Student Nurse/Midwife Responsibilities with Fluid and Medication Management

Transcription

1 All staff using the Fluid & Medication Management policies must first familiarise themselves with the contents of: Roles & Responsibilities Policy, Basic Infection Prevention & Control Principles related to Fluid & Medication Patient Identification Policy (Volume 11) Student Nurse/Midwife Responsibilities with Fluid and Medication Management 1.1 General Responsibilities for all staff and students in Fluid and Medication Management Bachelor of Nursing Considerations Bachelor of Nursing Student Fluid and Medication Administration Table CPIT Competency Assessment Programme (CAP) for Registered Nurses (RN s) Bachelor of Midwifery Considerations Bachelor of Midwifery Student Administration Table Diploma in Enrolled Nursing (Enrolled Nurse) Considerations Diploma in Enrolled Nursing Student Fluid and Medication Administration Table CPIT Competency Assessment Programme (CAP) for Enrolled Nurses (EN s) Clinical Lecturer Considerations Purpose To ensure CDHB staff, CPIT clinical lecturers and Students in Nursing and Midwifery Programmes are aware of their responsibilities with Fluid and Medication Management and to further broaden students clinical experiences to better reflect their work requirements on graduation. Scope CDHB RN/RM, LMC s, CPIT Nursing and Midwifery Students and Clinical Lecturers Please Note: Students from other training institutions will need to be considered on a case by case basis depending on previous training/curriculum content Authorised by Executive Director of Nursing Issue 2: April 2013 Ref: 4722 Page 1 of 14

2 Associated documents Volume 12 Roles and Responsibilities Policy Fluid and Medication Checking Procedure Direction and Delegation Policy (to add hyperlink once on Vol 11 site) Definition Direct Direction The RN/RM/LMC/Clinical Lecturer is required to be physically present to direct the student at all stages of medication/fluid management e.g. preparation, checking, identification of the patient and administration, and must counter sign the student s signature on the patient s drug chart to verify that they have done so. The registered staff member remains legally responsible for any medication or fluid administration by a student. 1.1 General Responsibilities for all staff and students in Fluid and Medication Management The RN/RM must provide direct direction of the student (as per above policy definition and in support of the NCNZ/MCNZ Scopes of Practice, and the NCNZ guidelines on direction and delegation). All students who are invited to administer medication or fluids or be a double independent checker can request not to be involved if they are unsure about the IV fluid and medication checking/preparation and/or administration requirements. At all times the RN/RM may request another RN/RM to be involved in any stage of Fluid and Medication management. Where an activity is restricted, the RN/RM who is overseeing the student practice should ensure that the student understands the reason for the restriction and has the opportunity to participate in related care as a learning experience. E.g., reconstituting medications, phlebitis score assessment, patient monitoring following IV opioids or blood administration. Any student checking/administering Controlled or Recorded drugs (as per below tables) must sign the register and record their name AND designation on the signatory sheet at the back of that and every subsequent register. All students are permitted to stop an IV fluid/medication administration in the following instances: extravasations allergic reactions when the infusion has run through/been disconnected/or air in line The student must inform a RN/RM immediately of their action and rationale. Where there is a CDHB or Divisional policy/requirement for further competency/training in modalities e.g. Cytotoxic or Entonox administration, the RN/RM and student will be guided by that policy. Authorised by Executive Director of Nursing Issue 2: April 2013 Ref: 4722 Page 2 of 14

3 1.2 Bachelor of Nursing Considerations BN Bachelor of Nursing students are permitted to participate in Fluid and Medication checking, preparing and/or administration as outlined in the following tables after they have successfully completed the relevant CPIT Fluid and Medication Management Workbooks and Clinical Calculation Tests and can provide evidence of completion of these (Refer below for students who have not successfully completed these requirements). The CPIT Schools of Nursing are responsible for informing the Student Placement Coordinator (for Specialist Mental Health Services) or CNM/Unit Manager (for all other areas) in writing of any student who has not passed their CPIT clinical course requirements (i.e. Clinical Calculations test and Fluid and Medication Workbook) prior to the students clinical start date. These students cannot be responsible for any Fluid or Medication Management until they have successfully completed this. IMPORTANT: Students in Neonatal (NICU) have NO SC, IM or IV responsibilities. Students will have an observational role in NICU. See NICU policy on medications that can be administered orally/enterally following successful completion of the service specific clinical calculations test Students must only check fluid and medications with their allocated RN, for their own patients. Exception: Students in Year 3 Part B can second check but not administer another RN s patient medications (if they are not working in Neonatal or Child Health) Authorised by Executive Director of Nursing Issue 2: April 2013 Ref: 4722 Page 3 of 14

