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On the Wards

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‘Let’s rethink drug rounds’

Protected drug rounds sound great. Put on a coloured tabard and off you go to ‘do the drugs’ and no one will interrupt you. If only I worked in a ward where such a thing were feasible.

Perhaps I should start by describing the major drug round of my day in a short-stay medical ward.

The drug round starts first thing in the morning immediately after report. I might know some of the patients but most will be new to me. As I go to each patient, I check my handover sheet, ask how they are feeling, talk to them about issues raised at report and record their observations. I check intravenous fluids and urine drainage bags if they have them. Then I check the drugs, their identification and give out the drugs that I obtain from their bedside drug locker.

If the person is a new admission over the last 16 hours, I will usually have to obtain some drugs from our stocks. Many of my patients are old and cannot be rushed, although some amaze me with the speed at which they can down anything up to 15 tablets. Some need help positioning themselves into a suitable position to take their drug.

Breakfast comes at some stage during this round. Should anyone need help with feeding or sitting up, I assist, as do all the other nurses I work with. And, inevitably, people need bottles and commodes.

In addition to all this, the telephone starts ringing at around 7.30am and I am back and forth answering enquiries.

All in all, the entire ‘drug’ round usually takes me one hour 45 minutes to complete, which works out at 15 minutes per patient. However hard I try, I just cannot do it any faster. If I have a lot of ill and dependent patients, I am often slower.

However, by 9.00am I am in a position to actively participate in the consultant ward round, fully equipped to make comments about the readiness of the person for discharge.

How could a protected drug round possibly work in the circumstances I describe above? Drug rounds cannot be done in isolation. Every interaction with a patient is an opportunity to learn more about them and their condition.

What I would really appreciate – and I haven’t yet been able to work out how to achieve this – would be a system whereby I can give one person all their drugs from start to finish without any interruptions.

It is difficult being disturbed in the middle of working your way through a complex drug chart with some drugs in the medicine pot and more ready for checking. In
this situation, unless you are paying complete attention, it is so easy to make a mistake. I wonder if anyone can come up with any suggestions.

Gail Smith is a staff nurse in Cardiff

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