Medication Administration Competency Assessment

A. Responsibilities & Ethics Theory

1.

Describe whose responsibility it is to check that the medication is prescribed

correctly prior to administration

List what must be checked

The responsibility belongs to the nurse or midwife and she/he has to check if is the: right
medication, medication, dosage, form and time.

2. Which staff member may hold the drug keys

The nurse has to hold the drug keys.
3.

Explain what to do if asked to administer medication:

a. At a dose exceeding BNF recommendation

OR
b. Through route not specified in BNF

In both cases I won`t administer the medication.

4. Explain what to do if asked to leave a prepared injection or pot of medication
unsupervised
If a problem appears and I have to leave a prepared injection or a pot of
medication, I will lock them in a cupboard and take they key with me, or if I`m
just asked to leave them for no reason I won`t leave them.
5.

With regards to Ethics & Law, explain each of the following:

a.

Can a medication be given to a resident who is willing to take it, but lacks the
capacity to understand what it is for?

The nurse cannot prescribe the medication, the medic prescribes it and is the medic
considers that a certain medication is vital for a resident I will administer that
medication.
b.

Can covert medication be given to a person who has the capacity to decide,
and who does not wish to take the medication?

I will explain the benefits of taking the medication and if the person is able to decide and
he will refuse is, I won`t for him to take the medication.
1.

Explain where to get up to date information about any medication

You can get information about medication from the prospect, dedicated books, online.

2.

Study the list of medication groups below and explain why each might be
prescribed and list some common side effects, also give an example of each
medication that is in use in the home:
a.

Analgesics

An analgesic is any member of the group of drugs used to achieve analgesia, relief from
pain. Common side effects may include: rash, swelling, in over dose liver or kidney damage,
difficulty in breathing. In my nursing home we use paracetamol.
b.

Antibiotics

drug used in the treatment and prevention of bacterial infection. The

most common side effects of antibiotics affect the digestive system, a symptom
is diarrhoea. Other symptoms may be: feeling sick, loss of appetite, indigestion,
abdominal pain. A common antibiotic that we use is Augumentin.
Antibiotic is a

c.

Antidepressant drugs

Antidepressants are drugs used for the treatment of major depressive disorder. Frequent side
effects are: nausea, weight gain, blurred vision, insomnia.
d.

Benzodiazepines

are a class of psychoactive drugs used to treat anxiety, insomnia,

and a range of other conditions. Common side effect are: drowsiness, confusion,
dizziness, weakness, lack of coordination.
Benzodiazepines

e.

Mood stabilisers

A mood stabilizer is a psychiatric pharmaceutical drug used to treat mood

disorders characterized by intense and sustained mood shifts, typically bipolar
disorder type I or type II or schizophrenia. Common side effects are: nausea,
vomiting, diarrhoea, confusion, trouble breathing.
f.

Antipsychotic drugs

Antipsychotic drugs are medications that are used for some types of mental distress or disorder mainly schizophrenia and manic depression (bipolar disorder). They can also be used to help
severe anxiety or depression. Side effects: sleepiness and slowness, weight gain, increased
chance of developing diabetes.
g.

Anti-epileptics

Are a diverse group of pharmacological agents used in the treatment of epileptic

seizures. Freaquent side effects: feeling tired, stomach upset or discomfort,
dizziness, or blurred vision. In my nursing home we use buccolam.
h.

Hypnotics

Are a class of psychoactive drugs whose primary function is to induce sleepand to be used in the
treatment of insomnia (sleeplessness), or surgical anesthesia. Side effects: weakness, headache,
constipation, diarrhoea, dizziness.
i.

Anticoagulants

Anticoagulants are a class of drugs that work to prevent blood coagulation (clotting). Common side
effects: excessive bleeding, diarrhoea, constipation, dizziness, headache. We use Clexane.
j.

