This audit is relevant to an in-patient setting. It is designed to be completed in conjunction with the prescribing audits in relation to the British National Formulary (BNF) (audit 94, p. 219) and Mental Capacity Act (audit 95, p. 221).
There are various pieces of legislation and various guidelines relating to the administration of medications (Royal Pharmaceutical Society, 2005; Nursing and Midwifery Council, 2007). If these are not adhered to, the result may be unlawful or unsafe practice. It is important for in-patient units to check that they are being lawful and following best practice.
This audit can be broken down into parts that are deemed relevant to a service. The audit can be done on all medication, just psychiatric medication, regular prescribing or ‘as required’ prescribing, or simply focused on one particular group of medicines or one patient group. There are guidelines for administering medication on wards. In addition to these, there are additional regulatory requirements for controlled drugs. Medicines currently classified as controlled drugs are listed in the current Misuse of Drugs Regulations (Home Office, 2009) and the British National Formulary (Joint Formulary Committee, 2009).
From the guidelines produced by the Royal Pharmaceutical Society (2005) and the Nursing and Midwifery Council (2007), the following standards in relation to nurses’ administration of general drugs were used:
ᐅ A record of administration should be made (e.g. time and date).
ᐅ The administering nurse should be identified (e.g. signature or initials).
ᐅ Medication that is not given owing to refusal, wastage or lack of availability should be recorded.
ᐅ A record should be made when the task of administering medicine is delegated.
ᐅ The signature of a student administering medicines must be countersigned by a supervisor.
With specific reference to nurses’ administration of controlled drugs, the standard was that the following details should be recorded in the ‘Controlled Drug Register’:
ᐅ date on which the issue was made
ᐅ name of the patient
ᐅ the amount of drug issued
ᐅ the form in which the drug was issued
ᐅ the name/signature of the nurse or authorised person making the issue
ᐅ the name/signature of a witness (nurse, student nurse, doctor or pharmacist)
ᐅ the balance of the drug left in stock
ᐅ the amount of drug given and the amount wasted (if part of a vial is given to the patient).