Download Expanded Role Training for Support Staff

Hampshire Hospitals NHS Foundation Trust
Family & Support Services Division
Child Health
Expanded Role Training
for
Support Staff
Helen Frizell, LLM, BsC (Hons), PGCEA, RSCN, RGN, RM
Lead Educator, Child Health
Hampshire Hospitals
NHS Foundation Trust
Hampshire Hospitals NHS Foundation Trust, August 2012
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HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST
FAMILY & SUPPORT SERVICES DIVISION
CHILD HEALTH
HEALTH CARE SUPPORT WORKERS EXPANDED ROLE TRAINING:
DRUG ADMINISTRATION AT FIRVALE & IN THE COMMUNITY
STATEMENT OF INTENTION
Wherever possible, drug administration should be undertaken by a
Registered Nurse but it is recognised that this might not always be
possible in the community and respite care settings. This training has
been implemented to ensure that children in such circumstances
outside of the acute areas of care are able to receive their drugs in a
timely manner by appropriately trained staff. It supports the position
adopted by the Nursing and Midwifery Council, the Department for
Education and the Royal Pharmaceutical Society of Great Britain
relating to such circumstances (DfE, 2011; NMC, 2008; RPSGB, 2007).
Support workers (HCSW’s) will be permitted to administer oral drugs within
defined areas of clinical practice provided the following criteria are met.
1. The health care support worker must hold a Band 3 or 4 position and
have an appropriate qualification in care (eg Level 3 NVQ, diploma).
2. Within Firvale, the member of health staff must have the agreement of
the Registered Manager and Deputy Manager before undertaking the
training as part of performance development. The Clinical Services
Manager will also be aware of this agreement. For HCSW’s providing
respite care in the community or providing support in the special
schools; they must have the agreement of the Community Children’s
Nurse Team Leader and the Clinical Services Manager.
3. There must be sufficient opportunity to practice the skill under the
direct supervision of a Registered Nurse in order to gain competence.
4. The HCSW must have undertaken the core expanded role training that
includes more detailed consideration of accountability and consent
issues.
SCOPE OF PRACTICE
Staff are reminded that, due to the differences between the various clinical
areas covered by Child Health, competency within one clinical area does not
automatically mean competency within another. Drug administration by
HCSW’s other than in Firvale, the special schools or when providing respite
care in the community is not permitted under any circumstances. The
decision to allow drug administration by appropriately trained HCSW’s
remains with the Registered Nurse responsible for the child’s care and must
be respected at all times. The Registered Nurse retains the right to withhold
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permission if there are any concerns about the competence of the HCSW at
that time or in a given situation. This is in compliance with professional
requirements relating to delegation of activities (NMC, 2008).
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Suitably trained HCSW’s may single check and administer oral drugs
once they have been deemed competent by a nominated Registered
Nurse. The training does not cover drug administration by any other
route.
Drugs may only be administered by HCSW’s where they have been
labelled and dispensed for an individual child and there are no
calculations required to determine the amount to be given.
Controlled drug administration for children within the health care
provision of Firvale should be undertaken either by two Registered
Nurses or one Registered Nurse and one suitably trained and
experienced HCSW.
HCSW’s providing respite care are not permitted to single check and
administer controlled drugs.
The HCSW will be held accountable and responsible for their actions.
All relevant policies, guidelines and legislation must be adhered to.
Failure to do so will result in immediate withdrawal of permission to
administer drugs and possible disciplinary action.
Competence in drug administration will be reviewed by a nominated
Registered Nurse on an annual basis or that determined by local
policy.
Contemporaneous records must be maintained including actions taken where
difficulties/problems were encountered.
All training competencies must be achieved to level 3 of the competency
rating scale before a health care support worker is considered competent and
documents are signed to that effect.
This training supports KSF Health and Well-Being Dimension 5, level 2.
