2005 Edition Report on Drug Administration Procedure & Practices ...

(D) RECOMMENDATIONS ON DRUG ADMINISTRATION PROCEDURES IN THEWARDSNo medications should be administered to a patient if a drug order is unclear or when there isdoubt in the appropriateness and safety of the patients.Level of Nursing Personnel involved in Drug Administration4.93 Under normal circumstances, a Registered Nurse is competent to administer medications onhis/her own. However, it is advisable to have a second person counter check the processespecially in situations where skill, experience and familiarity with the clinical conditionsare required to ensure safe practice, such as with paediatric medication, intravenousinjections, dangerous drugs, cytotoxic drugs and drugs added to infusion fluids. In any case,nurses should exercise care to double check themselves and not to rely solely on others withregard to the checking process.4.94 Enrolled Nurses should work within their qualification and training. In normalcircumstances, they can administer medications, when delegated this duty by RegisteredNurses. In the case of the extended and expanded role of the Enrolled Nurse, an enablingcourse or clear guidelines should be provided.4.95 Nurse learners who have undergone training in medication administration and are deemed tobe competent, may administer medications under the supervision of qualified nurses.Order and Receipt of Drug Supplies from the Pharmacy4.96 All drugs orders should be sent (e.g. by fax or by NCR) to the pharmacies for vettingirrespective of whether the supplies of drugs are required. Prior to sending of the drugorders, authorized nurses should screen the information on the orders to ensure the correctpatient’s label has been affixed and all important information for drug dispensing andadministration have been clearly written.4.97 All “discontinued” medications on the MAR should be faxed to the pharmacy as soon aspossible so that unnecessary re-dispensing of discontinued drugs can be avoided. In thecases of urgent / uncertain situations, the pharmacy department should be called to confirmthe receipt of the drug orders.4.98 All drugs delivered to wards must by checked by the authorized nursing staff as soon as theyare received. Drugs with special storage instructions such as refrigerated items must be putin the refrigerator promptly. The patient’s name on each of the drug label and the name andcondition of each of the drug dispensed must be checked for accuracy and acceptabilitybefore putting them into the drug trolleys.34