Trainee nursing associates must be given adequate supervision when learning about medicines management but employers should name any “safety critical” drugs those in the new role will be expected to administer once qualified, new guidance from Health Education England states.
The guidance also recommends a change in legislation so that nursing associates can administer medicines under agreements that allow regulated staff to give drugs to certain patients without individual prescriptions – known as patient group directions.
“Nursing associates should not be precluded from administering [safety critical] medicines”
A document, published today, by the government arms’-length body contains a series of recommendations for employers about how associates should be involved with medicines management. It has been drawn up to ensure nursing associates can work “safely and appropriately,” according to HEE.
As previously reported by Nursing Times, HEE brought together a group of experts, chaired by Professor David Sines, to scrutinise the introduction of the new role, which led to today’s guidance.
The group concluded nursing associates should not be able to adminster medicines through certain routes – such as intravenously – or give controlled drugs, when they first qualify, but that this may be possible if they complete further training.
In its guidance today it has recommended that the Nursing and Midwifery Council should require associates to be taught oral, topical, subcutaneous, per rectum and inhaled routes of administration as “core” proficiencies.
If employers expect associates to use different routes, such as enteral or intramuscular, this should be defined in a “robust” organisational policy in which associated risks have been assessed, stated HEE’s guidance.
The document also underlines the need for nursing associates to have “adequate levels of supervision” during training, and that those supervision levels should be “clearly stated” in employers’ medicine policies.
Meanwhile, employers must put additional measures in place, such as naming which “safety critical” medicines – those with a higher risk of harm – they intend nursing associates to give in practice.
These could include methotrexate, warfarin, insulin, digoxin, lithium and opioids, medicines used outside of their license, and drugs new to the market, known as black triangle medications, said HEE.
“While nursing associates should not be precluded from administering these medicines, caution should be exercised to overtly promote a patient safety culture,” said the guidance.
The guideline highlighted that, while previous concerns had been raised about the possibility of nursing associates giving controlled drugs, the threat to patient safety was down to the route of administration as well, which applies to a wider range of higher risk drugs.
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Therefore, employers should focus more on the use of “safety critical” medicines in general, rather than just those that are controlled and come under the Misuse of Drugs Act, it added.
Meanwhile, HEE said it intends to work with employers and NHS England to develop proposals for nursing associates to be able to supply and administer medicines using patient group directions (PGDs).
Employers had reported it would be useful for associates to use PGDs in certain situations – such as giving immunisations as part of a national programme or using a saline flush following the insertion of a cannula, said HEE.
Once nursing associates are regulated, NHS England would need to request a public consultation from the government on the possibility of nursing associates administering drugs under a PGD before any change in legislation could be made, noted HEE.
The creation of the controversial new role, which is intended to act as a bridge between healthcare assistants and registered nurses, was announced in December 2015.
The two-year training programmes are now half-way through for most of the 2,000 trainee nursing associates in the pilot phase, which began in December 2016.