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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:

Course Leader:

Cohort:

PTG Leader:   

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.

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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 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. With reference to the enclosed prescription chart, discuss the specific administration and monitoring considerations for this patient’s medication.

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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