61 terms

Meds Standards


Terms in this set (...)

Registrants must only supply and administer medicinal products in accordance with which 7 processes? [Standard 1: Methods]
1. Patient specific direction (PSD)
2. Patient medicines administration chart (/medicines administration record MAR)
3. Patient group direction (PGD)
4. Medicines Act exemption
5. Standing order
6. Homely remedy protocol
7. Prescription forms
What does Standard 1: Methods say about medicinal products once they have been prescribed and dispensed to an individual?
The drug is then the individual's own property. To use it for someone else is theft
What is a patient-specific direction (PSD)? [Standard 1: Methods]
A written instruction from a prescriber for a medicine to be supplied/administered to a named patient. Includes the dose, route and frequency to be administered
Give an example of a PSD in primary & secondary care. [Standard 1: Methods]
Primary care - simple instruction in the patient's notes.
Secondary care - instructions on a patient's medicines administration chart
What is the patient medicines administration chart? [Standard 1: Methods]
It is a direction to administer medication. It is NOT a prescription. It must be signed by a registered prescriber and authorises the delegation to administer medication on the prescriber's behalf. In doing so, the registrant is accountable for their actions and raising any concerns about the direction with the prescriber
What are patient group directions (PGDs)? [Standard 1: Methods]
Specific written instructions for the supply/administration of a licensed named medicine to specific groups of patients who may not be individually identified before presenting for treatment. It is NOT a form of prescribing
How are PGDs drawn up? [Standard 1: Methods]
PGDs are drawn up locally - must be signed by a doctor and a pharmacist, both of whom should have been involved in developing the direction
Who should PGDs be used by? [Standard 1: Methods]
PGDs should only be used by registrants who have been assessed as competent and whose name is identified within each document. The administration of drugs via a PGD may not be delegated
What are Medicines Act Exemptions? [Standard 1: Methods]
Allow certain groups of HCPs, including occupational health nurses under occupational health schemes, to sell, supply & administer specific medications directly to patients/clients
What are homely remedy protocols? [Standard 1: Methods]
Protocols to enable administration of GSL and Pharmacy only listed medicines in certain settings - e.g. care homes, children's homes & some educational institutions. They are NOT prescriptions and have no legal standing - required for liability purposes
What information should a homely remedy protocol contain? [Standard 1: Methods]
Protocol should clarify what medicinal product may be administered & for what indication (e.g. "paracetamol for a headache"), dose, frequency, and time limitation before referral to a GP
Explain NHS prescription forms, including for CDs [Standard 1: Methods]
NHS prescription forms are classified as secure stationery. They are serially numbered and have anticounterfeiting and anti-forgery features. Specific CD prescription forms are available from the local health care organisation (e.g. PCT) for use in the private healthcare sector
Who can write a prescription? [Standard 1: Methods]
Any qualified and registered independent prescriber may prescribe all prescription only medicines (POMs) for all medical conditions. Nurse independent prescribers may also prescribe some controlled drugs
What can supplementary prescribers do? [Standard 1: Methods]
Supplementary prescribers may prescribe in accordance with a clinical management plan (CMP) in a tripartite arrangement with a doctor, the patient, and the supplementary prescriber. When acting in accordance with the terms of a CMP, they may administer/supply/direct a person to administer CDs in schedules 2, 3, 4 and 5 and can prescribe unlicensed medicinal products
What regulations allow nurses to prescribe? [Standard 1: Methods]
The Medicinal Productions: Prescription by Nurses Act 1992 and subsequent amendments to the pharmaceutical services regulations allow nurses, who have recorded their qualification on the NMC register, to become nurse prescribers
What are the 2 levels of nurse prescribers? [Standard 1: Methods]
1. Community practitioner nurse prescribers
2. Independent and supplementary nurse prescribers
What are community practitioner nurse prescribers? [Standard 1: Methods]
Registrants who have undertaken programme of preparation to prescribe from Community Practitioner Nurse Prescribers' Formulary. They can prescribe the majority of dressings and a limited range of POMs
What are independent and supplementary nurse prescribers? [Standard 1: Methods]
Consists of both independent and supplementary prescribing:
> Independent prescribing - nurses who are trained to make a diagnosis and prescribe the appropriate treatment;
> Supplementary prescribing - where a doctor has made an initial diagnosis, they may then go on to prescribe or review the medication and change the drug, dosage, timing or frequency or route of administration as part of a clinical management plan
What medications can nurse independent prescribers prescribe? [Standard 1: Methods]
Nurse independent prescribers can prescribe all POMs including some CDs, and all meds that can be supplied by a pharmacist/bought over the counter. They must only prescribe drugs within their area of expertise & level of competence & only prescribe for children if they have the expertise/competence to do so
What does Standard 2: Checking state that nurses must do?
