1. What do you understand by the term accountability?

The Code of NMC states that:

As a professional, you are personally accountable for actions and omissions in your
practice and must always be able to justify your decisions.
Accountability is integral to professional practice. Nurses and midwives make judgments in
a wide variety of circumstances, and use their professional knowledge, and skills to make a
decision based on evidence for best practice and the persons best interests. Nurses and
midwives need to be able to justify the decisions they make.
Nurses and midwives hold a position of responsibility and other people rely on them. They
are professionally accountable to the NMC, as well as having a contractual accountability to
their employer and are accountable in the law for their actions.
If a nurse or midwife is asked to deliver care they consider unsafe or harmful to a person in
their care, they should carefully consider their actions and raise their concerns to the
appropriate person. Nurses and midwives must act in the best interest of the person in their
care at all times

2. Under which protocol or process can medicine be administrated?

Care home providers should have a own care home medicines policy, which they review to make
sure it is up to date, and is based on current legislation and the best available evidence also. The
policy should include written processes for:

sharing information about a resident's medicines, including when they transfer between
care settings
ensuring that records are accurate and up to date
identifying, reporting and reviewing medicines-related problems
keeping residents safe (safeguarding)
accurately listing a resident's medicines (medicines reconciliation)
reviewing medicines (medication review)
ordering medicines
receiving, storing and disposing of medicines
helping residents to look after and take their medicines themselves (self-administration)
care home staff administering medicines to residents, including staff training and
competence requirements
care home staff giving medicines to residents without their knowledge (covert
administration)
care home staff giving non-prescription and over-the-counter products to residents (homely
remedies), if appropriate.

Care home providers should consider including the following in a medicines administration
process:

the 6 R's of administration:

right resident
right medicine
right route
right dose
right time
resident's right to refuse
making a record of the administration as soon as possible
what to do if the resident is having a meal

what to do if the resident is asleep

how to administer specific medicines such as patches, creams, inhalers, eye drops and
liquids
using the correct equipment depending on the formulation (for example, using oral syringes
for small doses of liquid medicines)
how to record and report administration errors and reactions to medicines
how to record and report a resident's refusal to take a medicine(s)
how to manage medicines that are prescribed 'when required'
how to manage medicines when the resident is away from the care home for a short time
(for example, visiting relatives)
monitoring and evaluating the effects of medicines, including reactions to medicines.
Care homes with nursing care should also include the correct use of infusion and injection
devices (for example, syringe drivers).
Care home providers should ensure that a process for administering 'when required' medicines
is included in the care home medicines policy.
The following information should be included:

the reasons for giving the 'when required' medicine

how much to give if a variable dose has been prescribed
what the medicine is expected to do
the minimum time between doses if the first dose has not worked
offering the medicine when needed and not just during 'medication rounds'
when to check with the prescriber any confusion about which medicines or doses are to be
given
recording 'when required' medicines in the resident's care plan.

Care home staff (registered nurses and social care practitioners working in care homes) should
ensure that 'when required' medicines are kept in their original packaging.
The care home provider, health professional prescribing the medicine and pharmacist should agree
with the resident the best time for the resident to take their prescribed medicines. Busy times
should be avoided.
Care home providers should consider ways of avoiding disruptions during the medicines
administration round, such as:

having more trained and skilled care home staff on duty at that time
reviewing the times for administering medicines (for example, administering once daily
medicines at lunchtime rather than in the morning, if the health professional prescribing
the medicine agrees that this is clinically appropriate)
avoiding planned staff breaks during times of medicines administration
ensuring fewer distractions for care home staff administering medicines.

3. By what routes may medicines be administrated?

Routes of administration

Oral administration: swallowed by mouth as a pill, liquid, tablet or lozenge

Sublingual: under the tongue
Enteric administration: delivered directly into the stomach with a G-tube or J-tube
Pulmonary administration & inhaled: inhaled through a tube or mask (e.g. lung
medications)
Rectal administration: suppository inserted into the rectum
Vaginal administration; vaginal products inserted into the vaginal canal
Topical administration: applied to skin (creams, ointments, lotions, pastes, wound
products)
Transdermal: a patch on the skin
Nasal administration: sprays or pumps that deliver drug into the nose
Otic administration: drops into the ear
Ophthalmic: drops, gel or ointment for the eye
Parental administration
o intra-arterial injections
o intraosseous injections
o intra-articular injections
o intravenous injections: injected into vein with a syringe or into intravenous (IV) line
o infusion: injected into a vein with an IV line and slowly dripped in over time
o intramuscular injections: injected into muscle through skin with a syringe
o subcutaneous: injected just under the skin
o intradermal inections (small amount anestezic, allergy & skin testing, etc.)

