Transition to the Accountable Practitioner

302 NHS
Student I.D –
Word Count: 1,000
Actual word Count: 1,068

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The transition from a student nurse to an accountable registered nurse is both

exciting and challenging. As a registered nurse I will be accountable to the patient

through the law of negligence, my employer and professionally to the Nursing and

Midwifery Council (NMC) (Griffith, Tengnah, 2008).

As a student nurse I am guided and supported by a registered nurse whom is

accountable for my actions, however I am still responsible for my actions .The law

enforces a duty of care to all practitioners, including student nurses whereby

responsibility is considered a duty of care in law irrespective of job role. The duty of

care applies whether the task involves bathing a patient or major surgery as in each

case there is the opportunity for harm to occur to the patient in which the practitioner

is responsible (Cox 2010). A registered nurse should only delegate tasks to a

student nurse if they deem the task as appropriate, ensuring the student nurse

understand the task and how it is performed, whilst having the skills and abilities to

perform the task competently and accept responsibility for carrying it out (Scrivener,

Hand, Hooper, 2011).

Medicine management is a personal concern of mine, due to the harm that adverse

medication errors can cause to patients, an increasingly litigious society, and legal

implications. As a student nurse, I am under direct supervision from the registered

nurse at all times and should not be giving medication without supervision (O'Brien,

Spires, Andrews,2011). As a registered nurse I will be accountable for the

administration of medication so I must ensure that I am safe and competent in

undertaking this role. The NMC (2015) state that you must maintain the knowledge

and skills for effective practice but must recognise and work within the limits of your

competence.

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The NMC (2010) use the definition from Medicines & Healthcare products

Regulatory Agency (2004) which states medicine management is “The clinical, cost-

effective and safe use of medicines to ensure patients get the maximum benefit from

the medicines they need whilst at the same time minimising potential harm’’.

Medication errors cost the NHS up to 2.5 billion a year (Turjesen 2014) .The National

Patient Safety Agency (2009) found that there were 72,482 medication errors in

2009. Most cases resulted in little or no harm however 100 resulted in death or

serious harm. Medication errors can be in the form of prescribing, preparing,

dispensing, administering, monitoring or providing advice on medicine (NHS England

2014) According to the National Reporting and Learning System (2013) the most

frequently reported source of medication errors were giving the wrong dose, omitted

or delayed medication and administration of the wrong medicine.

Research has shown that there is a number of reasons as to why medication errors

may occur. Distractions whilst administering medication was identified as one of the

main factors influencing medication errors being made by nurses. Fry and Darcy

(2007) found that 94% of nurses stated that interruptions during drugs rounds was

the most common cause of medication errors , especially interruptions from patients,

phone calls and interruptions from other staff member . In recognition of the amount

of interruptions that nurses were experiencing, red tabards were introduced with

‘drugs round in progress, do not disturb’. The use of these tabards have been shown

to reduce the number of medication errors (Griffiths, Robins, 2011) however further

research is still required to evaluate the use of tabards in practice. Lee (2008) found

that 92% of nurses felt that they lacked confidence in drug calculations for infusions

and felt that they would benefit from drug calculations update sessions. Jones (2009)

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found that some nurses did not follow protocols and were not incorporating the five

R’s when administering medication. The five R’s in medication administration is Right

patient, Right route, Right dose, Right time, Right drug (Copping,2005) Nurses were

found not to be checking patient identity (Right patient) which led to a number of

medication errors being made. Additionally Nichols, Copeland, Crabit et al (2008)

found that workload and stress increased medication errors and the knowledge of

the nurse in preparation and administering were also a contributing factor to errors.

In order for me to reduce the risk of making medication errors and to become

competent in medicine management I have devised an action plan to aid me in the

transition from a student nurse to an accountable practitioner.

Identified Goals Planned Actions Resources Time

Learning
need
To become a To administer Remembering 5 Support from Within first
competent medication in a R’s in medication preceptorship 12-18 months
nurse safe, efficient administration. mentor and of
practitioner in manner with Right patient, right nursing staff. preceptorship
medicine minimal errors route, right dose, programme.
management made. right time, right
drug
(Copping,2005)

Ofusu, Jarrett
(2015) recommend
by having a
structured
preceptorship
programme in
medicine
management can
reduce medication
errors as staff feel
more supported.

