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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