered, prescribed, administered and reviewed to make sure that the medicine is having the desired affect (Dougherty et al 2004). Drug administration is an integral part of a nurse’s role and as such responsibility for correct administration of drugs rests with the nurse (O’Shea 1999). It is stated that nurses spend up to 40% of their time administrating medicine (Armitage et al 2003) In order to perform this intervention safely a nurse needs to know about the drug its immediate effect and any side effects it may cause. This role involves safe handling and administration of medicines, the role also includes the nurse being responsible for the patients knowing what medicines they are taking and why. Legal, professional and cultural boundaries are changing in health care settings, which mean that a nurse’s role is now medicines management. (Dougherty et al 2004).

Medication errors can place a patients life at risk. Errors are an unavoidable subset of human behaviour, no amount of proficiency or expertise will reduce it (Reason 2000). Drug errors can be costly the results are increased hospital stay, patient harm, loss of life in some circumstances; careers ruined or fear of reprisal (Anderson et al 2002). Medication errors account for 25% of all litigation claims in the United Kingdom. The government has now promised to reduce this by 40%; one of the initiatives is to promote competence in calculating drug dosages to ensure safe administration by nurses (DH 2004).

The safe administration of medicines is supported by legislations in that the law requires that medicines are given to the right person, at the right time, in the right form, using the right dose, via the right route known as the five rights of administration of medicine (Griffith, 2003). The legislation is designed to provide nurses and other health care professionals with a comprehensive framework for their clinical practice. A legal framework brings together four different areas of accountability to help safeguard patients from any damaging effects that medicines may cause while allowing them to benefit from their therapeutic properties. One being The Medicines Act 1968, and The Consumer Protection Act 1987, these protect society through the public law, to the person through civil law, to the employers through contract law and to the profession through the Nursing and Midwifery Order 2002. The Consumer Protection Act 1987 has a strict liability principle, the producer of the product must always be identifiable. These areas regulate the right to administer medicine and the standard required when giving medicine (Griffith, 2003).

The Medicines Act 1968 regulates the manufacture, distribution and importation of all medicines for human use. The Health and Agriculture Ministers are responsible for this act and they receive advice from the Medicines Commission. The Act regulates drugs that are used for medicinal purposes, such as ‘prescription only’ that have been prescribed by a doctor, dentist or nurse practioner The ‘General’ category allows the drugs to be sold without a prescription in any shop, and a pharmacist can sell ‘Pharmacy Medicines’ without the need for a prescription. This act also recommends how the medicines should be packaged and labelled. The Misuse of Drugs Act 1971 is also vital in the administration of medicines, because it controls the import and export, supply, production and possession of dangerous drugs. The drugs subject to control are termed ‘controlled drugs’ and are divided into classes, depending on the harm they can cause. Class A being the most harmful Class B middle range and Class C the least harmful (Griffiths 2003). Professional bodies such as the Royal Pharmaceutical Society of Great Britain, British Medical Association (BMA), and the Nursing and Midwifery Council (NMC) are also involved to a degree in the regulation of administration of medicines (Department of Health 2004).

The (NMC 2004) state “The administration of medicines is not solely a mechanistic task to be performed in strict compliance with a written prescription; it requires thought and the exercise of professional judgement.” Pg 4

The Nursing and Midwifery Council (NMC) primary function is to ‘protect the public’ by setting professional standards and giving advice and guidance to registered nurses, midwives and community public health nurse. Registered nurses need to abide by the Code of Professional Conduct (2004) as set out by the (NMC). There are two main standards from the Code of Professional Conduct (2004) that relate to the safe administration of medicine, these principles are that all registrants must exercise their professional judgement and apply their knowledge and skill in the given situation and to minimise risk to patients and clients. The standards state that you are accountable for your practice. Therefore you are responsible for your own actions and omissions, regardless of advice or directions from another professional, you must deliver safe and effective care based on current evidence and best practice (Nursing and Midwifery Council 2004).

The (NMC) have written drug administration guidelines along side the Code of Professional Conduct (2004) An overview of these are that because nurses are accountable for the drugs they administer they need to be knowledgeable of side-effects, correct dosage, and its therapeutic uses, be able to give information to the patient relating to the medication concerned including knowing any contra-indications that may occur with other medicines. Check the identity of the patient with the prescription and their wrist label, Check the label on the medicine which as been dispensed by a pharmacist, check the expiry date of the medicine, make sure the drug card states the correct time, drugs like antibiotics can be absorbed better if given before food when the stomach is empty and therefore they become more effective in treating the cause (Whitehead, E 2006) Check the route, name, and correct dose and that it relates to the medicine to be given, and gain consent, along with the correct dose.