4. For what reason would a medicine be withheld and what further action should be taken?
A medicine would be withheld when:
the patient develops an allergic reaction,
exist contraindications or the negative side effects are very strong
or one of next situations is not fulfilled,

correct packaging and labeling

dispensing date
expiry date
instructions for use
dose
the medicinal product matches what is on the label
the patient information leaflet is enclosed
correct patient name and ownership.

If the registrant is in any doubt as to the suitability of any of the medicinal products they must
discuss this with their line manager, GP or the pharmacy department.
Where the prescription is changed the registrant has a responsibility to ensure that the
medicinal products are re-dispensed as soon as possible. Where a medicinal product is
discontinued, it must be removed and with the patients permission disposed of in the
appropriate manner.

5. Describe the preparation and administration of a substance for injection:

A. Read the prescription carefully - Confirm the prescription relates to the patient
being treated. Check the patient is ready to have the medication.
Confirm that the prescription relates to the patient being treated by
checking all of the following: Full name / Address / Date of birth

Prescribers signature
The approved medicine name
The dose and frequency of administration
The date and route of administration
The allergy status of the patient Also check, where relevant:
Brand name and formulation of the medicine
Concentration or total quantity of medicine in the final infusion
container or syringe
Name and volume of diluent and/or infusion fluid
Rate and duration of administration
Type of rate-control pump or device(s) to be used
Date on which treatment should be reviewed
Clean preparation area - Area should be clean, uncluttered and as free from
interruptions and distractions as possible.
Assemble everything you need - Assemble sharps bin, medicine
ampoule(s)/vial(s), diluent, syringe(s), 21g, 23g, 25g needle(s), alcohol wipes,
disposable protective gloves, clean re-usable plastic tray. Check product expiry
dates and packaging, and read their labels carefully. Also check that products
were stored correctly (e.g. in a refrigerator). Prepare a label for the prepared
medicine
Check that:
a. The formulation, dose, diluent, infusion fluid and rate of administration
correspond to the prescription and product information
b. The patient has no known allergy to the medicine
c. You understand the method of preparation and administration
d. Calculate the volume of medicine solution required, write it down and get
it checked by another qualified person.
Wash your hands - Wash hands thoroughly according to local policy and put on a
pair of disposable gloves.
Prepare plastic tray and products - Disinfect a plastic tray with a 70% alcohol
wipe or spray. Peel open wrappers on syringes and needles carefully. Arrange all
ampoules/vials, syringes and needles neatly in the tray
Use a non-touch technique - Avoid touching areas where bacterial
contamination may be introduced. Never put down a syringe attached to an
unsheathed needle
Prepare the injectable medicine using the adequate procedure (single-dose
ampoule solution or power preparation)
Inspect the solution for cloudiness or particulate matter. If this is present
discard and follow guidelines on what action to take.
Cover the neck of ampoule with a sterile topical swab and open it.
Inspect the solution for glass fragments, discard if present,
Attach a sterile needle to the syringe
For powder preparations
o Inject the correct diluents slowly into the power within the ampoule
o Agitate the ampoule
o Inspect the content
For solution and powders after dilution
Withdraw the required amount of solution Replace the sheath on the
needle using one-handed scooping method and tap the syringe to
dislodge any air bubbles, expel air
Attach a new needle if required or a plastic end cap, etc.

B.
C.

D.

E.
F.

G.

H.

I.

Attack a label
All checks to be repeated before administering any injection

6. Outline the procedure to administer a controlled medication

Two practitioners must be involved in the administration of controlled drugs,
and both practitioners should be present during the whole administration
procedure. The two practitioners should have clearly defined roles. One should
be the checker and the other should take responsibility for taking the drug out
of the cupboard, preparing and administering the drug. This roles should not be
interchangeable during the procedure as this can results errors. They should
both witness the preparation, the controlled drug being administrated and the
distruction of any surplus drug. An entry should be made in the controlled drug
record book recording the following information:
the date and time the dose was administrated
the name of the patient
quantity administrated
the name
formulation
the strength being administrated
the name and signature of the person administering
the name and signature of the person witness
the balance in stock

7. What action would you take if:

A contraindication is discovered or the patient develops a reaction to the

medicine?
The medication will be stopped and the following persons will be informed
Registered Manager, and the service Users GP and family.
The medicine to be administrated is out of stock?
In case a medicine product is out of stock will be informed the manager in line,
GP and the pharmacy for take the next steps. A accurate input and output of
monthly medication is preferable to avoid such situations.
You discover someone else has made a drug error?
When a error in administering medicine is discovered or suspected the following
persons will be immediately informed:
The service Users and their family, as appropriate
The registered manager
The service Users GP