the law, our guidance and other relevant policies, guidance and regulations.
NMC, 2018a – see Table 1.2
Table 1.2 Medicine administration, preservation of safety.
| To preserve safety in relation to medicine administration, you must: | |
| 18.1 | Prescribe, advise on, or provide medicines or treatment, including repeat prescriptions (only if you are suitably qualified) if you have enough knowledge of that person’s health and are satisfied that the medicines or treatment serve that person’s health needs |
| 18.2 | Keep to appropriate guidelines when giving advice on using controlled drugs and recording the prescribing, supply, dispensing or administration of controlled drugs |
| 18.3 | Make sure that the care or treatment you advise on, prescribe, supply, dispense or administer for each person is compatible with any other care or treatment they are receiving, including (where possible) over the counter medicines |
| 18.4 | Take all steps to keep medicines stored securely |
| 18.5 | Wherever possible, avoid prescribing for yourself or for anyone with whom you have a close personal relationship |
Source: NMC (2018a). This extract is reproduced and reprinted with permission with thanks to the Nursing and Midwifery Council.
It must be clarified at this point that not all registered nurses are permitted to prescribe, as further qualifications and registration with the NMC as an Independent Prescriber must be achieved first. The NMC’s Future Nurse: Standards of Proficiency for Registered Nurses (2018b) are designed for newly registered nurses to be ‘prescriber‐ready’ on admission to the register, and therefore have more knowledge of pharmacology as detailed within the previous education standards. Although the knowledge level will be in more depth, further training, practice and supervision will be required to be a registered prescriber. This is reinforced in the NMC Code, section 13.5, which states that you must complete the necessary training before carrying out a new role (NMC, 2018a). Table 1.2 outlines the NMC’s (2018a) requirements regarding medicine administration.
The Importance and Value of Medicine Within Healthcare
It has been identified that medicines are the most common intervention in healthcare and are used to prevent, treat and manage conditions and illnesses for people of all ages (National Institute for Health and Care Excellence (NICE), 2015). With the increase in technology and the increase in survival rates of premature births and complex health conditions, the need for medicines has increased. As with adults, more CYP are living with several long‐term conditions that are being managed with an increasing number of medicines. Medicine use can be complex and how patients can take their medicines safely and effectively can be a challenge for the health service (NICE, 2021).
The safety of administering medicines is imperative as healthcare professionals strive to ‘do no harm’. Despite this, it has been estimated that there are 237 million medication errors within England each year across all ages and areas of primary and secondary care (Elliott et al., 2020). It is also estimated from the same systematic review that 72% of errors have little or no harm on the patient and they are identified before the medication reaches the patient. The National Patient Safety Agency (NPSA) monitors medication errors across all aspects of the process and reports to the multidisciplinary team involved in medication management. The NPSA (2007) reported that 1 in 10 patients experience medication‐related errors somewhere in the process and that 41% of the most serious incidents that are reported are caused by errors in administration. Within the literature, it is considered that many errors are unreported and so the statistics available are not completely accurate.
Therapeutic Pharmacology
In general, when a prescription is issued it should not be issued unless a detailed clinical assessment is completed and before having explored the psychological mechanisms underlying symptoms (this especially important in the case of mental ill health).
Healthcare providers and patients should consider that mental health disorders can effectively be managed by the use of pharmacological and non‐pharmacological interventions. When a decision has been made to prescribe, for example, a psychotropic drug, it should never be suggested that psychological and/or psychosocial interventions will not be indicated. Combining medicines with psychosocial interventions can be associated with better patient outcomes. Considering medications as the only therapeutic strategy is very often unacceptable (World Health Organization, 2009). Articulated, comprehensive and individualised treatment plans can very often be seen as the best therapeutic option.
Social Prescribing
Social prescribing is a key component of universal personalised care (NHS, 2020). Based on the notion that medicine alone may not always provide a solution, it can help to point patients in the right direction to seek advice or social activities that aim to encourage partnership working between health and social sectors in order to attend to the wider determinants of health. Those patients who have non‐clinical needs can be referred to community activities with the intention of improving their health and well‐being. Social prescribing can work for a wide range of people, including:
Those with one or more long‐term conditions
People who need support with their mental health
Individuals who are lonely or isolated
People who have complex social needs which affect their well‐being.
Horner (2019) discusses how social prescribing can provide social support for those young people who have been socially excluded. The key elements associated with social prescribing that need to be in place for effective social prescribing are summarised in Figure 1.1.
Figure 1.1 The key elements associated with social prescribing (NHS, 2020). Source: National Health Service/Public Domain/Open Government Licence.
Safety Within Paediatric Care
Within paediatric environments care may be provided for CYP across a wide age range, from birth (possibly premature) to 16 years or potentially older depending on the clinical environment and the needs of the young person. Calculating medicine doses can be complicated as they can be very small doses in neonates and babies, requiring accurate calculation skills. Even a small miscalculation resulting in an overdose can have a severe or life‐threatening effect due to the prematurity of the infant’s development and the body’s ability to process the medication. Barber (2013) identified that children are three times more likely to receive a medication error than an adult due to the complexity of the calculations required, a misplaced decimal point and the complexity of calculating the individual dosage for each CYP based on
