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NU2101 > Medicine Management > Flashcards

Medicine Management Flashcards

1
Q

what is the role of the midwife in medicine management?

A
  • Need to know why medication is being given
  • Contradictions
  • Side effects
    Interpreting prescriptions
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2
Q

when can a midwife only supply and administer medicine without the need for a prescription?

A
  • Midwives exemption (ME)
  • Patient group direction (PGD)
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3
Q

what does the human medicine regulations 2012 is used and outlines 3 classes of medicinal products.?

A
  • general sale list medicine
  • pharmacy medicine
  • prescription only
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4
Q

what is general sale list medicine?

A
  • General sale list medicine (GSL)
    GSL medicines need neither a prescription nor the supervision of a pharmacist. They can be bought in shops.
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5
Q

what is pharmacy medicines?

A
  • Pharmacy medicine (P)
    A pharmacy medicine does not need a prescription but can only be sold from pharmacies, either by pharmacist or by their staff.
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6
Q

what is prescription only?

A
  • Prescription only (POMs)
    These are medicines which may only be sold or supplied in accordance with prescriptions of an appropriate qualified practioner.
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7
Q

what are class A drugs?

A
  • Class A
    Drugs are those which are considered harmful when misuses e.g. diamorphine
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8
Q

what are class B drugs?

A
  • Class B
    Drugs are considered less dangerous than class A but they can still be harmful e.g. cannabis
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9
Q

what are class C drugs?

A
  • Class C
    Drugs are considered less dangerous to the user then class A and B. However, they are still illegal.
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10
Q

what regulation enables Class A,B,C drugs to be used clinically?

A

Misuse of drugs regulations 2002 enable class A,B, and C drugs to be used clinically.

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11
Q

what is midwives exemptions?

A

Midwives may supply and administer, in their own initiative, any of the substances specified in medicines legislation under ‘midwives exemptions (ME)’.

Therefore, as a midwife you can administer specified medicine from the ME LIst

  • Without the need for prescription, a patient specific direction (PSD) from a medical practioner or a parent group direction (PGD).
  • If a medicine is not included in the ME then a prescription, a PSD or a PGD will be required.
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12
Q

what does midwives exemptions cover?

A

Midwives exemptions cover all general sales list (GSL), all pharmacy (P) and some prescription only medicines (POM) used in the course of their professional practice.

Midwives exemptions will timely medication, such as pain relief to women without the need to involve a qualified prescriber.

This applies to you only in midwifery settings.

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13
Q

what is a patient group direction?

A

A PGD is a written instruction for the sale, supply and/or administration of named medicines in an identified clinical situation. It applied to group of patients who may not be individually identified before presenting for treatment.

  • In midwifery, a PGD would be required where a medicine is not a GSL or a P medicine and is not on the current POM midwives exemption list.
  • PGDs can only be administered by a registered practioner.
  • PGD should only be used where ME do not apply.

PSD do not need to comply with the requirements specified for a prescription.

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14
Q

what is medicine kardex an example of?

A

They should include sufficient information to safely administer. Medicine kardex is an example of PSD.

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15
Q

when can midwives prescribe medication?

A

Midwives can only prescribe medication when you have successfully completed an accredited prescribing course and this has to be noted on your entry in the NMC register.

Midwives who are qualified to prescribe, take responsibility for the clinical assessment of the woman.

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16
Q

As a registrant, in exercising your professional accountability in the best interest of the patient, you must do what?

A
  • Be certain of the identity of the patient to whom the medicine is to be administered
  • Check that the patient is not allergic to the medicine prior to administering it
  • Know the therapeutic uses of the medicine to be administered, normal dosage, side effects, precautions and contraindications
  • Be aware of the patients plan of care
  • Check that the label, expiry date, name, calculated weight, dosage, method of administration, route and timing.
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17
Q

what happens with medicines and home birth?

A

When medicines are prescribed for sue at a home birth (including controlled drugs), they are the woman’s responsibility and it is up to her to store and dispose of them safely.

Under the misuse of drugs regulations (2002) a midwife cannot possess on opiate for home birth without having obtained it via a midwife’s supply order. Therefore, you cannot take an ampoule from the unit drug cupboard to use from a home birth.