Laxatives

Laxatives are substances that loosen stools and increase bowel movements. Common side effects:
bloating, painful tummy (abdominal) cramps, feeling sick, dehydration, flatulence. We use
malaxole.
k.

Dementia medication

Medicines for dementia are used to help with symptoms that affect thinking and memory. Side
effects: nausea, vomiting, diarrhoea, and weight loss.
l.

Insulin

Insulin is a peptide hormone produced by beta cells in the pancreas. Side effects: hypoglycaemia,
local allergy (swelling, itchy skin, redness), nausea, trouble breathing, rapid heartbeat. We use
Lantus.
1.

Describe the symptoms and management of Anaphylactic shock

Symptoms is anaphylactic shock: severe itching of the eyes or face and, within minutes, progress
to more serious symptoms. These symptoms include swallowing and breathing difficulties,
abdominal pain, cramps, vomiting. The treatment for this is injection with epinephrine
(adrenaline).
2.

Describe the symptoms and management of Hypoglycaemia

Symptoms that appear in hypoglycaemia: confusion, dizziness, anxiety, weakness, headaches.

When hypoglycaemia appears you can
3.

glucose or simple carbohydrates.

Describe the symptoms and management of a seizure

There are two types of seizure: simple partial seizures (patient remains fully conscious throughout
and the symptoms are: a general strange feeling that is hard to describe, a deja vu feeling,
unusual smell or taste, stiffness or twitching in a part of the body) and complex partial seizures
(patient loses the sense of awareness and can't remember what happened after the seizure has
passed. The symptoms may include: making random noises, moving arms around, rubbing the
hands, picking at clothes, adopting unusual posture, smacking the lips.) When the seizure appears
try to protect the patient from injury by removing any dangerous or potentially harmful object
nearby, do not restrain them or attempt to move them (unless they are in immediate danger), stay
with them until they recover.
4.

Explain the correct course of action if the prescription sheet ;

a.

is missing

If is missing call the doctor to prescribe a new one.

b.

if there are errors on the prescription sheet

If there are any errors in the prescription sheet call the doctor and inform him.
1.

Explain the correct course of action if the prepared medication cannot be

administered;
a.

at the prescribed time

Inform the doctor and wait for his advice.

b.

immediately to the resident

Inform the doctor and wait for his advice.

c.

the resident declines the medication

If the resident refuses the medication we complete the refusal form.

d.

the resident is out of the home

Inform the doctor and ask for his advice.

1.

Explain what to do if a drug administration error occurs

Inform the doctor and wait for his advice.

2. Describe what should be checked on prescription charts when administering;

a. Regular medication - name of person, name of drug, the dosage, administration
rute, administration time.
b. PRN medication - Describe what should be checked on prescription charts when
administering and to check is they are multiple drugs that can lead to an overdose.
3.

Describe what issues should be considered before PRN medication is administered

The main issue is not to give same drug as in the regular medication.
4.

Describe the ordering procedure for medications

When we want to order medication from pharmacy we have to make sure that we
complete the pharmacy requisition form and this has to be faxed to pharmacy with the
prescription from GP. The pharmacy requisition is faxed to pharmacy, we confirm via
telephone and when the medication arrives we make sure that the prescription is send with
the person who makes the delivery.
5.

Describe the procedure for the disposal of medications

When a medications is to be disposal, it is store in a yellow bin and is send back to

pharmacy.
6.

Describe what must happen before a resident may self-administer medication

In case o self administer medication the resident is assessed for their suitability to self
administer by a nurse, a care plan is initiated, the nurse discusses with the resident the
scheme of administer, we obtain a consent signed by resident, the resident is reviewed.

A. Controlled Drugs (CDs) Theory

1.

Explain the procedure for ordering CDs and how does a prescription for controlled
drugs differ form a regular prescription

The prescription for a controlled drug is issued weekly on a special prescription form and
the prescription is send to pharmacy with a person not to be faxed.
2.

