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PHAM1151
Medicines Management
(insert the module occurrence number here and year of study here
e.g. MO1 2021-2022)
Summative Workbook Assessment
Max word count:
(+/- 10% 2000 for PHAM 1151 MSc students’ level 6)
Submission Deadline:
Word Count:
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The workbook assignment for PHAM 1151 Level 6 Medicines management module is in two parts:
Part 1: Completion of four summative questions linked to learning outcomes 1-4.Total word count for part 1 is 2000 words.
Part 2: Completion of Essential Skills health numeracy assessment using the SafeMedicate platform with a grade of 30/30 (100%) linked to learning outcome 4. Completion of this SafeMedicate assessment needs to be evidenced as a screenshot inserted into the section marked Part 2,
Further information about this assessment will be given during the module and using the Moodle virtual learning environment and external platform of SafeMedicate.
Parts 1&2 both need to achieve as a pass grade to pass the module. A grade will be assigned to the written part 1(pass mark being 40% for level 6 work). A potential word count per question has been allocated which are weighted respectively to the marks for each question. All questions need to be answered.
Part 1: Summative Workbook
Please use this template to complete your workbook. Details of your patient are given below, and you will find the patient’s PSD/MAR chart in Appendix 1:
Patient scenario:
Prudence Okeke is 17-year-old who identifies as female. She has been admitted to the Medical Unit (MU) where you are on placement. Her presenting complaint is a productive cough, shortness of breath and fever for the past 2 days which developed while she was recovering from insertion of pins for a compound fracture of her right radius, while an inpatient on the Surgical Unit. Please not she is right-hand dominant. She has tested Covid 19 negative. Her primary diagnosis for this admission is Hospital Acquired Pneumonia. Sputum specimens have been sent for microscopy culture and sensitivity (MC&S) and the organism has been identified.
Her past medical history is Diabetes Mellitus – type 1 which was diagnosed when she was 10 years of age. Her current medication for this is Novorapid 3 units subcutaneously via Novopen, 20 minutes before meals (or self-adjusted by carbohydrate coverage ratio adjustments). She also takes basal insulin Human Insulatard at 50 % of total daily insulin dose of 15 unit subcutaneously in the morning before breakfast. At last review her HbA1c was 46 mmol/mol. She has no other medical history of note.
Search Your Assignment
She lives at home while studying for A Levels. She has 6 younger siblings and both parents do not speak English. She is a non-smoker, non-drinker and denies use of recreational drugs.
Use the provided patient history and the Patient Specific Directions (PSD) and Medicines Administration Record (MAR) (combined) to develop your answers.
Please answer all four questions in Part 1 (Q1-4). Your work must be supported with appropriate references and includes a reference list.
Part 1
Q 1: Supports Learning Outcome 1 & 2:
Understanding the whole system of medicines management including prescribing, transcribing, dispensing, storage, administering and monitoring of medicines in accordance with local and national policy. Recognise and critically reflect upon the nurse’s role in medication management and delegation to others, administering medication under direct supervision of a registrant in relation to legislation and national guidelines.
Q1: Provide a critical discussion of your future registrants’ role when identifying the legal requirements of a medication prescription prior to the administration of a drug. Support your discussion with national guidelines and policies. (Approximately 350 words, 20 marks)
Q2: Supports Learning Outcome 3: Develop a greater understanding and critically reflect upon factors which contribute to medication errors and how to deal with errors if they occur.)
Q2a: Critically describe, with reference to known evidence base and theory, the “human factors” which contribute to medication errors and strategies which might be employed to reduce the risk of a medication error occurring. Include discussion of learning from mistakes. (Word 325 level 6 max marks 10)
Q2b: Reviewing the attached combined PSD/MAR chart, please identify any medication error(s) which have occurred. Critically evaluate and discuss any action that needs to be taken. (Word 325 level 6 max marks 10)
Q3: You are required to administer the following medication: Insulin Novorapid ®. Critically evaluate reflect on your role and the process involved in preparing and selection of the write equipment for this medication. The stock insulin is NovoRapid ®100 units/ml ampule it is in date. Your answer should include reference to risk management, legislation, and national guidelines. (Approximately 400 words 30 marks)
Q4 supports Learning Outcome 4: Demonstrate skills and evidence-based knowledge to critically deliver safe administration and monitoring of medication via a range of delivery routes including essential health numeracy/calculation skills.