4 1.3 Bachelor of Nursing Student Fluid and Medication Administration Table (Under the direct direction of a RN) Key to use of table = can administer medications or fluids under the direct direction of a RN = cannot check or administer medications or fluids (observation role only) Double Independent Checker (checker only) = can check with a RN but not medications or fluids BN Year One (Parts A & B) BN Year Two (Part A) After successful completion of CPIT BNKN601 Fluid & BN Year Two (Part B) After successful completion of CPIT BNKN602 Fluid & BN Year Three (Part A) After successful completion of CPIT BNKN700 Fluid & Authorised by Issue 2: April 2013 Ref: 4722 Page 4 of 14 administer BN Year Three (Part B) After successful completion of CPIT BNTR701 Fluid & Controlled drugs Oral /Topical Checker only Checker only IM Checker only Checker only SC Checker only Checker only IV Intra nasal Recorded Drugs Oral IM Checker only IV IV Medications (except Insulin/Heparin/Controlled Drugs) Checker only Checker only IV Infusions Premixed solution bags Checker only Checker only Premixed KCL bags Checker only Checker only Flushing of cannula with N/Saline

5 BN Year One (Parts A & B) BN Year Two (Part A) After successful completion of CPIT BNKN601 Fluid & BN Year Two (Part B) After successful completion of CPIT BNKN602 Fluid & BN Year Three (Part A) After successful completion of CPIT BNKN700 Fluid & BN Year Three (Part B) After successful completion of CPIT BNTR701 Fluid & Sub cut Insulin injections Anti Coagulant injections Premixed solution bags Premixed KCL bags Checker only Checker only Oral, Rectal, Eye, Topical, IM (refer also to Controlled and Recorded Drugs) Oral Eye IM Rectal (Laxatives only) Topical Inhaled Medications MDI s, O2, Nebs Other Fluid and Medication responsibilities Priming of lines IV Blood and Blood Products Checker only IV bolus or infusion of Heparin, KCL or insulin PCA/Epidural/Nitrous Oxide Cytotoxic Oral/IV Changes to responsibilities from the previous table versions are highlighted. Authorised by Issue 2: April 2013 Ref: 4722 Page 5 of 14 This document is to be viewed via the CDHB Intranet/Internet only. All users must refer to the latest version from the CDHB intranet/internet at all times.

6 BN Year One (Parts A & B) BN Year Two (Part A) BN Year Two (Part B) BN Year Three (Part A) BN Year Three (Part B) Any administration through a PICC/CVC/ Portacath/ Hickman/Tenkoff Catheter/AV fistula Responsibilities with Fluid and Medication devices Sub Cut needle insertion Sub Cut needle removal IV Cannula removal IV site dressing PICC/CVAD dressing Venepuncture/Blood Sampling IV or Arterial/Cannulation From Year 3 Part B under direct direction by a RN From Year 2 Part A under direct direction by a RN From Year 2 Part B under direct direction by a RN From Year2 Part B under direct direction by a RN NO NO Authorised by Issue 2: April 2013 Ref: 4722 Page 6 of 14

