Administration of Medicine

ADMINISTRATION OF MEDICINE WORKBOOK FOR STUDENT MIDWIVES

Faculty of Health and Wellbeing3 Year Midwifery Programme

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Introduction

This workbook should enable you to discuss the responsibilities of the midwife in relation to the administration of medicines (Rule 7, NMC 2004) and the Guidelines for the Administration of Medicines (NMC 2004).

This work book is designed to help with your study and knowledge in relation to your learning outcomes in pharmacological principles.

Throughout the workbook you will be able to work through activities which will enable you to meet the learning outcomes and meet the standards of proficiency you are expected to achieve in the assessment of practice in the clinical placement. It will allow you to explore issues around safe drug administration. You will be able to practice skills on your clinical placement with supervision and guidance by your mentor.

The workbook is compulsory formative which can be used for discussion with your mentor on placement and your personal tutor if you feel you require guidance in some areas. It will be handed in with all your assessment documentation at the end of each year.

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For your own knowledge and further study it is advised that you explore in depth resources such as articles and books to reference your work in the following activities.

Learning outcomesADM & BSc (Hons) Pre-registration Midwifery Def. Doc. (2006)

You will be able to explain:-

2.1.5 Pharmacological principles in relation to midwifery practice

2.3.12 Administer safely a range of permitted drugs. Select, acquire and administer safely a range of permitted drugs consistent with legislation, applying knowledge and skills to the situation that pertains at the time.

2.6 Demonstrate knowledge of drugs commonly used during pregnancy and childbirth.

Standards of Proficiency

Observes and participates in the administration of drugs, using a variety of methods, in accordance with local policy and NMC Guidelines for the Administration of Medicines (2004).

Observes and participates in the maintenance of treatments via the intravenous route.

Observes and participates in the completion of records pertaining to drug administration.

Observes and participates in the safe custody of drugs in accordance with statutory guidance and local policy.

Is familiar with local format of professional records e.g. Care records, drug Kardexes

Observes and participates in discussions with women about their choices for analgesia in labour.

Year 1

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ACTIVITY 1

Midwives can supply and administer non-prescription medicines without a doctor's prescription.

In your clinical area:-

1. Find out and list which medicines you can administer without a prescription and discuss their side effects.

2. Find out what controlled drugs can be administered and prescribed by the midwife (Rule 7, NMC 2004).

3. List some drugs that require a Doctor’s signature on a prescription chart.

4. What do you understand by the term "standing orders"?

5. What do you understand from patient group direction?

6. Look at different prescription charts that are used in both the hospital and community settings and how medications are prescribed. Under direct supervision of your mentor

Mentors signature...........................

7. What resources would you access to acquire more information in relation to a specific drug when considering the suitability, dosage, route and side effects?

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ACTIVITY 2

Discuss procedures regarding the supply of controlled drugs. You may wish to explore issues around ordering, receiving, storage, administration, surrender and disposing of controlled drugs and the equipment safely, applying the role of the midwife in relation to these issues and current registration, both in hospital and the community settings.

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ACTIVITY 3

The absorption, distribution, metabolism and excretion of drugs are known as pharmacokinetics.

1. Explain these four terms.

2. Compare how pharmacokinetics occurs differently between mother and baby.

3. Identify factors that can interfere with the metabolism of a drug.

4. Name some drugs which may pass via the placenta into the fetal circulation.

5. What are the signs and symptoms of anaphylaxis and how would you manage a woman and with anaphylaxis.

6. Do you think, maternal size matters in drug metabolism?

ACTIVITY 4

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1. Describe how you would safely administer oral drugs to both the mother and the baby.

2. Provide specific examples of different oral preparations available for both mother and baby thinking about contraindications.

3. Look at the side effects they may have for both mother and baby.

4. Please read Standard 10 in the NSF (National Service Framework for Children, Young People and Maternity Services) and discuss your understanding of the terms ‘licensed’ and ‘unlicensed’ in relation to the safe administration of medicines to children.

ACTIVITY 5

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1. Describe how you would safely administer intramuscular drugs to both mother and baby.

2. In the clinical area ask your mentor to witness the safe administration of an IM (intramuscular) and SC (subcutaneous) injection. Explain your reasons for administration, provide evidence of calculations and the relevant site area. Mentors signature.........................

3. Provide examples of intra muscular drug preparations available and discuss their relevance to both the mothers' and babies' care, discussing side effects and contraindications.

ACTIVITY 6

1. Discuss what medications maybe administered to the mother per vagina, applying the midwives role and responsibility in the administration.

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2. Describe what preparations are administered per rectum and why?

ACTIVITY 7

1. Describe the procedure for administering intravenous (IV) drugs.

2. Name some drugs/medications that may be administered IV.

3. Discuss with your mentor how you would calculate an infusion rate with a syringe driver. Mentors signature........................

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ACTIVITY 8

1. Explain the responsibilities of the midwife when administering 50% nitrous oxide/ 50% oxygen (entonox).

2. Assess and discuss the value of entonox in labour and delivery.

3. Describe how you would explain to a mother the use of entonox.

4. Participate in the administration of entonox to a woman you are caring for in labour.

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Mentors signature........................................