Explain the procedure for accepting and storing controlled drugs

When the controlled drugs arrive the resident name, the date and the quantity are enter
into controlled drug register and signed by either the two nurses or a nurse and the
pharmacist. Then the controlled drugs are stored separately secured seif into a locked
cupboard.

3.

Name the controlled drugs currently in use in the home and state why they are
prescribed

In my nursing home we use Methadone. Methadone is use in the treatment of opioid

addiction as substitution or maintenance therapy.

4.

Explain the procedure for administering a CD and what recording must take place

Methadone is administered in a quiet or private area and the consumption must be

witnesses in view of the nurse, the resident , dose and time is confirmed with a second
nurse, the resident has to confirm that he wants the dose. After administration there will
be some methadone remain in the bottom of bottle so we put some water and this should
be consumed by the resident. At the end we offer a glass of water to the resident.
5.

Explain who can be the second checker and the role of the second checker when
administering CDs

The second is the nurse and his role is to confirm the resident, the dose and the time.
6.

Describe what should be done if a discrepancy is noticed between medication

present and entry made in the CD register

If a discrepancy is noticed we inform the GP and we call the pharmacy.

7.

How many CD registers are there and what are their uses

There are two CD register in the nurses station and the role of this one is to keep record
on every dose.
8.

Describe the correct disposal procedure when;

a. A CD is out of date - any medication that are out of date must be returned to
pharmacy to be disposed of.

b. An attempt has been made to administer a CD but it has been declined by the
resident -if the CD is declined by the resident it will be returned to pharmacy

c. The CD is no longer required by the resident - if the CD is no longer required

by the resident the CD will be send to pharmacy
1.

Who has access to the CD cupboard

The nurses, the CNM and DON have the access to CD cupboard.

A. Controlled Drugs (CDs) Practical

1.

Explain in detail the procedure for the administration of CDs

The CD in our case methadone, has to be administered in a quiet or private area and the
consumption must be witnessed in view by a nurse, we confirm with the resident that he is
ready to take the dose, we suggest to the resident that he must adopt a sitting upright
position when consuming the dose, after consummation the will be still some methadone in

the bottle and we put some water and give it back to resident and we offer a glass of
water and we ask him if he is ok.
2.

Outline what needs to be checked both before and after, what needs to be
documented and by whom

Two nurses has to confirm the resident, dose and time before administering the dose and
has to be sign in the medical cardex and in the CD book.

A. Oral Medication Theory

1.

Discuss alternative strategies for medication administration should a resident be

unable to swallow tablets

If a resident is unable to swallow tablets, an alternative is to crush the tablets or in cases

to ask for liquid form medication.
2.

Explain the procedure taken prior to a decision to crush tablets

If a resident becomes unable to swallow their medication, the nurse is contacting the
medical practitioner to inform them of the change in the resident condition.
3.

Explain what has to be in place before a tablet can be crushed

Before a tablet can be crush the nurse should check with the pharmacist if the drug is for
crushing.
4.

Describe the distinguishing feature of tablets that cannot be crushed

The tablets that cannot be crushed are long acting or slow release tablets, capsules
containing powder that irritates the mucous membrane, sublingual or buccal tablets.
5.

Describe what you should do before administering DIGOXIN

We have to check the pulse.

A. Oral Medication Practical

1.

Explain in detail the procedure for the administration of oral medication

The nurse has to check the resident name, dose, time, route, has to take a glass of
water/juice and administer to the resident. We wait till the resident swallows the tablets.
2.

Outline what needs to be checked both before and after, what needs to be
documented and by whom

Has to be checked the resident, correct medication, dose, time, route. It need to be
checked if the resident swallow the tables, if he is ok and the medication has to be sign in
cardex by the nurse.
3.

What should be done if a resident constantly refuses medications

In case of refuse we call the doctor and we ask for alternatives.

A. Enemas and Suppositories Theory

1.