Registrants must check any direction to administer a medicinal product. In administering any medication, or assisting/overseeing any self-administration of medication, you must exercise professional judgement
Before administering a medicinal product, what must you always check regarding the prescription or other direction to administer? Including CDs. [Standard 2: Checking]
- not for a substance which the patient is known to be allergic/unable to tolerate
- based, whenever possible, on the pt's informed consent and awareness of the purpose of the treatment
- clearly written, typed or computer-generated and indelible
- specifies the substance to be administered, its form, strength, dosage, timing, frequency of administration, start and finish dates, route of administration
- signed and dated by the authorised prescriber
- in the case of CDs - specifies the dosage and number of dosage units/total course
You must have also:
- clearly identified the pt for whom the medication is intended
- recorded the weight of the pt on the prescription sheet for all children, and where dosage relates to weight or surface area
What is the MHRA definition of dispensing? [Standard 4: Prescription medicines]
"To label from stock and supply a clinically appropriate medicine to a patient, client or carer, usually against a written prescription, for self-administration or administration by another professional, and to advise on safe and effective use"
What may nurses do in regards to dispensing (usually for TTOs)? [Standard 4: Prescription medicines]
Registrants may, in exceptional circumstances, label from stock and supply a clinically appropriate medication to a pt, against a written prescription (not PGD), for self-administration or administration by another professional, and to advise on its safe and effective use
What actions in terms of checking should nurses take when dispensing prescription medications to patients? [Standard 4: Prescription medicines]
Dispensing includes activities such as checking the validity of the prescription, the appropriateness of the medicine, assembly of the product, labelling and providing information leaflets for the patient
What does Standard 8: Administration state?
1. you must be certain of the IDENTITY of the patient
2. you must check that the patient is not ALLERGIC to the medicine
3. you must know the THERAPEUTIC USES of the medicine, its normal DOSAGE, SIDE EFFECTS, PRECAUTIONS and CONTRA-INDICATIONS
4. you must be aware of the patient's CARE PLAN
5. you must check that the prescription or label on medicine dispensed is CLEARLY WRITTEN and unambiguous
6. you must check the EXPIRY DATE
7. you must have considered the DOSAGE, WEIGHT of pt, METHOD of administration, ROUTE, and TIMING
8. you must ADMINISTER/WITHHOLD in the context of the pt's condition
9. you must CONTACT THE PRESCRIBER / another authorised prescriber where contra-indications to the prescribed medicine are discovered, where the pt develops a reaction to the medicine, or where assessment of the pts indicates the medicine is no longer suitable
10. you must make a clear, accurate and immediate RECORD of all medicine administered, intentionally withheld or refused - ensure signature is clear and legible
If a medication is not given, what must you make sure you do? [Standard 8: Administration]
Where a medication is not given, the reason for not doing so must be recorded. You must contact the prescriber without delay where assessment of the pt indicates that the medicine is no longer suitable.
What may you administer with a single signature? [Standard 8: Administration]
Any POM, GSL or pharmacy medication
Who should sign for controlled drugs? [Standard 8: Administration]
It is recommended for the administration of CDs, a secondary signatory is required within secondary care. In a pt's home, where a registrant is administering a CD that has already been prescribed and dispensed to that pt, obtaining a secondary signatory should be based on local risk assessment
Who should be the second signatory for CDs in the community? [Standard 8: Administration]
Although normally the 2nd signatory should be another registered HCP (e.g. doctor, pharmacist, dentist) or student nurse, in the interest of pt care, where this is not possible a 2nd suitable person who has been assessed as competent may sign
How should nurses clarify identity in complex situations? [Standard 8: Administration]
Where there are difficulties in clarifying an individual's identity (e.g. in some areas of LDs or pts with dementia/confusional states), an up-to-date photograph should be attached to the prescription chart. For pts with burns where the wearing of a wristband is inappropriate & a photograph would not resemble the pt, local policies should be in place to ensure all staff are familiar with the pts and a system of identification is in place
What should nurses who are administering medicines with complex calculations consider? [Standard 8: Administration]
It is good practice for a 2nd HCP to check the calculation independently in order to minimise the risk of error
As a nurse, what are your responsibilities in regards to patients and self-administration of medicines? [Standard 9: Assessment]
- You are responsible for the initial & continued assessment of pts who are self-administering & have continuing responsibility for recognising and acting upon changes in a pt's condition with regards to safety of the pt.
