NURSES PRESCRIBING

Nurses Prescribing and giving drugs in the NHS Accident and Emergency Unit

Nurses Prescribing and giving drugs in the NHS Accident and Emergency Unit

In the UK many hospitals use a ward pharmacy system. However, this is in a state of transition to a system that uses the patient's own drugs. In the ward pharmacy system, a large proportion of the medications administered are held as ward stock. These drugs are the most frequently used and are stocked in bottles of 50 or 100 tablets or capsules and are kept in a locked trolley along with non-stock items. Nurses make a drug administration round four to six times daily, depending on the ward during which the trolley is taken to each patient's bed. The patient's own drug system enables the patient to continue using medication they would normally use at home whilst in hospital. This is kept in a locked cabinet at the bedside.

Successful drug administration is dependent on an effective patient information and patient monitoring system. Some drugs have a limited therapeutic range and various indicators (such as blood pressure, heart rate, anticoagulant levels) have to be checked before they can be administered in the appropriate quantity. Medical staff also need to know which drug is needed and when. This cannot be accurately ascertained in the absence of the medication chart. Physicians use the patient's chart to indicate to the nurse which medications the patient is to receive. This is kept with the patient and used to record drug administration. The order includes the drug name, the dose, the route and the drug administration round when it is to be administered. Each dose administered is recorded on the medication chart, which usually allows 14 days of documentation. This allows the patient's most recent drug history to be viewed. Pharmacists visit their designated wards daily to review all patient charts, performing a clinical and supply function (Dean et al., 1995). If a drug is ordered that is not held as ward stock or is not in the patient's bedside drug cabinet, the pharmacist makes a note on the medication chart and a supply sufficient for several days is dispensed with the patient's name on the container.

Giving medications to patients is a fundamental nursing role. It is also a complex activity that carries a high risk of error, as the involvement of different healthcare professionals means that errors may occur at any stage of the process (Hand and Barber, 2000). Nurses seek to give medications correctly or perfectly. However their efforts are often confounded by poorly written prescriptions, constant interruptions, conflicting demands and high workloads.

Addressing the problem

Failure mode and effects analysis (FMEA) has been applied to drug administration as a process of continuous quality improvement and is usually carried out by an interdisciplinary group of healthcare professionals (Cohen et al., 1994). An FMEA anticipates what errors can be made and what the results will be. Thus for each medication the analyst will ask what will happen when someone mistakes a drug package ...