register. The nursing associate (as is the case for the registered nurse) must be able, at the point of registration, to demonstrate and apply knowledge of pharmacology when delivering care. There is also a need to understand the principles of safe and effective administration and optimisation of medicines. Importantly, this must be done in accordance with local and national policies. Procedural competencies (very much related to local policy) must be demonstrated concerning the safe administration of medicines.
Safety: Rights of Medication Administration
Safety elements when administering medication include the 5 Rights, more commonly known as the 5 Rs (NMC, 2007):
Right patient
Right medication
Right dose
Right time
Right route.
Working within these 5 principles whilst preparing medications and again at the bedside ensures a safe process. As more confidence is amassed in medicine management these principles can be expanded. Elliott and Liu (2010) believe that you should also include giving the medication for the ‘right reason’ and ensure that the ‘right documentation’ is completed correctly. As more understanding of the reasons for errors in medication management are understood, a further 5 rights can be added to the list, culminating in 10 rights, which include the original 5 Rs listed earlier as well as the following five (Edwards and Axe, 2015):
The right to refuse (know what to do if the patient refuses)
Right knowledge and understanding (of the drug and patient)
Right questions (if there is any doubt with the process)
Right response (monitor the effectiveness of the medication
Right advice.
Chapter 4 of this text discusses medicines management and the role of the healthcare provider working with CYP and families in detail.
Specific Considerations for Babies, Children and Young People
When caring for CYP there are many aspects of medicine administration that need to be given special consideration, including the age of the child, gaining consent, if they have the ability to swallow tablets, the taste of medicines and what to do if a child refuses to take it. Consent will be explored in more depth in Chapter 3.
The changes in body proportions and composition in CYP change rapidly and this affects the efficacy, toxicity and dosage of medicines for children. Proportions of body fat, protein and extracellular water change over months in newborn babies, whereas at the age of 1 to 2, metabolism and elimination of medications from the liver and kidneys is at its greatest (NICE, 2021). Development of the gastrointestinal tract also affects the absorption of oral medications, and difficulties with this may indicate an intravenous route being more appropriate.
Infancy
Babies are unable to communicate their needs and feelings and assessment of a baby through body language and vital signs is important. The first 12 months of life involve rapid stages of development, from milk feeds through weaning to tolerating solid food as one example. Taste is developing and unusual tastes or textures can often be spat out or refused. It has been recommended that new foods should be introduced to babies four times before giving up, but this might not be possible with medicines. In babies and young children who cannot swallow tablets, liquid medicines or syrups are prescribed. Some liquid medicines/syrups do not have a palatable taste, antibiotics being the most common. Flucloxacillin is an example of a syrup that has a very bitter taste and is not palatable to many. Baguley et al. (2012) recommend not prescribing such medications without first allowing the child to taste it. If a child will not comply with taking the medication, this increases the stress for the parent(s)/carers in encouraging the child to take the medication. It also increases the risk of non‐concordance; the infection or condition not being treated appropriately and the development of drug resistance for the child. If a child is refusing to take liquid medicine due to the taste, further discussion should be had with the prescriber and involve the parent and child (where possible) to promote concordance to treatment.
Additional negative aspects to liquid medicines or syrups are that they often have sugar added to sweeten the taste and promote concordance in taking the medication (Baguley et al., 2012). If a medicine is to be taken long‐term or prescribed for a child with diabetes mellitus, a sugar‐free version should be considered if a tablet is not an option. This will also aid dental health, where taking sugary medicine regularly throughout the day can result in tooth decay. In Chapter 4 drug formulations are discussed.
Clinical Consideration
In cases where there is not an alternative or a baby or young child spits out the medicine or refuses to take it, having a drink of the child’s choice to take straight after the medicine will take away the taste quickly. If the medicine does not have to be given on an empty stomach, a favourite food or snack may also be an option. Putting the medicine into a drink or bottle of milk is discouraged due to the following risks.
If some of the drink is left, it is difficult to estimate how much of the medicine has been taken.
The medicine may react with the fluid.
If the medicine is denser, it will sink to the bottom of the container or adhere to the inside of the container.
If the drink takes a long time to drink, the medicine is not given at the same time.
The medicine may alter the taste of `the drink or milk and the child then refuse to drink it.
Clinical Consideration
With babies, oral syringes are commonly used to drip liquid medicine into the buccal cavity or onto the tongue. Assessing the swallowing ability is important and awareness of tongue tie, or cleft lip and palate difficulties should be considered. Oral and nasal cavities are closely linked, and liquid medicine can come out of the nasal passages if the baby does not suck and swallow and is distressed or sneezes. Cradling babies, ensuring their arms are not flailing about, and talking to them provides comfort and reassurance.
It is important for babies to feel secure and loved by those around them and cuddling a baby when giving a liquid medicine can often help. Family‐centred care, where the family is treated as a unit, recognises the importance of the parent/carers in nurturing the child whilst in hospital.
Clinical Consideration
In the first year, babies learn to roll over, sit, crawl, stand and walk. With these developing skills toddlers often want to be in control where they can, and allowing them to hold and press the syringe to control the medicine is often a positive approach for concordance.
As children develop and become more independent with everyday skills, they should understand what medicine they are taking is for and why it is important.
Safety