Describe why enemas and suppositories might be given and their method of action

have a faster onset,

higher bioavailability, shorter peak, and shorter duration than the oral
route. Another advantage of administering a drug rectally, is that it tends
to produce less nausea compared to the oral route and prevents any
amount of the drug from being lost due to emesis (vomiting).
When we administer medication via rectal route the drugs

2.

Describe how to reduce the risk of discomfort to the person and/or damage to the
bowel wall during administration of any of the above

The enema has to be warm by immersing in a jug of hot water and the suppository has to
be lubricate.
3.

Describe the appropriate disposal of equipment after use

After administration we use the bin for disposal.

4. Describe how to protect the privacy and dignity of the resident during
administration

We use a blanket or sheet to maximize the privacy.

A. Enemas and Suppositories Practical

1. Detail the procedure for administering medication via enema or

suppository
Explain the procedure to resident, ensure privacy, position the resident lying on
left side with knees well flaxed, the upper leg higher than the lower leg and with
the bottocks near to the edge of the bed, ensure that a commode is available,
wash hands, put gloves, lubricate the suppository, separete the resident bottocks
and insert the suppository, advancing 2-4 cm. After insertion, clean the excess of
gel, we ask the patient to retain the supository, dispose equipment and wash
hands and record the administration in resident`s medication administration
sheet.
2.

Outline what needs to be checked both before and after, what needs to be
documented and by whom

Checked the integrity and if the suppository is gone and need to be documented by the
nurse.

A. Buccal Midazolam Theory

1.

Describe two situations where the use of buccal Midazolam is required

We use the Midazolam we the resident has multiple simple partioal sizures or a complex
partial seizure.
2.

Describe the method of action for buccal Midazolam

The midazolam solution should be placed against the sides of the gums
and cheek so that the medicine is absorbed directly into the bloodstream.
This is known as the buccal or oromucosal route. If the medicine
is swallowed accidentally, it might not work as quickly.
3.

Demonstrate knowledge of possible side-effects

Drowsiness and sedation recovery is usually fast.

Amnesia or short-term memory loss your child may not remember
having had a seizure.
Breathing difficulties your child is unlikely to have breathing
difficulties if midazolam is given at the correct dosage. If breathing
difficulties do develop, seek medical assistance. Restlessness,
agitation and disorientation these can occur but are usually rar

1.

Explain the correct storage and recording of Midazolam

Midazolam should be stored into a locked cupboard.

2.

Describe the correct method of administration in line with manufacturer and best
practice guidelines

The midazolam solution should be placed against the sides of the gums
and cheek so that the medicine is absorbed directly into the bloodstream.
This is known as the buccal or oromucosal route. If the medicine
is swallowed accidentally, it might not work as quickly.

A. Buccal Midazolam Practical

1.

Describe how to assess the residents need and identify when buccal Midazolam
should be administered

We administer the Midazolam when the resident has a seizure. We can see that in his
medical history.

2. Detail the procedure for administering medication

The midazolam solution should be placed against the sides of the gums
and cheek so that the medicine is absorbed directly into the bloodstream.
This is known as the buccal or oromucosal route. If the medicine
is swallowed accidentally, it might not work as quickly.

3.

Outline what needs to be checked both before and after administration, what
needs to be documented and by whom

Need to be checked the type of seizures and if the resident has received previous a dose, if
the dose in not expired and is documented by nurse.

A. Dermatological Preparations Theory

1.

Describe the following dermatological problems and how they might be recognised:

a. Inflammation - a localized physical condition in which part of the

body becomes reddened, swollen, hot, and often painful,
especially as a reaction to injury or infection.
b. Infection - is the invasion of an organism's body tissues by
disease-causing agents, their multiplication, and the reaction of
host tissues to these organisms and the toxins they produce
c. Infestation - is the state of being invaded or overrun by pests or
parasites
d. Ulceration is a discontinuity or break in a bodily membrane that
impedes the organ of which that membrane is a part from
continuing its normal functions
e. Oedema is a condition characterized by an excess of watery fluid
collecting in the cavities or tissues of the body.
f.

a medical condition in which patches of skin become

rough and inflamed with blisters which cause itching and
bleeding
Eczema -

g. Bruising - is a common skin injury that results in a discoloration of

the skin

1.