7 1.4 CPIT Competency Assessment Programme (CAP) for Registered Nurses (RN s) R/N s who are undertaking the CAP must meet the same requirements and may check and administer Fluid and Medications as per Bachelor of Nursing (BN) policy for Year 3 Part B Students above (i.e. after successful completion of CPIT BNTR701 Fluid and Medication Management Workbook and Clinical Calculations Test) 1.5 Bachelor of Midwifery Considerations Clinical Placements within Neonatal Services for BM students Student midwives are NOT able to administer IV fluid or Medication to the baby and this includes IV antibiotics to babies on the Maternity Ward. General Bachelor of Midwifery (BM) Students are permitted to carry out monitoring of the IV cannula site and perform fluid balance recordings under the direction of the RM. Midwifery students who are invited to administer medication or fluids or be a double independent checker can request not to be involved if they are unsure about the IV fluid and medication administration requirements. Midwifery students are able to take blood and cannulate after they have been to their respective placements and completed their training in phlebotomy and IV cannulation. First Year Bachelor Midwifery Students are NOT able to administer fluid or medication until they have successfully completed the CPIT ProCal (Professional Calculation) and finished their BMPS102 (Bachelor of first year Midwifery Practice Skills) course component relating to medication administration and IV fluids. Second Year Bachelor Midwifery Students are NOT able to be a double independent checker until they have revisited the Student Midwife responsibilities in relation to fluid and medication administration. Authorised by Issue 2: April 2013 Ref: 4722 Page 7 of 14

8 This document is to be viewed via the CDHBIntranet/Internet only. All users must refer to the latest version from the CDHB intranet/internet at all times. 1.6 Bachelor of Midwifery Student Administration Table (Under the direct direction of a Registered Midwife) Key to use of table = can administer and 2nd check, medications and fluids = cannot check or administer medications or fluids (observation role only) Double Independent Checker (checker only) = can check with RM preceptor but not administer medications or fluids BM Year One following successful completion of the Procal exam (May) BM Year Two Second half of the year BM Year Three Oral, Rectal, Eye, Topical, IM (refer also to Controlled and Recorded Drugs All of above routes Sub cut medication Anti coagulant injection Insulin injection Tocolytic agent Inhaled medication Entonox Nebuliser and inhalers Nasal sprays Oxygen Recorded drugs Oral IM Controlled drugs Oral /topical IM IV PCA IV bolus medication Antibiotics Checker only Antiemetics Checker only Uterotonics Checker only N/Saline flush Authorised by Issue 2: April 2013 Ref: 4722 Page 8 of 14

9 IV infusion BM Year One Second half of the year BM Year Two Second half of the year BM Year Three Premixed solution bags e.g. Hartmann, N/Saline Premixed solution bags plus added medication Antibiotic infusion Other Priming an IV line with premix solution e.g. N/Saline, Hartman s Changing giving sets / connecting tubing Programming electronic pumps Blood products e.g. anti-d, immunoglobulin IV blood Checker only Epidural Checker only Any administration through a CVAD (e.g.picc line) IV cannula removal Venepuncture/Blood Sampling IV cannulation Changes to responsibilities from the previous table version are highlighted. Authorised by Issue 2: April 2013 Ref: 4722 Page 9 of 14

10 1.7 Diploma in Enrolled Nursing (Enrolled Nurse) Considerations Diploma in Enrolled Nursing (Enrolled Nurse) Students Responsibilities The Diploma in Enrolled Nursing (Enrolled Nurse) student is permitted to participate in the fluid and medication checking, preparing and/or administration as outlined in the following tables after they have successfully completed the relevant CPIT Fluid and Medication Management Workbook and and can provide evidence of completion. Students must only check medications with their allocated RN for their own patients. The RN/RM/LMC/Clinical Lecturer must directly direct the student at all stages of medication/fluid management e.g. preparation, checking, identification of the patient and administration, and must counter sign the student s signature on the patient s drug chart to verify that they have done so. Please Note: The registered nurse / midwife remains legally responsible for any medication or fluid administration by the Diploma in Enrolled Nursing student. Authorised by Issue 2: April 2013 Ref: 4722 Page 10 of 14