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18
Q

what is the midwife’s supply order?

A

In the event of a doctor’s prescription not being available, a midwife supply order (MSO) may be used by you as a midwife to obtain controlled drugs. This can be administered as a midwives exemption for a woman having a home birth .

19
Q

what medication can be a single signature?

A

. You may administer with a single signature any prescription only medicine (POM), general sales list (GSL) or pharmacy (P) medication.

20
Q

what does registrant do in relation to disposals?

A

a registrant must dispose of medicinal products in accordance with the legislation

21
Q

what should the registrant do with adverse event reporting?

A

as a registrant, if a patient experiences an adverse drug reaction to a medication, you must take any action to remedy harm caused by the reaction. You must record this in the patient notes, notify the prescribed ( if you aren’t) and notify via the yellow card scheme immediately.

22
Q

what should registrant do with controlled drugs?

A

registrant should ensure that patients prescribed controlled drugs are administered these in a timely fashion, in line with the standards for administering medications to these patients. Should comply with legal and local requirements.

23
Q

what is PGD medicines?

A
  • PGD should only be used once the registrant has been assessed and is competent and whose name is identified within each document. The administration of drugs via a PGD may not be delegated.
  • Students cannot not supply or administer under a PGC but would be expected to understand the principles and be involved in the process.
    Where medication is already subjected to exemption order legislation there is no requirement for PGD.
24
Q

how should a medication error be reported?

A
  • Contact the paediatrician to review baby any side effects
  • Inform the mother that her baby received a wrong dose
  • Record incident and action taken in baby’s notes
  • Inform your line manager
  • Inform your supervisor of midwives (SoM)
    Record and complete incident form
25
Q

As a registrant you are accountable for your actions and omissions. In administering any medication, or assisting or overseeing any self- administration of medication

this includes?

A
  • You must always exercise your professional judgement and apply your knowledge and skill in any given situation
  • Record the weight of the patient on the prescription sheet for all children, and where the dosage of medication is related to weight or surface area ……. or where clinical condition dictates recorded the patient’s weight
  • Some drug administrations can require complex calculations to ensure that the correct volume or quantity of medication is administered. In these situations, it is good practice for a second practitioner (a registered professional) to check the calculation independently in order to minimise the risk of error.
  • The use of calculators to determine the volume or quantity of medication should not act as a substitute for arithmetical knowledge and skill..
  • You must know the therapeutic uses of the medicine to be administered, its normal dosage, side effects, precautions and contra-indications.
  • Where medication is not given, the reason for not doing so must be recorded
26
Q

students and midwife exemptions?

A

Midwives exemptions - midwifery students may be administer all drugs except controlled drugs provided under the midwife exemptions list. However, with the ME, student midwives must be supervised by a registered midwife. Who is also a sign off mentor and who counter signs the administration.

27
Q

students and prescribed drugs?

A

midwifery student can administer all prescribed drugs under direct supervision of a registered midwife, including controlled drugs.

28
Q

student and PGD?

A

midwifery student cannot supply or administer a medicinal product against a PGD. However, they can be expected to understand the principles involved.

29
Q

why IV administration?

A
  • Intravenous drug administration provides the complete drug availability with a minimal delay
    • By controlling the administration rate, constant plasma concentrations can be obtained
    • Unexpected side effects during the administration period can be halted by stopping the infusion
    • Compounds that are poorly absorbed by the gastrointestinal tract may be advantageously administered intravenously
    • Compounds that are unacceptably painful when administered intramuscularly or subcutaneously may present no difficulties by the intravenous route.
30
Q

uses and limitation of IV?

A

ntravenous administration is used primarily where a rapid onset of action is required
- Where a drug cannot be given orally because of its inherent physicochemical properties
- Other patient factors (e.g. the patient is persistently vomiting or unconscious.
- Drugs in the form of suspensions or oily solutions cannot generally be given intravenously.
- In common with all parenteral injections, products should be sterile, free of pyrogens

31
Q

what are the 9 rights for IV drug administration?

