Fundamentals of Midwifery: A Textbook for Students (138 page)

The
Right
patient

The
Right
medication

The
Right
dosage

The
Right
route

The
Right
time

The
Right
reason

The
Right
documentation

The
Right
practitioner

The
Right
environment

The
Right
evaluation

but it has been identified that patients often do not have an ID bracelet or can have the wrong information recorded on it. This is why it is important also to ask the patient to confirm their name and date of birth.‌‌

Once it is clear that you have the

patient then the next checks are related to the actual medication itself. This includes that you have the

medication, and the

dosage, and that you are planning to give it using the

route and at the

time. All this information is available via the prescription chart or patient records. This is also linked to the issue of having the

documentation available prior to administration. It is essential to check that the pre- scription and medicine label are written clearly and there is no ambiguity. It is important to check for an expiry date.

This includes that the medication is being given for the

reason; in order to know this then you must have access to the patient’s records and care pathway. This must include any allergies that the patient might have. The NMC (2010) identify that prior to administration of any medi- cine you must know the therapeutic uses of the medicine, its normal dosage, side effects, precautions and contraindications. You must be aware that the patient has the

to refuse to take any medication and that you must have informed consent from a patient before admin- istration. This means that you need to explain to the patient the reason for taking the medica- tion and possible side effects. It is essential that you know if the patient has any allergies and if this would impact on the administration of this medication. This means that you need to know what the medication contains as it is not always clear what drugs are contained within a specific medication. Some Trusts have a policy of having special patient identity bracelets to warn of allergies, but it is always important to check that there are no allergies that the patient may not have informed staff about. Some medicines are linked to specific physiology of the patient, for example their weight, so it is essential to have an up to date weight on the patient prior to calculating the dosage. This is significant with the increasing numbers of obese women that are seen in maternity services, as well as caring for babies.

That there is the

environment for administering medicines; there should be no distractions and the practitioner giving the medicines is focusing solely on this task. It has been identified that this can reduce the number of medication errors. It is essential that the

practitioner is involved in administering medicines. This can depend on what type of medicine is being given and to whom, for example controlled drugs require two registered practitioners. It is important to check that the patient has taken the medication, and particularly with injections and intra- venous drugs that there is no immediate allergic reaction to the medicine. There are also the issues of the

duration if this relates to intravenous medication. If a patient queries the medication then it is important to follow up their questions before administering the medica- tion. Patients are often experts in their condition and medication. The Department of Health (DH; 2008) has published guidance for service users and practitioners suggesting appropriate questions.

It is important that the administration of the medicine is accurately recorded in the

docu- mentation. If the medicine has not been given for some reason, for example the patient declines, then this must also be recorded. Communication around the administration of medicines is crucial and can prevent errors occurring, for example: a patient being given a medicine in error

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as the first practitioner did not record that it had already been given. It is important that if there is a delay in giving a medicine then this is recorded, as many medicines have specific issues about timing between doses which must be adhered to, in order to prevent toxicity or a failure of reaching a therapeutic dose (Jordan 2010). This is explained in more detail in the pharmacol- ogy section.

This is in relation to the

evaluation; it is important to check that the medicine is having the right effect on the patient and to observe the patient for possible side effects. This evalua- tion should be recorded in the

documentation and any relevant changes made to the patients care pathway. There is no point in giving a medicine if there is no evaluation of its effects. If the medicine is not found to be effective, or has unacceptable side effects then the practitioner needs to discuss this with the relevant doctor or whoever prescribed the medicine. As Griffith (2013) identifies healthcare practitioners are well placed to report adverse drug reac- tions and it is important that they do so.

If a practitioner relates their practice to the above rights then this should reduce the possibil- ity of errors significantly.

It can be useful to review errors in care and to explore how these have happened, in order to learn lessons and prevent further mistakes (DH 2000). This can then alert health professionals involved in medicine management when and how they are at risk of making mistakes. Fry and Dacey (2007) split these incidents into different parts which are;

. These can then link into other issues such as similar packag- ing, similar names of drugs, problems with equipment such as infusion pumps, not following guidelines and policies, stress and poor memory of staff, distractions and excessive workload. This is in addition to poor numeracy skills and lack of knowledge around medicines (Cleary- Holdforth and Leufer (2013), inaccurate or incomplete documentation, wrong drug or the wrong dose (Cox 2008). Cleary-Holdforth and Leufer (2013) also discuss the issue of compla- cency with staff not keeping up to date and adhering to the guidelines and policies around medicine management. Harkanen et al. (2013) also identify errors in patient identification as a key area of concern. Tingle (2012) discusses the errors around prescribing medicines, which midwives need to be aware of. These include: incorrect medicine and dose, the medicine not being needed or appropriate, failure to prescribe, allergy or contra indication errors and poor documentation. As midwives work within a team it is their responsibility to check the prescrip- tion for such errors prior to administering any medicine.

It is important to ensure that the patient has enough information in which to make an informed decision around whether to consent to the administration of the medicine. This is also important in relation to patient compliance during self-medication. Chummun and Bolan (2013) identified that a large number of patients do not take their medication as prescribed because they do not believe that they need it and that it does not work; this they see as a breakdown in communica- tion between the patient and the healthcare practitioner. In order to overcome this problem the patient needs to be fully involved in the decision making process around medicines.

Medication errors are the most common mistake and reason for adverse events within the NHS and health services worldwide (Elliott and Liu 2010). An error can be related to using the wrongs of medication instead of the rights. These can be related to omission, in that the drug is not given, prescription mistakes, giving a drug that is not prescribed, wrong dose, wrong drug,

wrong route, wrong form (for example tablet instead of liquid), wrong time, wrong patient. There can also be errors made in dispensing of drugs (Meetoo 2012; Tingle 2012).

It is essential that a doctor is informed so that the possible effects on the patient can be assessed. The patient should be informed and a Supervisor of Midwives should be contacted to discuss the situation with the patient. It must be recorded in the patient’s notes that this error has been made. A critical incident form must be completed so the reasons behind this error can be reviewed. The medication needs to be given to the correct patient. A Supervisor of Midwives should be contacted so that the practitioner who made the error can discuss the situation with them and reflect on what happened, in order for them to learn from the situation and to support them. The National Patient Safety Agency reviews medicine errors and makes recommendations to prevent this type of error reoccurring. This is termed the ‘

’ in which it is hoped that the whole of the Trust and NHS can learn from these mistakes and put systems in place to prevent their reoccurrence (NPSA 2004; Agyemang and While 2010).

It is always important to keep up to date with current issues around any topic in midwifery, including medicine management and pharmacology, particularly as they are key to safe prac- tice. The British National Formulary (BNF) is aimed at health professionals involved in administer- ing medicines and should be available in clinical areas; information can also be found on medicines compendium UK, as well as specific texts related to maternity services (Hale 2012; Jones 2013). The NMC also regularly publish standards for medicines management. By going to the NMC website you can access the most up to date information regarding medicine manage- ment (see Further Reading Activity). Other NMC documents may also have information regard- ing medicine management. Anyone prescribing, dispensing or administering medicines needs to be aware of the relevant legislation around this practice. The Medicines and Healthcare products Regulatory Agency (MHRA) have a role to play in safeguarding the public in relation to medicines and provide information around safety alerts and legislation related to medicines (see Further Reading Activity).