11 1.8 Diploma in Enrolled Nursing Student Fluid and Medication Administration Table (Under the direct direction of a RN) Key to use of table = can administer medications or fluids under the direct direction of the RN preceptor = cannot check or administer medications or fluids (observation role only) Double Independent Checker (checker only) = can check with RN preceptor but NOt administer medications or fluids Diploma in Enrolled Nursing Course: NURS405 Foundation Limited fluid and medication responsibilities Diploma in Enrolled Nursing Course: NURS502 EN Practice - Acute Care After successful completion of CPIT Diploma in Enrolled Nursing Fluid and Medication Management Workbook and Clinical Calculations Test Diploma in Enrolled Nursing Course: NURS503 EN Practice Mental Health After successful completion of CPIT Diploma in Enrolled Nursing Fluid and Medication Management Workbook and Clinical Calculations Test Diploma in Enrolled Nursing Course: NURS501 EN Practice -- Rehabilitation After successful completion of CPIT Diploma in Enrolled Nursing Fluid and Medication Management Workbook and Clinical Calculations Test Controlled drugs Oral /Topical Checker only Checker only Checker only IM Checker only Checker only Checker only SC Checker only Checker only Checker only IV Intra nasal Authorised by: Issue 2: April 2013 Ref: 4722 Page 11 of 14 This document is to be viewed via the CDHB Intranet/Internet only. All users must refer to the latest version from the CDHB intranet/internet at all times.

12 Dip. EN Foundation Acute Care Mental Health Rehab Recorded Drugs Oral IM IV IV Medications (except Insulin/Heparin) Checker only IV Infusions Premixed solution bags Premixed KCL bags Flushing of cannula with N/Saline Sub cut Insulin injection Anti Coagulant injection Premixed solution bags Premixed KCL bags Oral, Rectal, Eye, Topical, IM Oral medications Rectal medications Eye medications Topical medications IM Medications (see above re: controlled and recorded drugs) Inhaled Medications MDI s, O2, Nebs Changes to responsibilities from the previous table version are highlighted. Authorised by: Issue 2: April 2013 Ref: 4722 Page 12 of 14

13 . Dip. EN Foundation Acute Care Mental Health Rehab Other Fluid and Medication Responsibilities Priming of line Connecting IV tubing, programming electronic pumps IV Blood and Blood Products IV bolus or infusion of Heparin, KCL or insulin PCA/Epidural/Nitrous Oxide Cytotoxic Oral/IV Any administration through a PICC, CVC, Portacath or Hickman, Tenkoff Catheter, AV fistula Responsibilities with Fluid and Medication devices Sub Cut needle insertion NO NO NO NO Sub Cut needle removal NO Yes under direct RN direction IV Cannula removal NO Yes under direct RN direction Yes under direct RN direction Yes under direct RN direction IV site dressing NO NO NO NO PICC/CVAD dressing NO NO NO NO Venepuncture/Blood Sampling IV or Arterial/Cannulation NO NO NO NO Yes under direct RN direction Yes under direct RN direction Changes to responsibilities from the previous table version are highlighted Authorised by: Issue 2: April 2013 Ref: 4722 Page 13 of 14 This document is to be viewed via the CDHB Intranet/Internet only. All users must refer to the latest version from the CDHB intranet/internet at all times.

14 1.9 CPIT Competency Assessment Programme (CAP) for Enrolled Nurses (EN s) EN who are undertaking the CAP must meet the same requirements and may check and administer Fluid and Medications as per Diploma in Enrolled Nursing (DEN) policy above (i.e. After successful completion of CPIT DEN Fluid and Medication Management Workbook and ) 1.10 Clinical Lecturer Considerations As Registered Nurses with a current Annual Practising Certificate clinical lecturers are able to check and administer medications with students (with the exception of IV fluids/medications unless CDHB IV Certified or for modalities that require further competencies/training). Any queries or area specific requirements related to this should be discussed first with the CNM or Nurse in Charge of the ward/unit. References Agreement made between Canterbury District Health Board (CDHB) and the Christchurch Polytechnic Institute of Technology (CPIT), December 2009, and April 2013 Feedback Document from the NETS re IV Policy/Certification in National BN Programmes (Collated by Rose Whittle, CPIT, April 2008) Health Waikato Policy/Procedures August 2008 Medication Management NCNZ guidelines on direction and delegation Policy Owner Date of Authorisation May 2013 Directors of Nursing and Midwifery Authorised by: Directors of Nursing and Midwifery Issue 2: July 2013 Ref: 4722 Page 14 of 14