This training package must be used in partnership with the local policy for
drug administration/management and competency assessed using the criteria
set out in the national Skills for Health Competence CHS3 Administer
medication to individuals.
References:
Department for Education (2011) Children’s Homes. National Minimum Standards, Children’s
Homes.
https://www.education.gov.uk/publications/standard/Lookedafterchildren/Page1/DFE-000302011
Nursing and Midwifery Council (2007) Standards for medicines Management.
www.nmc-uk.org/Publications/Standards
Nursing and Midwifery Council (2008) The Code: Standards of conduct, performance and
ethics for nurses and midwives. www.nmc-uk.org/Publications/Standards
Royal Pharmaceutical Society of Great Britain (2007) The Handling of Medicines in Social
Care. www.rpharms.com/support-pdfs/handling-medicines-socialcare-guidance.pdf
Skills for Health (2010) CHS3 Administer medication to individuals. www.skillsforhealth.org.uk
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Level of Competency Rating Scale
Level
Descriptor
0
Limited ability and is unable to demonstrate understanding
1
Ability to perform, but a high level of supervision and
assistance necessary. Introduced to reflective practice
2
Able to perform safely with minimal
supervision/assistance. Participate in reflective practice
3
Able to perform/achieve safely without assistance,
demonstrating a clear understanding and insight into the
competency. Initiate reflective practice
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Competences to be achieved (Skills for Health)
CHS3 Administer medication to individuals
OVERVIEW
This standard covers the administration of medication to individuals and
monitoring the effects. This role is complex and will not be the role of all care
staff, only those designated to undertake this activity according to their
expertise and employers decisions.
The standard applies to all medication used for and by individuals, both
prescribed and non-prescribed. This includes immunisation and vaccination.
This standard is intended to be used in a variety of care settings including
hospitals, nursing and residential homes, hospices, and community settings
including the individual’s own home and GP surgeries.
This standard does not cover the use and administration of intra-venous
medication.
Users of this standard will need to ensure that practice reflects up to date
information and policies.
Version No 1
KNOWLEDGE AND UNDERSTANDING
You will need to know and understand:
1. the current European and National legislation, national guidelines,
organisational policies and protocols in accordance with Clinical/Corporate
Governance which affect your work practice in relation to administering
medication to individuals
2. your responsibilities and accountability in relation to the current European
and National legislation, national guidelines and local policies and protocols
and Clinical/Corporate Governance
3. the duty to report any acts or omissions in care that could be detrimental to
yourself, other individuals or your employer
4. the importance of working within your own sphere of competence and
seeking advice when faced with situations outside your sphere of competence
5. the importance of applying standard precautions to the administration of
medication to individuals and the potential consequences of poor practice
6. the hazards and complications which may arise during the administration of
medications and how you can minimise such risks
7. the importance of offering effective verbal and non-verbal support and
reassurance to individuals, and appropriate ways of doing so, according to
their needs
8. the importance of communicating effectively and how communication
differences may be overcome
9. the factors which may compromise the comfort and dignity of individuals
during drug administration - and how the effects can be minimised
10. the common types of medication and rules for their storage
11. the effects of common medication relevant to the individuals condition
12. medications which demand for the measurement of specific clinical
measurements and why these are vital to monitor the effects of the
medication
13. the common adverse reactions to medication, how each can be
recognised and the appropriate action(s) required
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14. the common side effects of the medication being used
15. the different routes of medicine administration
16. the information which needs to be on the label of medication, both
prescribed and non-prescribed, and the significance of the information
17. the various aids to help individuals take their medication
18. the types, purpose and function of materials and equipment needed for
the administration of medication via the different routes
19. the factors which affect the choice of materials and equipment for the
administration of medication to individuals
20. how to read prescriptions/medication administration charts to identify:
1. the medication required
2. the dose required
3. the route for administration
4. the time and frequency for administration
21. how to prepare the medication for administration using a non-touch
technique
