we need to be aware of this when keeping our patients comfortable and pain free.
Single‐Nurse Administration
In most adult hospital settings, it is one nurse who administers the medications to the patients. This is considered to be the safest option as it thought that the lone nurse will take extra care due to their sole responsibility. The exception to this is often injected drugs and controlled drugs, whereby two nurses check and sign for the drug and go to the patient's bedside together to administer the drug.
When there are any calculations or working out to do, two nurses should also check their workings out to agree on the correct answer and dose that the patient requires.
PAEDIATRIC PATIENTS
When medication errors occur, paediatric patients have a higher risk of death than adults due to the fact that most drugs are developed in concentrations for adults, necessitating often complex weight‐based calculations for paediatric doses and dilutions. Many drugs are not licensed for use in children. The gastric pH of children only reaches the same level as that of adults when they reach two to three years of age. The British National Formulary (BNF) classifies children into four groups:
Neonates (up to one month)
Infants (up to one year)
One to six years of age
6–12 years of age
These patients are infants, children, and adolescents.
One of the special safeguards the paediatric clinical areas often have in place is that two nurses have to check and sign the prescription chart. One of these should be a Registered Paediatric Nurse.
Question 1.4
Other than paediatric patients, who may be considered as another high‐risk group?
Older Adults
Ageing can influence many aspects of absorption, distribution, metabolism, and excretion (ADME) with excretion the most affected. This is because by the age of 65, the human kidney is almost a third less efficient than younger adults. This can lead to drugs not being cleared as efficiently from the kidneys, building up, and causing toxicity. Another cause for concern is the effects and side‐effects of some drugs which may contribute to falls in frail adults due to postural hypotension and other factors.
A form of low blood pressure that happens when you stand up from sitting or lying down. Symptoms include dizziness, fainting (syncope), confusion, or blurred vision.
Patients being admitted to hospital from the community, on any of these ‘high risk drugs’ should be reviewed by a Doctor or Pharmacist and all staff should be made aware of this risk factor. Table 1.2 shows some of these drugs to be made aware of.
Table 1.2 Drugs which may contribute to falls.
| Drug class | Indications | Examples of drugs |
|---|---|---|
| Antipsychotics | Psychosis delirium | Haloperidol, Promazine, Trifluoperazine, Quetiapine, Olanzapine, Prochlorperazine. Risperidone |
| Antidepressants | Mood | Amitriptyline, Trazodone, Fluoxetine, Citalopram. Paroxetine, Sertraline |
| Hypnotics (sedatives) | Insomnia | Zopiclone, Zolpidem |
| Benzodiazepines Hypnotics (sedatives) | Insomnia, agitation | Diazepam, Lorazepam, Temazepam, Nitrazepam |
| Anti‐hypertensives | High blood pressure | Ramipril, Lisinopril, Perindopril, Valsartan, Hydralazine, Bisoprolol, Atenolol, Propranolol |
| Antidiabetics | Diabetes | Glibenclamide, Glipizide, Metformin, Sitagliptin |
| Opiates | Pain | Codeine, Tramadol, Morphine, Fentanyl, Buprenorphine, Oxycodone |
| Diuretics | Heart failure, fluid overload, hypertension | Bendroflumethiazide, Furosemide, Bumetanide, Amiloride |
| Nitrates | Cardiovascular disease | Isosorbide mononitrate, Glyceryltrinitrate (GTN) Nicorandil |
| Parkinson's Medication | Parkinson's disease | Co‐Beneldopa, Co‐Careldopa, Selegline Hydrochloride, Pramipexole |
| Non‐steroidal anti‐inflammatory drug (NSAIDS) | Pain, inflammation | Ibuprofen, Naproxen, Diclofenac |
| Antimuscarinics (anticholinergics) | These are mentioned in other classes, e.g. for urinary incontinence | Procyclidine, Oxybutynin, Tolterodine, Amitriptyline |
| Aminoglycosides | Infection | Vancomycin, Gentamicin |
| Antihistamines | Allergies, itch | Chlorphenamine, Hydralazine, Cetirizine |
ADMINISTERING DRUGS SAFELY
Drug Administration Competence
Many hospitals have drug administration competencies for staff to ‘prove’ that they are competent in the clinical skill of drug administration. Only when these competencies have been signed off can a nurse administer medications alone. Also, the student in healthcare, i.e. Registered nurse, Nursing Associate, etc. will need to be signed off in their medicines management competencies as part of their pre‐reg training. Appendix 1 shows an adaption of a typical section of post‐reg medicines management competencies.
Calculations Competence
Also,
