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Nurses could be breaching code by administering drugs in ignorance


One in four nurses administer drugs to patients without knowing the possible contraindications and side effects, Nursing Times’ survey has revealed.

A senior nursing academic told Nursing Times those nurses were “failing their code of conduct”.

The Nursing and Midwifery Council’s standards for medicines management state a nurse must know the therapeutic uses of a drug, its normal dosage, and any side effects and contraindications before it is given to a patient.

yet one in ten respondents to our survey also said they did not know the normal dose of a drug before administering it to a patient.

Margaret Edwards, senior lecturer and head of post graduate studies at King’s College London’s Florence Nightingale School of Nursing and Midwifery said the finding was “truly shocking”. She said those nurses “should not be putting themselves back on the register” if they were not competent to administer medication.

Nursing Times’ revelations about the competence many nurses feel they lack in medicines came as the annual inpatients’ survey from the Care Quality Commission found a quarter of patients said they were discharged from hospital without having their medicines explained to them properly.

Nearly half of the 50,000 patients surveyed also said they were not told about side effects and 40 per cent said they had not been told about any danger signals to watch out for after they went home.

Dr Edwards said: “Trusts have a shared responsibility with nursing staff to ensure they are competent in drug administration and all nurses employed within the acute trusts of King’s Health Partners undergo a competency test when they join.

“But it is down to the nurse to ensure competency is maintained and that they work within the scope of their practice to make sure they are safe [to administer medication].”


Readers' comments (53)

  • having done several drug assessments in the recent months this comes as no suprise.

    I was shocked when assessing some of the senior band 5 nurses at their lack of drug knowledge.

    How can we expect the patients to be informed or the junior staff if those senior nurses on the ward do not have the knowledge themselves.

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  • too much theory not enough about we make it a degree for entry job?

    perhaps our educators should take a stance here as if nursaes can't nurse who is responsible?

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  • there are so many nurses on my course who struggle with basic maths - as drugs calculations are more often than not a daily task, it should be a fundamental requirement for entry to the course... its hardly advanced calculus! i think my GCSE maths was more advanced... i also think its quite shocking that nursing has a 40% pass mark - i would not want anyone nursing me who only knew 40% anatomy and physiology etc

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  • In reponses to the above , Do you know that drug caslculation pass mark is 100% is not 40%. Even not 99% in my uni.

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  • I am very concerned that the headline for this article reads that "Nurses could be breaching the code", surely there is no doubt that they are breaching the code by administering drugs in ignorance! I was also sad to see in another NT atricle about nurses being scared to report drug errors, that a senior nurse from Manchester said that it wasn't nurses fault as they may need further training and were probably too rushed or short staffed. What utter nonsense. This just shows a total lack of understanding regarding accountability and vicarious liability. Nurses have a duty to keep themselves updated and to refuse to perform taskes that they are not competent to perform. Stop sticking up for nurses that are failing to care for our patients correctly. They may be "rushed" and "short staffed" but they should still be able to prioritise their work and ensure that really important tasks like drug administration and observations are done correctly.

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  • As a third year student about to qualify I still find myself using the BNF in drug rounds. What does not help is the time constraints on the administration of drugs. Though this is no excuse. Nurses always seem to be balancing this time constraint against safety, but safety is surely our paramount concern!

    Being a student I am paranoid about drugs, not wanting to make any mistakes. I check bothe the pack and contents names and dosages, then the date on the contents. This is done every time, yet often have I seen nurse whizz through this with confidence. On one occasion I found a pack, nearly have empty, that had the correct drug in, but the contents where a different dose to the pack. What had the patient been getting? Why had the nurses in the previous few days not noticed?

    As for maths! Thank goodness it is 100% pass. When we had a self assessment test in university only a handfull had that level of competence. Thankfully there is now a mandatory maths test in place.

    It is not all bad though as a couple of days ago I worked with a conscientious nurse who challenged the dose prescribed. Good on her I say! Our patients rely on such standards!

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  • It is impossible to know about every drug you are administering to a patient, however nurses should always have a BNF to hand so that you can research/learn about he drug immediately. Also it is inportant to report a drug error as it could save a patient's life that is why some Trusts/wards insist on having two qualified nurses administering medication especially in the mornings and nightime.

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  • It seems everything that happens in the health service is down to Nurses. Would I advise anyone to take up nursing on the problems that are highlighted on an hour to hour basis NO. Having worked in the courts it seems to me that there people higher in the chain of command that escape responibility and accountability. These are where the true problems are. But Nurses will and shall contginue to be the "scape goats". There are and still are plenty of excellent what I call "Golden Nurses" out there. And it would serve us all well if helped other nurses to be better nurses. To point out their mistakes in a positive manner. To correct errors for the better of staff and patients. Not to hound out the mistakes and crucify the nurses for them as I see. On a previous post it states "Stop sticking up for nurses that are failing to care for our patients correctly. They may be "rushed" and "short staffed" but they should still be able to prioritise their work and ensure that really important tasks like drug administration and observations are done correctly." which i accept BUT they are RUSHED, STRESSED, BADLY SUPPORTED BY MANAGEMENT AND OTHER AUTHORITIES, SHORT STAFFED,WORK LONG HOURS,UNDER PAID, UNDERVALUED AND MORE OFTEN THAN NOT UNDERTRAINED AND MISINFORMED. Once you sort all that out then go on the look for the so callled accountability and vicarious liability cases. But remember that as managers, director, CEO anyone above the nurse are also under a legal obligation to provide training, safe working envioroment and working practice, adequate staffing. My advice is if you dont like it record it in the ward records so that others are aware of difficulties. Its a legal binding record and your only defence.

    "Dont Just Suffer it CHANGE IT"

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  • tim stokes CAMHS, you are joking right? Too much theory? There is NO bloody theory on the courses beyond a few basic pharmacology lectures, they are far too busy pi**ing about with research modules or ethics!!!

    What is needed is a full module EVERY YEAR on basic drugs, what they are for, what they do, what the contraindications are for!!! THIS IS NEEDED!!!!!

    I agree with Anonymous | 26-May-2010 10:37 am, it is impossible to know everything, that is why extra time must be allowed on drug rounds for checking in the BNF when needed.

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  • Anonymous | 26-May-2010 10:44 am, Hear hear!!!

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