1.

Describe the clinical indications for the use of :

a.

Antibiotics

b.

Antifungals

c.

Barrier creams

d.

Emollients

e.

Steroids

Name two dermatological preparations in use in the home

Diclac gel
2.

Demonstrate knowledge of when PRN dermatological preparations should be used

If the resident requests we can use or if the nurse considers that the resident needs it.

A. Dermatological Preparations Practical

1. Detail the procedure for administering dermatological preparations

If the resident requires we can administer the dermatological preparation. We

make sure that the resident has privacy, we wash hands, put gloves, check the
expire date and we applied on the area. After we dispose the materials.
2.

Outline what needs to be checked both before and after administration, what
needs to be documented and by whom

We check the medication, the resident, time, expire date. Has to be checked by the nurse.

A. Dressings Theory

1.

Explain the process of how dressings promote skin healing

Dressings that create and maintain a moist environment, however, are

now considered to provide the optimal conditions for wound healing.
Moisture under occlusive dressings not only increases the rate of
epithelialisation but also promotes healing through moisture itself and the
presence initially of a low oxygen tension (promoting the inflammatory
phase)Explain how to obtain help with complicated wounds and / or dressings, or a
wound that is not healing

2.

Describe the symptoms of an infected wound and appropriate management

Feeling of malaise, redness, fever, fluid drainage, hot incision site, pain. We contact the
doctor and tell him. In some cases we can clean it and apply a dressing.

A. Dressings Practical

1. Detail the entire procedure for one of the dressings here in the home
Make sure that the resident has privacy, sterile gloves, we prepare the dressing,
we clean the area with sterile water, we applied the dressing and secured with
mefix and dispose the materials. The complete the wound assessment in epic.
A. Eye preparations Theory

1.

Describe two common reasons for eye preparations

Pain and redness

2.

Explain the expiry date for eye preparation, once in use

Each medication has different expiring date, but they expire after x amount of months
after opening.
3.

Explain when it is necessary to have separate containers for each eye and when / if
needed

Is needed if the resident receives more than one type of preparation

4.

Explain the time delay required if a resident receives more than one type of eye
preparation at the same time

Five minutes
5.

Explain the standard precautions which should be taken when administering eye
preparations

6.

Explain where and how to store eye preparations and how to check if unsure

It is store in the medication cupboard and the opening date is written on the tube.

A. Eye preparations Practical

1.

Detail the procedure for administering eye preparations

A. Inhalers and Nebulisers Theory

1.

Explain why metered-dose inhalers and nebulisers might be prescribed

2.

Describe the correct technique for using a metered-dose inhaler in line with
equipment guidelines

3.

Discuss alternative strategies which could be used if a resident is unable to

effectively operate a metered-dose inhaler

4.

Describe the correct technique for the administration of medication via a nebuliser

5.

Describe the correct procedure if more than one drug is prescribed at the same
time via the nebuliser

6.

Describe the procedure for cleaning the mask and the nebuliser following each use

7.

Describe the correct use of a spacer and how to maintain it

A. Inhalers and Nebulisers Practical

1.

Detail the procedure for administering medications via inhalers and nebulisers

A. Transdermal Patches Theory

1.

Name the transdermal patches in use in the home and explain why each patch is
prescribed

2.

Describe the safe precautions for the use of fentanyl patches

3.

Describe a common side effect of fentanyl patches

4.

Describe appropriate sites for each transdermal patch

5.

Describe suitable site for scopoderm patch

6.

Explain why gloves should be used when handling transdermal patches

7.

Describe how used patches should be disposed of safely

A. Transdermal Patches Practical

1.

Detail the procedure for administering medication via transdermal patch