In order to improve medication safety, it is recommended that nurses undertake a variety of pragmatic steps. The primary principle of this paper is to establish the theoretical importance of the nurse’s role in the safe administration of oral medication. This will be accomplished by firstly identifying the importance of patient safety in drug calculations and the complexed nature of paediatric dosages. Secondly, the guidelines on medicine administration imposed by The Nursing and Midwifery Council (NMC) will be addressed and considered in light of current legislation and government policy. Finally, this paper will emphasise the importance of training of both knowledge and skills in relation to practice before discussing the unique role of the children’s nurse in the safe administration of oral medication.
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Medications are now available in multiple varieties for administration, via multiple routes. For most patients, the oral route is the most adequate and beneficial method of consuming medications, this is to provide the optimum effect and minimise any related adverse side effects. Medications administered by mouth are commonly absorbed from the small intestine to the liver through the portal vein. One the medication is metabolised it enters the circulation system for systematic effect. The Nursing and Midwifery Council (2008) states that it is the duty of the nurse to understand the pharmacology and medical speciality of pharmaceutical care. This is in order to support safe and professional practice on the nurse’s behalf.
In modern nursing practice, the demand to calculate drug dosages is not uncommon. It is essential that the nurse ensures that these calculations are executed with competence and accuracy, so as not to put themselves but more importantly the patient at risk of administering inaccurate drug dosages or lapses. Therefore it is the responsibility of the nurse as a duty of care to patients to ensure that they are competent in the successful execution of various required mathematical calculations. They must ensure that the take adequate time when working out calculations, recheck answers and ensure that any distraction are kept to a minimum.
The results of a recent study (Pentin & Smith, 2006) identified that many nurses do not have the ability to mentally calculate, resulting in the need for the use of calculators. It further establishes that nurses have anxiety issues in relation to being encouraged not to use calculators within clinical practice, as many nurses depend on this to minimise potential miscalculations. It is the role of the nurse to ensure patient safety is the number one priority in all aspects of patient care, including that of drug calculations. However guidelines imposed by the NMC (2008) states that calculators should not be used as a substitute for manual arthritic. Consequently medication calculations are a complexed and daunting activity, if nurses do not have the required level of mathematical ability.
Safe and efficient disposal of medications to children and infants requires a combination of professional competencies, which will be addressed later in this paper. The oral route is favoured for distributing medicines in infants and children whenever realistic. This is because children associate less pain and anxiety with taking medication by mouth, it is often cheaper than other methods and it is more feasible to facilitate. Children are more susceptible to medication dosage errors because of the unique calculations involved. Nurses must ensure that they are aware of their own ability and are fully competent in undertaking required calculations, however these skills should be established before qualification and registration. Drug dosages for infants and children are calculated on either body surface area or the child’s body weight , hence more complexed calculations are required. Paediatric dosages must be accurate to guarantee adequate therapeutic levels. It is the nurses responsibility to understand the system of measurement and the relationship between units to fully understand the arithmetic involved in calculations.
All registered nurses within the United Kingdom are governed by the same professional code of conduct, in order to protect the public and maintain high standards of care. Therefore all healthcare professional are accountable for their own individual practice and conduct. It is the role of the nurse to understand their own limitations in regards to all aspects of care, including that of administering oral medication to patients. The NMC (2008) stresses that the disposal of medications is an integral and crucial entry criteria for the Council’s Professional Register, as it is part of daily practice with the potential for errors to occur. Hence it is the role of the nurse to protect and support the well-being of patients in their care in the receiving of oral medication. Furthermore, the Code of Professional Conduct distinctly expresses that medication administration must not be seen entirely as a mechanistic undertaking but as a task that requires thought and professional judgement .It is the sole responsibility of the nurse to practice with competence and ensure that they have required knowledge and skills to be able to practice safely and lawfully.
A recent study (Elliot & Liu, 2010) established that it is the role of the nurse to implement the “Nine Rights” of medicine management. This involves ensuring the patient receives the right drug, therefore correct treatment will be received and omissions reduced. The next steps are to ensure that the medication is given to the right patient and at the right time, hence this minimises the risk of exposure to potentially harmful medications and the risk of overdosing a patient or the patient’s care being affected reduced. Then follows ensuring it is the right does and the right route, meaning patients are competently medicated and the best course of action is being taken. It is then the duty of the nurse to ensure the right documentation is completed to ensure lawful and competent practice and for any confusion regarding the medication to be minimised. Lastly the nurse has to ensure the right action has been taken, it has been the right form and that the right response from the patient is visible, therefore this reduces any adverse side effects or complications.