22. how you would check that the individual had taken their medication
23. how you dispose of different medications
24. the importance of correctly recording your activities as required
25. the importance of keeping accurate and up to date records
26. the importance of immediately reporting any issues, which are outside
your own sphere of competence without delay to the relevant member of staff
PERFORMANCE CRITERIA
You must be able to do the following:
1. apply standard precautions for infection prevention and control and any
other relevant health and safety measures
2. check that all medication administration records or protocols are available,
up to date and legible
3. report any discrepancies or omissions you might find to the person in
control of the administration and to relevant staff as appropriate
4. read the medication administration record or medication information leaflet
accurately, referring any illegible directions to the appropriate member of staff
before administering any medication
5. check and confirm the identity of the individual who is to receive the
medication with the individual themselves, and your assistant (if applicable),
using a variety of methods, before administering medication
6. check that the individual has not taken any medication recently and be
aware of the appropriate timing of medication
7. obtain the individuals valid consent and offer information, support and
reassurance throughout, in a manner which encourages their co-operation
and which is appropriate to their needs and concerns
8. select, check and prepare correctly the medication according to the
medication administration record or medication information leaflet
9. select the route for the administration of medication, according to the
patient’s plan of care and the drug to be administered, and prepare the site if
necessary
10. safely administer the medication:
1. following the written instructions and in line with legislation and local
policies
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2. in a way which minimises pain, discomfort and trauma to the individual
3. report any immediate problems with the administration
11. check and confirm that the individual actually takes the medication and
does not pass medication to others
12. monitor the individual’s condition throughout, recognise any adverse
reactions and take the appropriate action without delay
13. clearly and accurately enter relevant information in the correct records
14. maintain the security of medication throughout the process and return it to
the correct place for storage
15. monitor and rotate stocks of medication, maintain appropriate storage
conditions and report any discrepancies in stocks immediately to the relevant
staff
16. dispose of out of date and part-used medications in accordance with legal
and organisational requirements
17. return medication administration records to the agreed place for storage
and maintain the confidentiality of information relating to the individual at all
times
ADDITIONAL INFORMATION
This National Occupational Standard was developed by Skills for Health.
This standard links with the following dimension within the NHS Knowledge
and Skills
Framework (October 2004):
Dimension: HWB5 Provision of care to meet health and wellbeing needs
CHS3 Administer medication to individuals
Final version approved June 2010 © copyright Skills For Health
For competence management tools visit tools.skillsforhealth.org.uk
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Competency statement (once completed, a copy of this can be kept in the
individual staff member’s file)
1. Able to discuss the reasons why the individual child requires specific drugs by
specific routes.
2. Able to apply knowledge and understanding of standard precautions for
infection control and apply other health and safety measures in a manner that
demonstrates understanding of accountability before, during and after the
procedure.
3. Demonstrates exercising of accountability and responsibility and adherence to
policies and guidelines when checking and recording medication administration
records.
4. Takes appropriate action when medication records / dispensing label
information is unclear
5. Demonstrates ability to obtain informed consent where this is possible and
takes appropriate action where consent is withheld or the child is unable to give
consent.
6. Promotes the safety and well-being of the child at all times including the
checking of identification prior to drug administration.
7. Identifies, selects and confirms required equipment that is appropriate to the
individual child and is fit for purpose.
8. Selects, checks, prepares and administers oral drugs correctly in accordance
with medication records and drug information.
9. Demonstrates ability to maintain the security of medications at all times and in
accordance with local policy, national guidance and legislation (including safe
disposal of drugs).
10. Initiates appropriate action in the event of a drug discrepancy or error.
9. Applies appropriate level of working knowledge of pharmacology to the whole
procedure.
10. Observes the child before, during and after drug administration, recognising
and reporting any indicators of adverse responses and takes appropriate action.