Q4 a) Regarding the intravenous fluids and IV medication prescribed, calculate the flow rate in mls per hour for the IV fluids to be delivered by a pump. Show your formular and calculated answer in full (5 marks).
b) Critically evaluate and discuss the monitoring considerations for medications via this IV route. Include reference to a range of relevant principles and guidance (Approximately 600 words 30 marks).
Reference list:
Part Two:
Evidence of completion of summative Essential Skills SafeMedicate assessment with 30/30 grade.
Please insert a screenshot here as proof of successful completion of the SafeMedicate summative Essential Skills numeracy assessment. This screenshot must clearly show your name and student ID and grade achieved.
Example of a screen shot of your safe medicate results please delete the example below and replace with your own evidence of successful completion.
To take a screen shot you need to access your results in the assessment feedback, hover your mouse over this top section and press prt scr (which is usually at the top right of your computer).
You need to have your workbook word document open and right click past the document in this section and save the document as evidence of passing this element of the workbook.
During the module you will be given formative practice using Safe Medicate essential skills questions for this section of the workbook and then a set period of time for you to achieve the summative pass evidence as seen above. You will be given instructions about when you can take this assessment to be included here by your module team.
By placing a tick (√) in the box below you are indicating the safe medicate assessment was undertaken by yourself and is no one else’s work
Date competed:
I confirm this is my own work
Please remember to save this section of the workbook and ensure it is the one you want marked you do not need to submit the MAR below:
Appendix 1: Patient Specific Direction (PSD)/Medication Administration Record (MAR) chart
Greenwich University Hospitals
| Surname: OKEKE Forename(s): Prudence Date of birth: 7.7.2004 (currently 17years old) Hospital Number: 777222 | Height (m): not recorded on admission guestimate 156 CM Weight (kg): 55 Kg |
| Ward: Surgical ward P transferred to Medical Ward Q | Consultant: Dr Pepper Senior |
| Date of admission: 1.1.22 transferred on 3.1.22 | Time of admission: 09.00 |
| ALERTS: Allergies/sensitivities/adverse reaction | ||||
| Medicine(s) or foods | Effect(s) | |||
| Shellfish | Swelling of the tongue | |||
| Penicillin | Urticarial rash and itch | |||
| IF NO KNOWN ALLERGIES TICK BOX | ||||
| Signature: | Dr pepper | Bleep Number: 123 | Date: | 1.1.22 |
| Allergy status MUST be completed and SIGNED by a prescriber/pharmacist/nurse BEFORE any medicines are administered. | ||||
| Medication risk factors | |||
| Pregnancy o | Renal Impairment o | Impaired oral access o | Diabetes o √ |
| Other high-risk conditions o–specify | Patient self-medicating o |
| Medicine non-administration/self-administration: | |
| If a dose is omitted for any reason, the nurse should enter the relevant code on the administration record, sign, and date the entry. | |
| 1.Medicine unavailable | 2.Patient off ward |
| 3.Self-administration | 4.Unable to administer |
| 5.Stat dose given | 6.Prescription incorrect/unclear |
| 7.Patient refused | 8.Nil by mouth (on doctor’s instruction only) |
| 9.Low pulse and/or low blood pressure | 10.Other – state in nursing notes including action taken |
| ONCE ONLY MEDICINES, PREMEDICATION, ANTIBIOTIC PROPHYLAXIS AND PATIENT GROUP DIRECTIONS | |||||||||
| Date | Drug | Dose | Route | Instructions | Time required | Prescriber’s signature, print name & bleep number | Time given | Signature given | Pharmacy check |
| 1.1.22 1.1.22 | Oral morphine solution | 10 mg | oral | For pain | 09.00 | Dr Will Sleep 321 | 09.05 | Nurse K. AJA | √ |