The Drug card should be signed only after you have seen the patient take the medicine along with marking down on the drug card if the patient refuses or any other reason why the drug was not taken. Drugs should never be left by the bed for the individual to take when ready. These drugs could be taken by others or disposed of with dangerous consequences. The signature should be clear and legible on the drug card and the care plan of the patient should be checked. Whilst on placement I witnessed nursing staff asking doctors to re-write the drug card because they were concerns due to illegibility of the prescription. Illegible prescriptions can lead to the five rights of administration (as mentioned earlier) not being carried out correctly and a possible drug error could occur. Gladstone (1995) carried out a study that found that nurses frequently identified poor handwriting on prescriptions as a key contributory aspect in drug errors. If a registered nurse follows the guidelines above it may possibly cut down on the risk of medication errors from occurring.

Drug administration errors can occur in clinical settings when the practice of crushing tablets and opening capsules takes place. This as the potential to endanger patients safety and thereby breach legal and professional requirements. It also renders its use to be “unlicensed” which could mean the manufactures may assume no liability for any harm caused (Wright 2002). Under the ‘Medicines Act 1968’ only medical and dental practitioners can authorise the use of unlicensed medicines. Certain medicines have special coatings that affect how they are released in to the body, crushing them can disturb this complex system which in return could cause an adverse drug reaction. On some occasions due to swallowing problems with certain patients this intervention may be necessary but If possible a safer alternative should be sought such as liquid preparation (Wright 2002).

Another potential drug administration problem is poor calculation of the dose this can lead to inaccurate doses of drugs being administered to patients. There have been studies carried out on ‘calculation skills’ that have highlighted that in practice errors are made because of poor drug calculation skills (Wright 2006). Weeks et al (2000) indicates nurses need arithmetic skills as well as theoretical skills to be able to complete drug calculations effectively. Many of these studies conclude that the problem of medication calculation errors is not always a result of the system in which the nurses work, but can be directly caused by the poor skills and competence levels of the nurses undertaking these calculations (Polifroni et al, 2003). Studies have shown three main areas where errors are made in drug calculations. The first is the lack of understanding the logic of a problem or how to calculate a formula. The second is not being able to add, subtract, multiply and divide correctly (Weeks et al 2000). The third is where nurses can not decipher the instructions to be able to carry out the instruction (Giorgio et al 2002).

The use of written exams to predict nurses drug calculation skills have been criticised, as it is suggested that exams to do not reflect performance in clinical practice (Hutton 1998a). However Calliari (1995) disagrees with this and indicates there is evidence to suggest that poor performance in drug calculation exams could indicate increased drug errors in clinical practice.
Therefore it is paramount that nurse educators take this into account the difficult area of mathematical competency and ensure that student nurses and registered nurses are constantly being assessed on these skills.

Other factors that may be affecting why medication errors occur could be because the nurse has a lack of knowledge or information (Griffith, 2003). Whilst on placement I noticed that very few nurses actually checked any medicines that they do not know of within the British National Formulary (BNF) they also did not check why a patient had been prescribed a specific drug if they did not know why. Bullock (2002) indicates that Nurses who have a strong knowledge in pharmacology would have the skills to comply with their roles in the management of drug administration. Cooper (1995) further suggests that the lack of pharmacological knowledge can also conceal a nurse’s knowledge of generic names or trade names. If a nurse has these skills it may help with the reporting of errors.

Reporting of errors is a voluntary and reactive process, it relies on a nurse being aware of actual errors and also having willingness to report it. The NMC (2002) is also clear in its advice and states that it is important for an open culture to exist in order to promote the immediate reporting of errors or incidents in the administration of medicines. Unfortunately, the attitude for dealing with error is for employers to hold the individual responsible (Anderson et al 2001). However, this only makes nurses wary of reporting such incidents, particularly if their career is to be ruined as a consequence of this action.

The National Patient Safety Agency (NPSA) has been set up by the Government to collect, review and analyse drug errors and produce solutions to reduce risk, such as education and training into medication processes, setting up systems for reporting and learning from medication errors National Patient Safety Agency (2006).

In conclusion the administration of medication is an area of concern for public safety and as such the right to administer and the standards of administration are regulated both by statute and common law, by implied contract terms and professional standards. The practice of crushing tablets and opening capsules has the potential to endanger life and breach legal and professional requirement. If there is a safer alternative such as a liquid preparation, then this must be used. Where there is no alternative the practitioner must show that they have fully considered the safety issues by consulting the prescriber, pharmacist and patient (Wright 2002).

Nurses and student nurses need to keep updating their knowledge and training in the area of the administration of drugs; this will also protect them legally and professionally. If the “Five Rights” that the DoH recommend are followed then this should minimise the risk of a drug error occurring. Patient safety needs to be maintained so the need for knowledge in pharmacology is paramount. Also illegible prescriptions should be challenged with the prescriber.

Nurses need to apply key principles of maths to administer correct doses of medication. Educators need to ensure that registered and student nurses are given opportunities to revise and improve their maths skills.

Honest reporting of a drug error and near misses where the potential for error has been identified is the way forward. However, this can only take place if the incident-reporting system is conducted in an open environment (Preston, R 2004).