A
  • Right Patient
    • Right Medicine
    • Right route
    • Right dose
    • Right time
    • Right dilution/compatibility
    • Right flow rate
    • Right monitoring
    • Right documentation
      Think of examples , we are human and we all make mistakes
32
Q

what are the practice requirements areas of note?

A
  • Consent…by patients with capacity, must be informed
    • Competency…knowledge and skills
    • Delegation…if so must be done to required standard
      Duty of care…does it exist, has it been breached, ?suffered harm, either physical psychological, or financial.
33
Q

what are the legal professional issues of IV’s?

A
  • Professional code of conduct
    • Accountability
    • Public
    • Patient
    • Employer
    • Professional body
    • Patient safety culture requires all four to be in place
34
Q

what are the infection control chain of infection?

A
  • Infectious agent
    • Reservoirs
    • Portal of exit from reservoir
    • Means of transmission
    • Portal of entry into host
    • Susceptible host
35
Q

what are the standard precautions to avoid chain of infection?

A
  • Hand hygiene
    • PPE
    • Clinical waste
    • Spillages
    • Occupational exposure
    • Environment
    • Patient care equipment
    • Linen Isolation
      Cough etiquette
36
Q

what are possible detectable signs of infections with IV?

A
  • Greatest risk during preparation and administration
    • Detect minor infections
    • Vital signs monitoring and Early Warning Score
    • PVC bundles completed
    • Symptoms of pain, redness and swelling
    • Always re-site cannula if concerned
    • Observe for signs of advanced infection
    • Dressings should always be in place
37
Q

what are the IV procedure guidelines?

A
  • Preparation… is everything available
    • Practitioner’s competence….confident/ mentor around, checking with second person, competent with calculations
    • Patient….check name band and alerts, check TPAR, is the patient available, consent
    • Medications….right time, concentration, expiry dates
    • Equipment…right pump, cannula, appropriate infusion device
    • Environment….uncluttered, time to concentrate
      Infusion devices….in working order, clean and maintained
38
Q

what is CATS Iv?

A
  • Check compatibility with other medicines
    • Allergy…check name band
    • Tubing…is it kinked?
    • Site……does it need changed?
39
Q

what is the IV drug administration procedure?

A
  • Check prescription
    • Gather equipment
    • Aseptic technique
    • Peel wrappers, don’t push through in case of contamination
    • Wash hands
    • Check if bolus is to be given and if appropriate
    • Watch for rate of maintenance dose, in case its still on rate of loading dose?
      Documentation
40
Q

what are adverse incidents in relation to IV drug administration?

A
  • Extravasation…leakage of vesicant (damage to tissues)
    • Burning
    • Redness
    • Blisters
    • Increased resistance
      Need to monitor carefully and choose appropriate cannula
41
Q

cannula occlusion/ air embolism?

A
  • Flush 12 hourly
    • Avoid sites such as ante-cubital fossa
    • Right size of cannula
    • Mix medicines properly
    • Air removed from tubing prior to infusion
    • Central access lumens should be clamped off during line changes
    • Infusion lines should never be allowed to empty …this can cause a fatal air embolism
42
Q

anaphylaxis?

A
  • Severe allergic reaction to substance
    • Can cause airway and breathing problems
    • Tongue swelling
    • Bronchospasm
    • Acute cardiac collapse
    • Hypotension
    • Rashes and itching
    • Face swelling
    • Treatment….A B C D E
      Adverse drug reporting is vital
43
Q

what to think when doing IV calculations?

A
  • Converting from one unit to another
    • What do you WANT divided by what you have GOT x what is it in the volume you want to deliver
    • Dose patient is prescribed
    • The volume of fluid in the ampule
    • Amount of medicine in ampule
    • Infusion rate calculations
    • Dose available in 250mg in 10mls amp
    • We need 200mg?
      200mg in 10 ml ampule=200 divided by 250mg x 10 =8mls
  • Convert units to smallest unit so that they are all the same
  • Estimate answer before starting , so you have a realistic idea
  • Use formulae to check if unfamiliar
    Be systematic doing one step at a time

NU2101 (33 decks)

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