11. Maintains clear, accurate and relevant records of events and actions taken.
12. Recognises and acknowledges limits to personal knowledge and competence
and seeks assistance at an appropriate stage from an appropriately qualified
person.
Signed: ……………………………………… (Supervisor / Assessor) Initials …………
Signed: ……………………………………… (Staff member) Initials ………………..
Review date:
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SUPERVISED PRACTICE
There is no required number of times a Support Worker should be
supervised before competency is assessed. This has to be determined
on an individual by the Registered Nurse / Registered Manager and the
HCSW.
SUPERVISOR: Band 5 Registered Nurse who has completed or is undertaking the
mentorship and assessing course and who has been authorised to act as supervisor
for Health Care Support Workers undertaking expanded role training.
ASSESSOR: Band 6 or above Registered Nurse who has completed the mentorship
and assessing course and who has been familiarised with the competencies and
learning outcomes for the Health Care Support Worker. In residential care settings,
the Registered Manager or Deputy Manager will undertake this role
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PROFESSIONAL, LEGAL AND ETHICAL ISSUES
1. How would you define accountability and responsibility?
2. Who determines what you are responsible for and how do you know
this?
3. We owe our patients and clients a ‘duty of care’. What does this
mean? How do we apply this duty when administering drugs?
4. What does ‘vicarious liability’ mean? How does it affect our daily
work?
5. There are 2 main responsibilities linked with the Health and Safety
at Work Act 1974.
What are these and how do they and
subsequent regulations affect how you work?
6. How does this apply to infection control eg when administering
drugs, when do you wash you hands?
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7. Precautions re shelf lives of drugs – before & during use?
8. How must drugs and lotions (including handwashing agents) be
stored?
9. When might you be at risk of being negligent?
10. What is the purpose of consent and why must you obtain it?
11. When can you act without an individual’s consent?
12. Who can give consent on behalf of a minor?
13. What makes consent ‘valid’?
14. What information should be given when seeking consent?
15. What do you do if consent is refused or cannot be given?
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16. What do you understand by ‘covert’ drug administration?
17. Are there any situations when this might be permissible? What
safeguards would need to be in place to protect the young person?
Should we give drugs covertly?
How might we do this?
Beware of honey!
AREAS FOR DISCUSSION
Who holds the overall accountability – the Registered Nurse or the
HCSW administering the drugs?
I’ve told someone else, am I still responsible?
Security and key-holding – who does what?
Personal
responsibilities – health
&
safety,
infection control,
equipment
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What are medicines?
These are defined by the Medicines Act 1968 and, in broad terms,
are substances or articles ‘manufactured, sold, supplied, imported or
exported for use wholly or mainly…’ to be administered or used as an
ingredient in the preparation of a substance to be administered for a
medicinal purpose. This includes the treatment or prevention of
disease and the preventing or interfering with the normal operation of
a physiological function temporarily or permanently.
Medicines are classified as either ‘Pharmacy only medicines’, ‘General
Sales Medicines’ or ‘Prescription Only Medicines’. What examples can
you think of for each of these?
Medicines are ‘licensed’ or ‘unlicensed’ for use. What do you think
these means and what might the impact be?
Controlled Drugs
These drugs are defined under the Misuse of Drugs Act 1971 and
classified according to the degree of harmfulness. There are strict
regulations controlling how they must be prescribed, supplied, labelled
stored and destroyed as well as the records that must be kept.
Class A drugs: includes morphine and pethidine
Class B drugs: includes codeine
Class C drugs: includes diazepam
The Misuse of Drugs Regulations 2001 further classified controlled
drugs into 5 schedules. These set out the circumstances in which it is
lawful to possess, supply, produce, export and import controlled drugs
Schedule 2 drugs (eg morphine) are subject to full controlled drug
requirements. How are they stored & what happens with the key?
Schedule 3 drugs (barbiturates) are subject to similar controls but
requirements relating to record keeping are less strict.