Training and development is essential in the nurse’s role in order to maintain the required standard of practice. Guidelines and protocols in relation to the administration of oral medication are continually adapting in light of medical research, which is forever progressing. It is the individual nurse’s responsibility to be able to identify their own training needs, to provide opportunities for them to develop and enhance required skills.
Safe storage of medication is a fundamental role of the nurse in ensuring patient safety. Local policies and procedures must be adhered in regards to the safe storage and security of medicines. It is the role of the nurse to ensure that medication is stored in accordance with guidelines and consequently information must be accurately documentation.
The safe and competent administration of medication to minors is one of the most important obligations of the children’s nurse. A paediatric study (Kanneh, 2002) identified that the physical, metabolic and physiological state of infants and children is perpetually dynamic. This has an effect on the pharmacokinetics of medications administered, further perplexing the administration process of medications to children. Hence it is the role of children’s nurses to fully comprehend these developmental processes in which children radically undergo and to understand any related complications arising from this.
The NMC (2008) encourage that paediatric nurses incorporate family centred care into nursing duties, especially pre-discharge. It is therefore the role of the children’s nurse to promote independence and influence parents/guardians to take part in administering medication to their child. The children’s nurse should also support self-administration for children who are age appropriate and are deemed to have a sufficient understanding of their treatment. However it remains the responsibility of the nurse caring for the child to ensure that the medication has been given. The nurse must understand that children have the right to refuse treatment if they have the mental capacity of understanding the implications in doing so, then therefore it is the role of the nurse to use a temperamental approach and reinforce the importance and benefits of the treatment, to attempt to gain consent. If the child does not have the mental capacity are not deemed age appropriate then consent must be gained for a parent or guardian.
It can therefore be concluded that the safe administration of oral medication to patients requires a combination of professional competencies. Nurses must act with integrity and professionalism at all times to support safe and professional practice. Furthermore it has been identified that in order to improve patient safety in the safe administration of oral medication a variety of pragmatic steps must be taken by all healthcare professionals involved in the administration process. It is therefore essential that all registered nurses are competent in delivering the required level of care to patients. Moreover all nurses must adhere to specific guidelines and protocols in accordance with trust policies, adhering to all principles and guidelines therefore ensure safe and competent practice on the nurse’s behalf.
BMJ Group. 2009, BNF for Children. London, RPS Publishing.
Copping, C. 2005, “Preventing and reporting drug administration errors”, Nursing Times, Vol. 101, no. 33, pp. 32-34.
Elliot, M. and Lui, Y. 2010, “The nine rights of medicine administration: an overview”, British Journal Nursing, Vol. 19, no. 5, pp. 300-305.
Fry, M.M. and Dacey, C. 2007, “Factors contributing to incidents in medicine administration: Part 1”, British Journal of Nursing, Vol. 16, no. 9, pp. 556-559.
Griffith, R. Griffiths, H. And Jordan, S. 2003, “Administration of medicines. Part 1: The law and nursing”, Nursing Standards, Vol. 18, no. 2, pp. 47-53.
Kanneh, A. 2002, “Paediatric pharmacological principles: an update. Part 1: Drug development and pharmacodynamics”, Paediatric Nursing Times, Vol. 14, no. 8, pp. 36-42.
Nursing and Midwifery Council (NMC). 2008, “Guidelines on the Administration of Medicines”, London, NMC.
Nursing and Midwifery Council (NMC). 2008, “THE CODE: Standards of conduct, performance and Nursing and ethics for nurses and midwifes”, London, NMC.
Pentin, J. and Smith, J. 2006, “Drug calculations: are they safer with or without a calculator?”, British Journal of Nursing, Vol. 15, no. 14, pp. 778-781.
Preston, R.M. 2003, “Drug errors and patient safety: the need for a change in practice”, British Journal of Nursing, Vol. 13, no. 2, pp. 72-78.
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