NURSING STAFF

Introduction

It is important that by whatever process we arrive at the patient's bedside with the drug trolley the administration of medicines via the EMM system is fast and efficient. In this way we can improve on the current system and improve the quality of care for patients both directly, having medicines there when they need them and indirectly by freeing more nursing time. Firstly the process of administration of medicine must be considered:

Take for an example Ward M:

• No. Beds: 33
• No. Teams: 3 (Blue, Red and Green)
• No. of Bays: A-J (A-D - Blue team, E-F & I-J - Red team G-H Green team)
• Drug round times: 08:00, 12:00, 17:00 & 22:00
• No. Drug Trolleys: 3
• Medical teams: General medicine & renal medicine

Therefore over the day there are 12 drug administration rounds (DAR) four by each of the three teams.
These rounds include IV drugs, but not dialysis. Drug administration is not witnessed unless it is either:

• A Controlled Drug
• Making up of an IV preparation

As is common with most drug administration, medication given is in accordance with an entry on a prescription chart. It is charted as given and signed for. If for any reason it is not given a note(usually coded) is made in the appropriate section of the chart.

The sections on the chart are:

• Regular medication
• As required medication
• Once only medication

There are alsothe following chart sub-types available:

• An anti-coagulant chart which has protocols for:
  Heparin treatment for DVT

  LMWH (Tinzaparin) treatment of DVT

  Wafarin loading as well as follow up therapy with warfarin

  An I.V. infusion chart

  A syringe driver/infusion pump chart

  A PCA administration record

Any system must offer facilities to handle/incorporate the features all of these. Further more it must be user friendly as well as fast and 100% accurate.

System requirements

1. The system must be able to allot patients to teams and location (e.g. A bay) as well as ward & consultant
2. The system must be able to have user defined drug round times
3. The system must record the 'electronic' signature of the nurse administering the drug(s) as well as the date and time
4. The system must record reasons for non-administration of medicines
5. The system must have a switch that will turn on/off witnessing either by ward or staff grade (E.g. Nurses on training)
6. The system must allow for and clearly highlight patients who are self administering medicines. This facility should be switchable by ward or by location on a ward.
7. Self administration drugs will be handled differently as TTA packs will be requested from Pharmacy. This will have an impact of request for discharge prescriptions for self administering patients which the system MUST handle.
8. The system must allow for use of patients' own drugs. This facility MUST be reversible (when patients run out of their own drugs)
9. The system must allow for nurse prescribing E.g. dressings, limited lists, emergency administration for which Drs have to subsequently sign.
10. The system must be able to produce drug administration round listings (DARx) sorted by:

• Team
• Location
• Patient
• Consultant
• Ward

11. The sort must be user definable. I.e. a DARx can be produced for an individual patient through to the entire ward.
12. The DARx must be available in hard copy as well as online
13. The DARx must have a unique reference number for facilitating retrospective recording of administration of medicines where it has not been recorded online.
14. Once a DARx has been printed off (I.e. intention to administer) it must not be able to be printed again in that format, I.e. Reprints MUST be clearly defined as such.
15. Once a DARx has been printed/compiled the next DARx (for the next round) must not be available until the present DARx has been completed I.e. all doses actioned i.e. given or not given and 'signed' for.
16. The system must incorporate continuos IV infusions (including TPN) into the rules for DARx
17. Hard copies of a patient medication chart must be available E.g. in the event of system failure or transfer to another unit
18. Nursing staff must have the facility to transfer patients 'electronic' charts' to other wards
19. The must be a facility to display/print a patient drug administration history with user defined sorts (e.g. by Drug, patient, Team, consultant)
20. The system must have the facility to highlight, stock, non-stock and patient's own drugs.
21. The system must have the facility to automatically order non-stock drugs from Pharmacy
22. The system must identify diluents and for injectable preparations
23. The system must highlight administartion information, either automatically appended to the prescribed drug by the system or later by a Pharmacist or prescriber. For example after food, omit if BP <90/60, omit if apex rates <60bpm.
24. The system should allow for tracking of jobs on request (e.g. TTAs or Individually dispensed medicines IDM) in Pharmacy
25. Nursing staff should have access to the Trusts IV guide on line
26. The system should have the facility to order ward stock drugs, such requests should be routed to the relevant distribution area in Pharmacy
27. The system should warn staff about handling precautions (e.g. cytotoxic agents)
28. The system should allow nursing staff to identify wards which stock a drug that is not stocked by their own ward so that they may borrow and subsequently administer a drug out of hours.

Conclusion

This section is vital, it must work. After all nursing staff deliver the majority of care and thus any tools that we seek to introduce must increase thier ability to deliver this care. Electronic administration of medicines is no exception. The facility must be fast, reliable and secure if it is not to pose more of a threat than benefit. Some of the advantages that are highlighted above are:

• Access to patient medication history
• The 'chart' never leaves the ward
• Tracking of TTAs
• Identification of diluents for IV administration
• Links to the Trusts IV guide
• Reduction in the no. of 'charts' to ONE
• A method of gathering evidence for competancy based training I.e. Student nurses training on Drug rounds.
• The ability to electronically transfer charts
• The ability to print of administration lists/jobs which are time sorted.
• The ability to allow staff to recognise at once whether a drug is stock or non-stock

All these will, I believe, prove both useful and time saving for the nursing staff and will in turn allow them to concentrate on patient care as opposed to adminitration.

Please feel free to E-mail me any comments/contributions or questions

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Copyright - Will Willson 1999
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