Risk Management

Medicine and vaccine storage
As a practice manager, you are responsible for
protecting your patients and ensuring that systems are in place to ensure that
the correct medication or vaccination will be administered to the correct
patient, at the correct time, in the correct dose and by the correct route as
ordered. To ensure this occurs, it is essential to provide staff with
guidelines on minimum requirements for correct medication management,
including ordering, storing, checking and administration.
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- Only authorised
registered nurses (RNs), appropriately endorsed enrolled nurses (ENs) under
the supervision of an RN or a GP and medical practitioners are authorised to
check and administer medications. Some states may have different and specific
drug therapy protocols e.g. Queensland Health has specific protocol details
for isolated practice areas and rural hospitals, nurse practitioners,
midwives and orthoptists.
- Registered nurses should only administer
medications as prescribed by a medical practitioner. Unless an emergency, all
medication orders should be documented prior to administration. In an
emergency situation, medication may be administered by an RN on the advice of
a telephone order from the medical practitioner (preferably confirmed by a
second RN if available). The telephone order should be confirmed in writing
as soon as possible after the event and within 24 hours.
- The RN
should not alter any medication order. Any changes to a medication order
should be confirmed with the relevant medical practitioner, the order
cancelled and if the medical practitioner is unavailable, written in progress
notes in the patient’s medical record.
- Once the medication has been
administered, it should be documented in the appropriate section of the
patient’s clinical notes and on the patient’s medication chart if available.
Vaccinations should also be recorded in the patient’s medical summary
(electronic or otherwise).
- All medications should be checked before
administration.
- The following classifications of medication and
patient identity should always be checked by two registered nurses (Division
1) or one registered nurse (Division 1) and a medical practitioner:
- all drugs of addiction (S8 drugs), regardless of route.
- the
oral medication warfarin.
- all injections, regardless of route
- all infusions
- all parenteral medications.
-
The protocol for administering any medication involves
checking:
- the doctor’s orders before administering the correct
medication is given to the right patient
- the correct dose is
given.
- it is given via the correct route
- it is given at the
correct time
- the expiry date of the medication is checked.
- that any cold chain requirements have been met (vaccines, particularly if
not stored appropriately, can become ineffective).
- If a
medical practitioner is administering a medication – and especially if a
parenteral medication – and an RN is not available to check the medication,
then (unless an emergency) at the minimum, the patient (or their nominated
carer/parent) should check, as they have a vested interest in ensuring they
will be receiving the correct medication/dose.
- The person
administering the medication is responsible for knowing:
- the clinical
status of the patient receiving the medication
- the storage
characteristics of the medication they are administering
- the
indications and contraindications of the medication to be administered
- the action and normal general dosage of the medication to be
administered
- the medication’s side effects and potential
complications
- how to recognise any reaction to the medication
- how to recognise as early as possible serious or life-threatening reactions
to the medication
- the practice protocols for reactions to
medications
- how to institute first line support to the patient while
awaiting the doctor
- the location of emergency drugs for treating
severe medication reactions and that those drugs are available and
in-date.
Practice managers should be aware that a medication
should not be administered until all these factors are clarified. When in
doubt, the medical practitioner or pharmacist should be contacted for advice.
Additional information may be gained from current pharmacological reference,
e.g. MIMS or from the manufacturer’s information line and often, poisons
information lines are able to provide such information. - Before
administering a medication to a patient, the patient’s identity should be
confirmed by checking.
- name
- ID number
- date of birth
on the medication chart
- details on the patient’s identification
band.
- The RN or medical practitioner responsible for the
administration of a medication should always check the patient’s allergy and
sensitivity status prior to a medication being administered. The medication
should be withheld if the patient has had any previous reaction to the
medication or if the patient’s allergy/sensitivity status is not able to be
determined.
- Medications should be kept in a locked cupboard if they
are in areas where non-authorised people/patients might have unsupervised
access.
- Vaccines should be kept in an appropriate temperature
controlled environment in line with the manufacturer’s recommendations.
Appropriately trained practice staff must regularly monitor the temperature of
vaccine storage to ensure vaccine viability.
- An unlocked cupboard
containing medications should not be left unattended.
- The RN/medical
practitioner administering a medication should only sign that a medication has
been administered after it has been administered.
- The RN/medical
practitioner responsible for the administration of a medication is also
responsible for monitoring the patient for side effects and complications,
after the medication has been administered, and ensuring the patient remains
under observation for an appropriate time (dependent upon the medication).
- If a drug is withheld or contraindicated for any reason, the reason should
be documented in the patient care plan/progress notes stating the date, time
and the reason the medication was withheld. The relevant medical practitioner
should be informed.
- The RN/medical practitioner should
monitor for any adverse reactions from an administered medication and report
any complications. In the event of an adverse drug reaction, the following
should occur:
- Promptly
inform the relevant medical practitioner concerned about the reaction.
- Administer emergency treatment as necessary according to practice
protocols.
- Place drug alert labels/warnings on the medication chart
and medical record (electronic or otherwise).
- Document the
incident in the patient’s clinical notes and complete an adverse event form.
- Medications should be returned to their boxes/cartons
where possible, as these may contain information such as storage, use by
dates, etc.
- Medications should preferably never be transferred from
their original container to another container (unless a parenteral medication
is being drawn up into a syringe), but if the medication/syringe is not to be
used immediately then it must be clearly labeled as to its contents and date
and appropriately stored. Unlabeled medications must never be given unless
the practitioner themselves has transferred the medication and the medication
has not been put down whilst awaiting administration.
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Tracking tests
- Setting up your practice support systems
- Computer systems
- Manual systems
- Central register