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The Use of

Medication ProtocolsPatricia McQuillanProfessional Development Co-ordinator

for Practice Nurses

HSE South (SE)

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What are Medication Protocols?

Development of Medication Protocols

Using Medication Protocols

Current situation

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An Bord Altranais Guidance

The Code of Professional Conduct for Each

Nurse and Midwife (April 2000)

Scope of Nursing and Midwifery PracticeFramework (April 2000)

Guidance to Nurses and Midwives on

Medication Management (July 2007)

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Immunisation and vaccination

Immunisation and vaccination programmes are an

accepted mechanism in public health for theprevention and eradication of infectious diseases

Nurses and midwives are key health

professionals involved in providing immunisationsto the patient/service-user and communities in thepromotion of public health and prevention ofinfectious diseases

Examples include childhood immunisationprogrammes, seasonal vaccinations, occupational

health vaccinations and travel vaccinations.

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An Bord Altranais supports thedevelopment of medication protocolsfor nurses and midwives using a

nationally recognised template basedon international evidence and bestpractice.

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What are Medication Protocols?

Medication protocols are written directions thatallow for the supply and administration of a namedmedicinal product by a nurse or midwife inidentified clinical situations.

Using a Medication Protocol involves theauthorisation of the RN/RM to supply andadminister a medication to groups of

patients/service users in a defined situationmeeting specific criteria and who may not beindividually identified before presentation fortreatment.

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An individually named prescription is NOT requiredfor the supply and administration of medicationwhen a medication protocol is in effect.

Its use should be considered in the context of theclinical situation, safety assurance for thepatient/service-user and acceptance ofaccountability by the healthcare professional

involved.

Medication protocols

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Rational

medication protocols can support efficient timelydelivery of quality healthcare and optimally utilise

the skills of healthcare professionals. However, theuse of a medication protocol should be reservedfor situations where it offers an advantage for thepatient/service-user and where it is consistent with

appropriate professional relationships.

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The legislative basis for medication protocols for thesupply and administration of medication is theMedicinal Products Regulations of 1996 andsubsequently 2003, (Prescription and Control of

Supply), which provides authority for hospitals toutilise medication protocols in order to meetpatient/service-user need for medicationmanagement.

Legislative basis for Medication protocols

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In operationalising a protocol, a nurse/midwife whois authorised to supply, is also responsible foradministration of the medication.

This activity cannot be delegated.

Medication protocols

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must be developed based on evidence of bestpractice and supported locally by a multidisciplinary

team (i.e. senior doctors, nurses, midwives,pharmacists, and healthcare managers).

Developing MedicationProtocols

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Provisions should be made to enable :

nurses, midwives and members of the multidisciplinaryhealthcare team to devise and implement medicationprotocols where there is a service need;

this can be achieved by a multidisciplinary approachusing the Medication Protocol Framework to writeup the protocol for each medication to be supplied andadministered by RNs/RMs.

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specific exclusion and inclusion criteria should bestated and a review date for evaluation of the protocolshould be included

particular standards, such as identifying who isresponsible and competent to implement the protocolshould be articulated

And

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ensure that the education and training is availableto disseminate information to nurses/midwives andall members of the healthcare team involved in theuse of protocols

these key provisions should be in place in advanceto facilitate and direct nurses and midwives in safepractices for the supply and administration ofmedication utilising a written medication protocol.

Provisions should be made to:

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The responsibility for developing and quality-assuring medication protocols rests with healthservice providers.

It is important that local policies are devised tosupport the development and implementation ofany medication protocols for patient/service-user

care.

Medication protocols

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Medication protocols

a review and audit process should be in place to

evaluate the use of medication protocols as part ofquality care provision and risk management

the Medication Protocol Framework has beendeveloped from a project supported by An BordAltranais and the National Council for the ProfessionalDevelopment of Nursing and Midwifery

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Setting a standard of vaccine

delivery in general practice

Nurses and midwives involved in immunisation programmes

and/or working under a Medication Protocol should maintaintheir competency and current knowledge with all aspects ofthis practice.

This encompasses:

Obtaining consent Vaccine handling and delivery

Storage and stock control

Proper technique of administration

Recognition and intervention with side effects, adverseevents and/or complications post immunisation.

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Using Medication Protocols

A RN/RM must be competent, educated and haveauthority to use Medication Protocols Educational workshops

Basic Life Support

Adhere to good documentation practice

It is recommended to attend AnaphylaxisTraining and also to complete the eLearning

Medication Management Programme online fromwww.nursingboard.ie

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Current situation

Group meeting with representation from the NIO, HSE,ICGP, PDCs

Considering the development and use of MedicationProtocols by PNs in general practice

Educational workshops and dissemination

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Change

In bringing about change, it is recognised thatchange itself is not easy - it can be stressful andsometimes difficult to understand in the beginning.

However, if change brings about improvements inhow we as RNs /RMs advance the practice ofNursing/ Midwifery and deliver an effective andefficient service, then all our efforts will be worth it .

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Sources of Information /websites

An Bord Altranais guidance documents available onhttp://www.nursingboard.ie/en/homepage.aspx

HSE National Immunisation Officehttp://www.immunisation.ie/en/ Irish Medicines Board http:// www.imb.ie Department of Health and Children: http://www.dohc.ie/ HSE Health Protection Surveillance Centre

http://www.hpsc.ie/hpsc/default.aspx/ Irish College of General Practitioners (ICGP) http://www.icgp.ie/ World Health Organization (WHO) http://www.who.int/en/ European Medicines Agency

http://www.ema.europa.eu/ema/index.jsp?curl=pages/home/Hom

e_Page.jsp&mid