Follow local Locate hospital Local policies

hospital policies and and procedures
policies and procedures on on medicine
procedures management

4
 medicine
management

Be aware of Ensure I am aware Local Policies

how to report of the hospital and Procedures
adverse drug policies in
errors reporting adverse
medication error.
NMC (2010) states
that as a
registered nurse ‘if
you make an error
you must take any
action to prevent
any potential harm
to the patient and
report as soon as
possible to the
prescriber, your
line manager or
employer
(according to local
policy) and
document your
actions’

Be trained and Attend training Training

become courses. courses
competent in
giving
intravenous
fluid

To be Take time during

competent and drugs round and
confident in wear a tabard if
calculating one is available in
medication. the clinical
environment
Morgan (2012)
states that each
clinical area should
give newly
qualified nurses’
time to improve
their learning in
drug calculations.
This will improve

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 knowledge and
confidence which
would improve
patient safety and
staff and patient
moral.

Follow NMC Recognise and

(2015) work within the
Guidelines limits of your
competence (NMC
2015)
British National
Become more Use the British Formulary
knowledgeable National Formulary
in to check
Pharmacology medication, side
effects and
interactions.

By ensuring that I follow this action plan within the first 12-18 months of my

preceptorship programme it will help me to become an accountable, competence

nurse practitioner in medicine management whilst minimizing risks to patients.

Having identified the common themes for medication errors occuring I am able to

reduce the likelihood of errors occuring.

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References

Copping, C. (2005) Preventing and reporting drug administration errors. Nursing

Times. 101(33), 32–34.

Cox C (2010) Legal responsibility and accountability. Nursing Management. 17(3),

18-20

Fry, M., Dacey, C. (2007). Factors contributing to incidents in medicine

administration. Part 1. British Journal of Nursing, 16(9), 556-559.

Griffiths, M., Robins, J. (2011). Quiet please, drug round in progress. Nursing
Standard, 26(4), 26-27.

Griffith, R., Tengnah, C. (2008). Law and professional issues in nursing. Exeter:
Learning Matters.

Jones SW (2009) Reducing medication administration errors in nursing practice.

Nursing Standard. 23(50) 40-46

Lee P (2008) Risk-score system for mathematical calculations in intravenous

therapy. Nursing Standard. 22(33), 35-42.

Medicines & Healthcare products Regulatory Agency (2004) Annual Report and
Accounts 2004/05 [online] available from
>http://www.mhra.gov.uk/home/groups/comms-
ic/documents/websiteresources/con2022998.pdf< [ 30th September 2016]

Morgan, A., Mattison, J., Stephens, M. and Medows, S (2012) Implementing

structured preceptorship in an acute hospital. Nursing Standard; 26(28), 35-39.

National Patient Safety Agency (2009) Safety in Doses: Improving the use of
medication in the NHS. London. National Patient Safety Agency.

National Report and Learning System (2013) Medication Safety [online] available
from <http://www.nrls.npsa.nhs.uk/resources/patient-safety-topics/medication-
safety/?p=1> [30th September 2016]

NHS England (2014) Patient Safety Alert; Stage Three Directive. Improving
medication error incident reporting and learning [online] available from <
https://www.england.nhs.uk/wp-content/uploads/2014/03/psa-sup-info-med-
error.pdf> [30th September 2016]

Nichols P., Copeland T., Craib IA., Hopkins P., Bruce DG. (2008) Learning from
error: identifying contributory causes of medication errors in an Australian hospital.
Medical Journal Australia 188(5), 276–9

Nursing and Midwifery Council (NMC) (2010) Standards for medicines management
[online] available from >

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https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-
medicines-management.pdf< [29th September 2016]

Nursing and Midwifery Council (2015) The Code Online [online] available from >
https://www.nmc.org.uk/standards/code/read-the-code-online/< [30th September]

O'Brien, M., Spires, A., Andrews, K. (2011). Introduction to medicines management

in nursing. Exeter: Learning Matters.

Ofusu R, Jarrett P (2015) Reducing nurse medicine administration errors. Nursing

Times; 111(20), 12-14

Scrivener, R., Hand, T., Hooper, R. (2011). Accountability and responsibility:

Principle of Nursing Practice B. Nursing Standard, 25(29),35-36.

Turjesen, I. (2014). Medication errors costs the NHS up to 2.5 billion a year.
Pharmaceutical Journal, 293(7834).