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15.1 Medication: controlled drug administration

Essential equipment

  • Prescription chart
  • Controlled drug record book
  • Appropriate medication container, for example medicine pot or syringe

Pre‐procedure

ActionRationale

  1. 1.
    Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
    To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [257], C).
  2. 2.
    Before administering any prescribed drug, look at the patient's prescription chart and check the following:
    To ensure that the patient is given the correct drug, in the correct formulation, in the prescribed dose using the appropriate diluent and by the correct route (DH [61], C).
  3. 3.
    • drug name (generic)
     
  4. 4.
    • dose
     
  5. 5.
    • date and time of administration
     
  6. 6.
    • frequency
     
  7. 7.
    • route and method of administration
     
  8. 8.
    • formulation of oral preparation, e.g. modified release or immediate release
    To ensure the correct formulation is given as many different formulations are available for the same drug. R
  9. 9.
    • diluent as appropriate
     
  10. 10.
    • validity of prescription
    To ensure the prescription is legal (DH [61], C).
  11. 11.
    • legible signature and contact details of prescriber
    To ensure the prescription is legal and complies with hospital policy (DH [61], C).
  12. 12.
    • when the drug was last administered.
    To ensure the patient requires the drug at this time. E
  13. 13.
    If any of these pieces of information are missing, unclear or illegible, do not proceed with the administration. Consult with the prescriber.
    To prevent any errors occurring. E

Procedure

  1. 14.
    With the second registered nurse or registered healthcare professional, take the keys and open the controlled drug (CD) cupboard. Take the ward CD record book that contains the prescribed CD, consult the contents page, and turn to the relevant page headed with the name and strength of the CD.
    To check the stock and enter the details into the CD record book (DH [61], C; NICE [248], C).
  2. 15.
    With the second registered nurse or registered healthcare professional, take the correct drug out of the CD cupboard.
    To comply with hospital policy and to ensure the patient receives the correct medicine (DH [61], C; NPSA [263], C).
  3. 16.
    With the second registered nurse or registered healthcare professional, check the stock level against the last entry in the ward record book.
    To comply with hospital policy (DH [61], C; NPSA [263], C).
  4. 17.
    With the second registered nurse or registered healthcare professional, check the appropriate dose and concentration/strength (e.g. 10 mg in 1 mL or 5 mg in 5 mL) and formulation against the prescription chart. Remove the dose from the box/bottle and place it into an appropriate container, e.g. medicine pot or syringe.
    To comply with hospital policy and to ensure the patient receives the correct dose and strength of medicine (DH [61], C; NPSA [263], C).
  5. 18.
    Return the remaining stock to the cupboard and lock the cupboard.
    To comply with hospital policy (DH [61], C; NPSA [263], C).
  6. 19.
    Enter the date, dose, new stock level and patient's name in the ward record book, ensuring that both you and the second registered nurse sign the entry.
    Note: it may be necessary to make the entry in different sections if the dose is to be made up of different doses (e.g. 70 mg = 1 × 50 mg and 2 × 10 mg). If any is wasted then ensure it is documented correctly (e.g. ‘5 mg given and 5 mg wasted’).
    To comply with hospital policy (DH [61], C; NICE [248], C; NPSA [263], C).
  7. 20.
    1. With the second registered nurse or registered healthcare professional, take the prepared dose to the patient and check the patient's identity by asking them to verbally identify themselves (where possible). Check the information the patient gives against the identification wristband they are wearing.
    2. Tell the patient the name and dose of the drug where possible; advise them on the different methods of administration and check their understanding (NICE [248]).
    3. Ask the patient whether they have any allergies, checking their response against the prescription chart.
    4. Check when the patient last had the medication against the prescription chart.
    To prevent error and confirm the patient's identity (NPSA [262], C; NPSA [266], C).
    To ensure that the patient has not already received the medication. E
  8. 21.
    Administer the drug. If given orally, wait until the patient has swallowed the medication.
    To ensure the patient receives the medication (DH [61], C).

Post‐procedure

  1. 22.
    Once the drug has been administered, ensure the prescription chart is signed by the nurse responsible for administering the medication and the registered nurse or registered healthcare professional who witnessed the administration.
    To prevent duplication of treatment and to comply with hospital policy (DH [61], C; NICE [248], C; NPSA [263], C).
    To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NICE [248], C).
  2. 23.
    Check the patient after administration for effectiveness and/or toxicity.
    To ensure that the drug has been effective and to administer a breakthrough dose if necessary. To check that the patient has not experienced any toxicity that may require interventions. E
  3. 24.
    If the drug was given via a syringe pump, return to check the infusion (for rate) and site (for signs of any local complications) and document in the appropriate records.
    To ensure that the infusion is infusing at the correct rate and the site is suitable. E
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