Administration of medicines is a key element of nursing care. Every day some 7000 doses of medication are administered in a typical NHS hospital (Audit commission 2002).
Drug administration forms a major part of the clinical nurses role. Medicines are prescribed by the doctor and dispensed by the pharmacist but responsibility for correct administration rests with the registered nurse (O'Shea 1999). Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients ...view middle of the document...
The pharmacist is the expert on all aspects of medicine legislation and should be consulted. Pharmacy only medications are only available to buy from a registered primary care pharmacy provided that the sale is supervised by the pharmacist. General sale list medicines do not require either a prescription nor the supervision of a pharmacist and can be obtained from retail outlets (NMC 2002).
In 1992 the UKCC published Standards for administration of medicines and was replaced in 2002 by the NMC's Guidelines for administration of medicines. The guidelines state principles for the administration of medicines. They state that in exercising your professional accountability in the best interests of your patients the registered nurse must know the therapeutic uses of the medicine to be administered, its normal dosage, side effects, precautions and contra-indications, be certain of the identity of the patient to whom the medicine is to be administered, be aware of the patients care plan, check that the prescription, or the label on the medicine dispensed by the pharmacist is clearly written, has considered the dosage, method of administration, route and timing of the administration in the context of the condition of the patient and co-existing therapies, check the expiry date of the medicine to be administered, check that the patient is not allergic to the medicine before administering it, contact the prescriber or other authorised prescriber without delay where contraindications to the prescribed medication are discovered, or where assessment of the patient indicates that the medicine is no longer suitable, make a clear, accurate and immediate record of all medicine administered, intentionally withheld or refused by the patient, ensuring that any written entries and the signature are clear and legible, it is also the responsibility of the nurse to document if the administration of medicines is delegated to another member of the nursing team.
The guidelines also state that when complex calculations are being carried out it may be necessary for a second practitioner to check the calculation in order to minimise the risk of error and that the use of calculators to determine the volume or quantity of medication should not act as a substitute for arithmetical knowledge and skill.
The American Society of Hospital Pharmacists (1982) defined a medication error as a dose of medication that deviates from the physicians order as written in the chart or from standard hospital policy and protocol. From this definition the society have identified 9 categories of medication error. Omission error, unauthorised drug error, wrong rate error, wrong dose error, wrong route error, wrong dosage from error, wrong preparation of a dose and incorrect administration technique. Wolfe (1989) defines a medication error as mistakes associated with drugs and IV solutions that are made during the prescription, transcription, dispensing and administration phase of drug preparation...