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Other sources of advice and guidance include:
Medicines and Healthcare Products Regulatory Agency
Royal Pharmaceutical Society of Great Britain
National Patient Safety Agency
Nursing and Midwifery Council
Department of Health
Commission for Social Care Improvement / Care Quality Commission
Pharmacists
Drug information leaflets
Drug formularies
Public inquiries can generate new advice and guidance e.g. The Shipman
Inquiry.
Adverse Reactions and Contraindications
All drugs carry a risk of adverse reactions. These can include itching,
skin rashes, nausea, vomiting, tinnitus, drowsiness and shock. There is
a reporting mechanism for reporting adverse reactions in newly
licensed drugs or serious reactions in established drugs.
Select 2 different drugs that you might give to a child/young person
in your care. What adverse reactions might occur? What action will
you take?
Drugs may interact with other drugs, be affected by the presence or
absence of food in the stomach or be contraindicated by certain
circumstances e.g. pregnancy. A common example is a female taking
the contraceptive pill and antibiotics at the same time. The effect of
the contraceptive pill is lessened and so she must take other
precautions. Are there any contraindications or special considerations
that you must take with the 2 drugs chosen above?
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Drugs must be labelled to particular standards to reduce the risk of
mistakes. What is required?
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The approved name (not the trade name)
The strength of the drug (e.g. 125 mg per 5 mls)
The number of tablets or volume of liquid dispensed
The name and address of the pharmacy (unless hospital)
The batch number of the drugs
The expiry date
Any warnings, contraindications, special advice.
Why do you need all this information?
Labels can get sticky, worn or smudged. What should you do?
ROUTES FOR DRUG ADMINISTRATION
Can you identify 6 different routes by which drugs might be given? (You
are not responsible for administering drugs by all of these routes. We
will look at some of the techniques for administration.)
What forms might drugs come in that you can administer?
How are drugs absorbed?
Drugs have to be absorbed across cell membranes in order to pass into
the circulation. With oral drugs, this usually occurs in the intestine. The
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rate of absorption is affected by the solubility of the drug and
sometimes this is controlled by the manufacturer in order to give the
best benefit to the patient. Many drugs are broken down in the liver
before going into the general circulation where they are rapidly diluted
and moved around the body.
What do you think the effect of warmth or cold could be on this process?
What might the effect of food in the stomach be on the process?
Most drugs are excreted via the kidneys.
precautions that you might have to take?
Could there be any special
Discussion area:
Half-life and therapeutic levels
Sustained release tablets / capsules
Crushing / opening and product liability, are there alternatives?
Look at the advice for Phenobarbitone
How might illness affect someone’s ability to make a decision about their
drugs?
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DRUG ADMINISTRATION – THE 5 R’s
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Right
Right
Right
Right
Right
child
medicine
dose – how do you know?
time
route
Follow any special instructions
Has the child taken the drug?
Minimise interruptions / distractions
What do you do if there are any concerns about any of these issues?
Discussion Area:
Where or when might an error occur?
Who is responsible?
What should you do in each instance?
Verbal orders – what should you do?
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DOCUMENTATION AND RECORD KEEPING
What records must be kept?
Who signs what and when?
What makes a good record?
SPECIAL CONSIDERATIONS
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Children leaving the building to go to school, activities, return home
– who is responsible for ensuring that the right drugs go with the
right child for the right time?
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What does collaborative care mean in relation to medicines
administration?
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How do you know you are giving the child the right dose?
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You are not required to do drug calculations but it is helpful if you
understand how these are arrived at. The child’s age and weight (in
kgs) must be known. Doses are calculated at e.g. x number of mgs
per kg body weight. To decide how much needs to be given in one
dose, the formula is the amount needed divided by what is available
multiplied by the volume. For example, if we needed 125 mgs
Paracetamol and the bottle had 120 mgs in every 5mls; we would do
the following calculation: 125 ÷ 120 x 5 = 5.2mls to be given
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