| HOSPITAL MEDICATION PRESCRIPTION AND ADMINISTRATION RECORD | |
| Surname: OKEKE Forename(s): Prudence Date of birth: 7.7.2004 Hospital Number: 777222 | Height (m): Weight (kg): 55kg |
| Ward: MU | Consultant: |
| Date of admission: | Time of admission: |
| PRESCRIBED OXYGEN | ||||
| For most chronic conditions, oxygen should be prescribed to achieve a target saturation of 94-98% (or 88-92% for those at risk of hypercapnic respiratory failure i.e. CO2 retainers). Is the patient a known CO2 retainer? No | ||||
| Continuous oxygen therapy √ Target O2 saturation 94-98% √ ‘When required’ oxygen therapy Target O2 saturation 88-92% Other saturation range: Saturation not indicated e.g. end-of-life care (state reason) | Check and record flow rate (FR) and device (D) at each medicine round or other times specified. | |||
| Starting device and flow rate: N and 2 L/min | Start date: 3.1.22 Today | Date | Time | FR/D |
| 3.1.22 | 09.00 | Checked 2 L/min via N | ||
| Prescriber’s signature: Dr R Pepper | Stop date: | |||
| Print name: Dr R Pepper | Pharmacy check: | |||
| Codes for starting device and modes of delivery | ||||
| Air not requiring oxygen or weaning or PRN oxygen | A | Humidified oxygen at 28% (add% for other flow rate) | H28 | |
| Nasal cannulae | N | Reservoir mask | RM | |
| Simple mask | M | Tracheostomy mask | TM | |
| Venturi 24 | V24 | Venturi 35 | V35 | |
| Venturi 28 | V28 | Venturi 40 | V40 | |
| Venturi 60 | V60 | Patient on CPAP system | CP | |
| Patient on NIV system | NIV | Other device (specify) |
| Venous Thromboembolism Risk Assessment | |||
| Does this patient need thromboprophylaxis? | Y/N | Signature | Date |
| N | Dr R Pepper | today | |
| If yes, please prescribe appropriate thromboprophylaxis on prescription chart. If contraindicated please state reason: NB: reassess risk of bleeding and venous thromboembolism within 24 hours and if clinical situation changes |
| HOSPITAL MEDICATION PRESCRIPTION AND ADMINISTRATION RECORD | |
| Surname: OKEKE Forename(s): Prudence Date of birth: 7.7.2004 Hospital Number: 777222 | Height (m): not recorded on admission 156Cm Weight (kg): 55kg |
| Ward: transferred into medical ward | Consultant: Dr Pepper senior |
| Date of admission: 1.1.22 surgical unit transferred on 3.1.22 | Time of admission: 09.00 |
| ANTIMICROBIALS | ||||||||
| Review IV after 24-48 hours – Review oral after 5-7 days | ||||||||
| 1.Drug | Tazocin® | Date and signature of nurse administering medications and code if not administered. | ||||||
| Date | Dose | Frequency | Route | Duration | Date/Time/sig | Date/Time/sig: | Date/time/sig: | Date/time/sig |
| 3.1.22 | 4.5 g diluted in 50 mls 0.9% NaCl | Every 8 hours | IV infused over 30 mins | 5 days | 3.1.22 08.00 Tobi Xin | |||
| Start date | 3.1.22 | Indication/ Organism | For Hospital acquired pneumonia | |||||
| Finish date | 8.1.22 | Cultures sent? | Yes | |||||
| Prescriber’s signature and bleep | Dr R Pepper bleep 123 | Print name | Dr R Pepper | Pharmacy Check |
| 2.Drug | Gentamicin | Date and signature of nurse administering medications and code if not administered. | ||||||
| Date | Dose | Frequency | Route | Duration | Date/Time/ Sig | Date/time/sig | Date/time/sig | Date/time sig |
| Today | 385 mg diluted in 50 mls 0.9% NaCl | Once daily | IV infused over 60 mins | 3 days | 3.1.22 09.00 PEvans | |||
| Start date | 3.1.22 | Indication/ Organism | For Hospital acquired pneumonia per dose 7 mg/kg | |||||
| Finish date | 6.1.22 | Cultures sent? | Yes | |||||
| Prescriber’s signature and bleep | Dr R Pepper bleep 123 | Print name | Dr R pepper | Pharmacy Check | ||||
| HOSPITAL MEDICATION PRESCRIPTION AND ADMINISTRATION RECORD | |
| Surname: OKEKE Forename(s): Prudence Date of birth: 7.7.2004 Hospital Number: 777222 | Height (m): Weight (kg): 55 kg |
| Ward: Medical ward | Consultant: Dr R Pepper |