ACTIVITY 9

Epidural analgesia is available in most obstetric units.

1. Compare the advantages and disadvantages of using epidural analgesia in childbirth, looking at contraindications and side effects of the use of epidural analgesia.

2. Describe the differences between epidural and spinal analgesia.

3. Describe how an epidural is sited, topped - up and the epidural cannulae removed.

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4. Provide examples of drugs used in epidural analgesia and discuss their side effects.

ACTIVITY 10

Describe how TENS (transcutaneous electrical nerve stimulation) works as an analgesia and when it should be used?

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ACTIVITY 11

1. Name a variety of medications that may be contraindicated in breastfeeding and those that are safe for the mother to take whilst breastfeeding.

2. Is there a way of minimising the side effects of drugs by timing the drug intake and breastfeeding pattern? (knowing the metabolism of drugs and their excretion pattern)

3. What advice would you provide to women administering their own baby's medication?

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ACTIVITY 12

Reflect on a time when you administered a medicine to a woman or baby that you have recently cared for. Some examples for discussion are:-

Why the medication was used.

Consent and advice/choice.

Contraindications and side effects.

From this workbook you may wish to critique further information and discussional points around pain in childbirth, not only relating to labour and delivery but also issues throughout pregnancy and after. This will allow you to think about the advice you give women linking in their choices and self administration of drugs, with consideration for women from vulnerable groups . Also, think about the implications of pain that may be experienced by the neonate.

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(approx. 500 words)

Completion of Year 1

Mentors signature...................................

Tutors signature......................................

Year 2

ACTVITY 1

1. Name and describe the different drugs administered for induction of labour and augmentation of labour.

2. Discuss with your mentor how these different drugs are administered and what dosages are used and why.

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ACTIVITY 2

1. What drugs are used in "active management of the third stage"?

2. Name the drugs which might be administered during a postpartum haemorrhage.

3. Discuss the side effects and contra-indications of each drug that might be used in prevention of PPH.

4. Discuss with your mentor the drug dosages and methods of administration Mentors signature..........................................

5. Find out the type of drug, dosage and its administration route for the third stage of labour, in your Home Trust and see if they are any different with your companion Trust practices/guidelines.

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ACTIVITY 3

1. Discuss with your mentor who might make the decision to administer certain drugs to treat post partum haemorrhage. Mentors signature.......................................

2. Provide examples of the drugs commonly administered at an adult cardiac arrest.

3. Discuss examples of the dosages and methods of administration.

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ACTIVITY 4

1. Name the Drugs/Medication prescribed by a Doctor that you may administer to an eclamptic woman

2. What would be the most important sequence of these drugs?

3. Describe how you would administer these drugs.

4. Discuss with your mentor the sequence and importance of each eclamptic drug. Mentors signature................................................

5. Explore the chemical interactions of certain drugs given to treat eclampsia and what, if any, cautions should be considered when administering them.

6. Discuss the possible side effects of these drugs.




Year 3

ACTIVITY 1

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Analyse the alternative therapies available to childbearing women and discuss the responsibilities a midwife has in their usage.

Discuss the midwives responsibility with regard to record keeping and contemporaneous documentation in regard to drug administration and how this takes place.




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REFERENCES

British Medical Association and Royal Pharmaceutical Society of Great Britain British national formulary [ELECTRONIC DATABASE].

Dimond, Bridgit, (2006). The legal aspects of midwifery. 3rd ed., Books for Midwives.

Dimond, Bridgit, (2003). Midwives and the correct administration of medicines. British Journal of Nursing, 12 (17), 1048-1054

John R and Taylor (2006) Skills for Midwifery Practice Elsevier, Churchill Livingstone

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Little B B (2006) Drugs and Pregnancy A Handbook Hodder Education, Oxford Press Inc.,

Lui D.T.Y. (2004) Labour Ward Manual Third Edition, Churchill Livings

Humphries, Jennifer L. and Green, Joyce (eds.). (2002). Nurse prescribing. 2nd ed., Palgrave.

Lapham, R and Agar, H (2003). Drug calculations for nurses: A step-by-step approach. 2nd ed., Arnold.

McCormick, C, (2002). Midwives and Patient Group Directions: supplying medicine. British Journal of Midwifery, 10 (5), 286-287

National Service Framework for Children, Young People and Maternity Services (2004) Standard 10 Medicines for Children and Young People DOH Oct 2004

NHS Education for Scotland (NES) (2006). Midwives and Medicines. [online]. Last accessed 2 March 2007 at http://www.nes.scot.nhs.uk/documents/publications/classa/MidwivesandMedicinesCOMPLETE.pdf

Nursing and Midwifery Council (2004). Guidelines for the administration of medicines.

Young, F, (2001). Using over the counter medication in pregnancy. British Journal of Midwifery, 9 (10), 613-616

Yerby M and Page L (2001) Pain in Childbearing - Key Issues in Management Bailliere Tindall

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Documents

Administration of Medicine