- The pt's level of self-administration should be documented in the pt's notes
- The registrant must ensure the pt is able to open the medicine containers or is offered assistance, for example, with a compliance aid
What is the nurse's duty of care relating to using patient's own medicinal products? [Standard 9: Assessment]
At all times the registrant has a duty of care to the patient to ensure that only medicinal products which are prescribed and meet the required criteria are used by the patient
If a patient is assessed as Level 1 for self-administration of medicines, what does this involve? [Standard 9: Assessment]
The registrant is responsible for the safe storage of the medicine and the supervision of the administration process, ensuring the pt understands the medicine being administered
If a patient is assessed as Level 2 for self-administration of medicines, what does this involve? [Standard 9: Assessment]
The registrant is responsible for the safe storage of the medicine. At administration time, the pt will ask the registrant to open the cabinet/locker. The pt will then self-administer the medicine under supervision of the registrant
If a patient is assessed as Level 3 for self-administration of medicines, what does this involve? [Standard 9: Assessment]
The pt accepts full responsibility for the storage and administration of the medicine. The registrant checks the pt's suitability and compliance verbally
What information should be provided to a patient before they commence self-administration? [Standard 9: Assessment]
- the name of the medicine
- why they are taking it
- dose and frequency
- common SEs and what to do if they occur
- any special instructions
- duration of the course or how to obtain further supplies
Are nurses liable if a patient makes a mistake during self-administration? [Standard 9: Assessment]
No. Whilst the registrant has a duty of care towards all patients, the registrant is not liable if a pt makes a mistake self-administering as long as the assessment was completed as the local policy describes and appropriate actions were taken to prevent re-occurrence of the incident
What is remote prescription / direction to administer? [Standard 11: Remote prescription or direction to administer]
In exceptional circumstances, where medication (not including CDs) has been previously prescribed and the prescriber is unable to issue a new prescription, but where changes to the dose are necessary, the use of IT (e.g. fax, text, email) may be used but must confirm any change to the original prescription
Is a verbal order acceptable in remote prescription? [Standard 11: Remote prescription or direction to administer]
No. A verbal order is not acceptable on its own. The fax or email prescription / direction to administer must be stapled to the pt's existing medication chart. This should be followed up by a new prescription signed by the prescriber who sent the fax or email confirming the changes within 24h. The changes must have been authorised via text, email or fax by a registered prescriber before the new dosage is administered.
If they have not assessed the patient, can a nurse independent prescriber prescribe remotely? [Standard 11: Remote prescription or direction to administer]
No. Where a medication has not been prescribed before, a nurse independent prescriber may not prescribe remotely if they have not assessed the pt except in life-threatening situations.
Can remote prescribing be undertaken in a care home? [Standard 11: Remote prescription or direction to administer]
No, remote prescribing cannot be undertaken in a care home because they do not have access to a stock of medicines.
Can a medical practitioner remotely prescribe a previously unprescribed medicine? [Standard 11: Remote prescription or direction to administer]
Yes, in exceptional circumstances, a medical practitioner may need to prescribe remotely for a previously unprescribed medicine, e.g. in palliative care. The use of IT (fax, text, email) must confirm the prescription before it is administered. This should be followed up by a new prescription signed by the prescriber confirming the changes within 24h.
When is a prescription vs directioner to administer required in remote prescribing? [Standard 11: Remote prescription or direction to administer]
A prescription is required when the drug is to be both supplied and administered. For administration only, a direction to administer is sufficient.
What is a 'clinical management plan' (CMP)?
The CMP is the foundation of supplementary prescribing.
Before supplementary prescribing can take place, it is obligatory for an agreed CMP to be in place (written or electronic) relating to a named patient and to that patient's specific condition(s) to be managed by the supplementary prescriber. The CMP is required to include details of the illness or conditions that may be treated, the class or description of medical products
that can be prescribed or administered, and the circumstances in which the supplementary prescriber should refer to, or seek
advice from, the doctor. Supplementary prescribers
must have access to the same patient or client health records
as the doctor. Since April 2005, nurse supplementary
prescribers can prescribe CDs, provided the doctor or has agreed to this within the CMP.
Define 'dispensing'.
To label from stock and supply a clinically appropriate medicine to a patient, usually against a written prescription, for
self-administration or administration by another professional, and
to advise on safe and effective use.
What is an 'independent prescriber'?