| Date of admission: 3.1.22 | Time of admission: |
| REGULAR MEDICINES | |||||||||
| VTE PRESCRIPTION ONLY. Preparation: | Date and signature of nurse administering medications and code if not administered. | ||||||||
| Date | Dose | Frequency | Route | Duration | Time | Date: | Date: | Date: | Date: |
| Start date | Instructions/indication | ||||||||
| Finish Date | |||||||||
| Pharmacy Check | |||||||||
| Prescriber’s signature and bleep | Print name |
| Drug | Insulin Novorapid ® | Date and signature of nurse administering medications and code if not administered. | ||||||
| Date | Dose | Frequency | Route | Duration | Time | Date: signature | Time | Date: signature |
| 1.1.22 | 3 units | 20 mins before meals | S/c | Ongoing | 13.00 | 1.1.22 K. AJA | 18.00 | 1.1.22 K. K. AJA AJA |
| Start date | 1.1.22 | Instructions/indication Check peripheral Blood glucose levels via figure prick before meals give if blood glucose is between 4-7 mmols refer to Dr if above 7 mmols/l or needs adjusting for Carbohydrate coverage Withhold and consult Dr if below 4 mmols/l administer glyco stop as per hypoglycaemia policy | ||||||
| Finish Date | ||||||||
| Pharmacy Check | yes | |||||||
| Prescriber’s signature and bleep | Dr R Pepper bleep 123 | Print name | Dr R Pepper |
| Drug | Insulin human (Insulatard®) 100 IU/ml | Date and signature of nurse administering medications and code if not administered. | ||||||
| Date | Dose | Frequency | Route | Duration | Time | Date: signature | time: | Date: signature |
| 1.1.22 | 15 unit | Once a day | S/c | ongoing | 07.00 | 2.1.22 K. AJA | 07.00 | 3.1.22 A JA |
| Start date | 1.2.22 | Instructions/indication | ||||||
| Finish Date | ||||||||
| Pharmacy Check | yes | |||||||
| Prescriber’s signature and bleep | Dr R Pepper bleep 123 | Print name | Dr R Pepper |
| HOSPITAL MEDICATION PRESCRIPTION AND ADMINISTRATION RECORD | |
| Surname: Pepper Forename(s): Prudence Date of birth: 7.7.2004 Hospital Number: 777222 | Height (m): 156 cm Weight (kg): 55 kg |
| Ward: MUA | Consultant: Dr Pepper Senior |
| Date of admission: 1.1.22 | Time of admission: 09.00 |
| ‘AS REQUIRED’ MEDICINES | ||||||||
| Drug | Paracetamol | Date and signature of nurse administering medications and code if not administered. | ||||||
| Date | Dose | Frequency | Route | Duration | Time date | Signature | Time date | Signature |
| 1.1.22 | 1000mg | 4-6 hours max 4 g in 24 hours | PO | 3 days | 1.1.22 22.00 | Gale.Plage | 2.1.22 07.00 | Gale.Plage |
| Start date | 1.1.22 | Instructions/indication for distress /discomfort with pain or fever | 2.1.22 13.00 | P Evans | 2.1.22 21.00 | Gale.Plage | ||
| Finish Date | 3.1.22 06.00 | Gale.Plage | ||||||
| Pharmacy Check | ||||||||
| Prescriber’s signature and bleep | Dr R Pepper bleep 123 | Print name |
| Drug | Ibuprofen | Date and signature of nurse administering medications and code if not administered. | ||||||
| Date | Dose | Frequency | Route | Duration | Time Date: | signature | Date: | signature |
| 1.2.22 | 300mg-400 mg | 6-8 hourly max 2400 mg in 24 hours | Po | 2.2.22 18.00 | P Evans | |||
| Start date | 1.2.22 | Instructions/indication With food | ||||||
| Finish Date | ||||||||
| Prescriber’s signature and bleep | Dr R Pepper bleep 123 | Print name | Dr R Pepper |
| Height (m): Weight (kg): 55kg |
| Consultant: Dr R Pepper |
| Time of admission: 09.00 |
| INFUSIONS | ||||||||
| Bolus IM injections should be prescribed on the standard section of the drug chart. If no additive is to be used, enter ‘nil’ in the ‘drug added’ column. | ||||||||
| Date | INFUSION FLUID | Duration or rate | Prescriber’s signature | Given by | Checked by | Start time | Stop time | Vol. given (ml) |
| Name/strength | Volume (ml) | Route (IV/SC) | ||||||
| 3.1.22 | 0.9% NaCl with 10 mmols of KCl | 500 | IV | 8 hour | Dr R Pepper bleep 123 | |||
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