A prescriber who is legally permitted and qualified to prescribe and takes the responsibility for the clinical assessment of
the patient, establishing a diagnosis and the clinical
management required, as well as the responsibility for
prescribing, and the appropriateness of any prescribing.
What is the 'medicines administration record'?
Also known as patient administration chart, the record by which medicinal products administered to a patient are recorded.
Who are the Medicines Healthcare Products Regulatory Agency (MHRA) and what is their role?
The government agency responsible for ensuring that medicines and medical devices work and are acceptably safe.
Define 'nurse independent prescribers'.
Nurses who are on the relevant parts of the NMC register may train to prescribe any medicine for any medical condition within their competence with the exception of CDs.
What is 'repeat prescribing?'
A partnership between patient and prescriber that allows
the prescriber to authorise a prescription so it can be repeatedly issued at agreed intervals, without the patient having to consult the prescriber at each issue.
What is supplementary prescribing?
A voluntary partnership between an independent prescriber (doctor) and a supplementary prescriber, to implement an agreed patient or client-specific clinical management plan (CMP) with
the patient's agreement.
What is transcribing (aka transposing)?
Any act by which medicinal products are written from one form of direction to administer to another. May include discharge letters, transfer letters, copying illegible patient
administrations chart onto new charts.
What is the Yellow Card Scheme?
If a patient experiences an adverse drug reaction to a
medication the nurse should record this in the patient's notes, notify the prescriber (if they did not prescribe the
drug) and notify via the Yellow Card Scheme immediately.
Describe the Medicines Act 1968.
The first comprehensive legislation on medicines in the UK. The combination
of this primary legislation and the various secondary legislation on medicines produced since 1968 provides the legal framework for the manufacture, licensing, prescribing, supply and administration of medicines. Among recent statutory
instruments of particular relevance to registered nurses is The Prescription Only Medicines (Human Use) Order
1997. This consolidates all previous secondary legislation on prescription
only medicines and lists all of the medicines in this category. It also sets out who may
prescribe them. The Medicines Act 1968 classifies medicines into the following categories:
- Prescription only medicines (POMs)
- Pharmacy only medicines (Ps)
- General sales list medicines (GSLs)
- Controlled drugs (CDs)
Describe the Misuse of Drugs Act 1971.
The Misuse of Drugs Act (MDA) 1971 and its associated regulations provide the
statutory framework for the control and regulation of controlled drugs. The primary
purpose of the MDA is to prevent misuse of CDs. The MDA 1971 makes it unlawful
to possess or supply a controlled drug unless an exception or exemption applies. A CD is defined as any drug listed in schedule 2 of the Act.
Additional statutory measures for the management of controlled drugs are laid down in the Health Act 2006 and its associated regulations.
Describe the Health Act 2006
The key provisions of the act are:
• all designated bodies such as healthcare organisations and independent hospitals
are required to appoint an accountable officer
• a duty of collaboration placed on responsible bodies, healthcare organisations and
other local and national agencies including professional regulatory bodies, police
forces, the Healthcare Commission and the Commission for Social Care inspection to share intelligence on controlled drug issues
• a power of entry and inspection for the police and other nominated people to enter
premises to inspect stocks and records of controlled drugs.
Describe the Controlled Drug (Supervision of Management and Use) Regulations 2006
These regulations set out the requirements for certain NHS bodies and independent healthcare bodies to appoint an
accountable officer, and describe the duties and responsibilities of accountable officers to improve the management and use of controlled drugs.
The regulations also require specified bodies to cooperate with each other, including
with regard to sharing of information, concerns about the use and management of
controlled drugs, and the setting out arrangements relating to powers of entry and
State 4 people who can sign for controlled drugs in the community
1. Registered nurse
2. Student nurse/midwife
3. Other registered practitioners if they have witnessed administration (Dr/pharmacist)
4. Second competent person, which may be a carer
If only part of a vial of a CD is used how should this be recorded?
1. The rest of the vial should be documented as waste and recorded in the CD book
2. It should be disposed in a way so the rest is unable to be retrieved and used
3. The disposal of the drug not needed must be witnessed and signed by the second checker
Why is it important that the nurse in charge has possession of the keys?
1. NIC is responsible for the safe keeping, delegation and location of the keys
2. If the keys are given to someone else the NIC has effectively delegated control of access
3. NIC may give the keys to a responsible nurse, however they must ensure they do not go missing as this could lead to a member of the public accessing the cupboard putting them at risk
4. If keys go missing - need to check all staff / if someone goes home with them must return immediately / contact pharmacy & senior nursing staff