Drug Delivery

Drug Delivery

Delivery with controlled drugs:
  • Double-check: Two nurses must independently check and sign the controlled drug medication before administration. This ensures accuracy and minimizes the risk of errors.
  • Documentation: Both nurses must document the double-check process in the patient’s records.
  • NMC Standards: Refer to the NMC Standards for Medicines, Pharmacy, and Therapeutics (NMC 2018) for detailed guidance on controlled drug management.
  • Valid consent: For consent to be valid, it must be:
    • Voluntary: Given freely and without coercion. Consider:
      • Power imbalances: Be mindful of any power dynamics between you and the patient that could influence their decision.
      • Information overload: Avoid overwhelming the patient with too much information.
      • Independent witness: If necessary, involve an independent witness to ensure the consent is truly voluntary.
    • Informed: The patient must understand the:
      • Benefits: Potential positive outcomes of the treatment or procedure.
      • Risks: Potential negative outcomes, including side effects and complications.
      • Alternatives: Other options available, including doing nothing.
    • Capacity: The patient must have the ability to understand the information presented and make a decision based on their own understanding.
  • Verbal vs. written consent: Both verbal and written consent can be valid, but written consent is generally preferred for high-risk procedures or treatments.
  • Lack of capacity: If the patient lacks capacity to consent, you can proceed with treatment only if:
    • It is in the patient’s best interests.
    • You have consent from a substitute decision-maker, such as a family member or legal guardian.
Additional considerations:
  • Document all consent: Document the consent process, including the details of the information given, the patient’s understanding, and any decision-making aids used.
  • Escalate concerns: If you are unsure about a patient’s capacity or the validity of their consent, seek advice from a senior colleague or legal representative.
  • The NMC Code (NMC 2018) emphasizes the importance of patient autonomy and informed consent.
  • Always act in the best interests of the patient and uphold their human rights.
UK NMC Situations When Consent is Not Needed

You’ve outlined several situations where consent might not be necessary for treatment in the UK, according to the Nursing and Midwifery Council (NMC). Here’s a breakdown of each scenario:

  1. Emergency treatment to save the patient’s life:
  • Consent is not required if the patient lacks capacity to consent and the treatment is immediately necessary to save their life.
  • Examples include unconsciousness due to accident, illness, or intoxication.
  • Once the patient regains capacity, they should be informed about the treatment provided and their right to refuse further treatment.
  1. Immediate additional emergency procedures:
  • During an existing emergency procedure, if a further unplanned intervention becomes necessary to save the patient’s life or prevent serious harm, consent might not be required.
  • The key factor is the immediacy and urgency of the additional procedure.
  • The patient should be informed about the additional procedure as soon as possible and their consent sought if they regain capacity.
  1. Severe mental health condition:
  • If a patient with a severe mental illness lacks the capacity to consent to treatment and poses a danger to themselves or others, treatment can be provided without consent under the Mental Health Act.
  • This decision requires careful assessment by two medical professionals and authorization from an Approved Mental Health Professional (AMHP).
  • It’s important to note that even in these cases, the patient’s views and wishes should be considered as much as possible.
  1. Refusal of treatment for severe mental health condition:
  • If a patient with a severe mental illness who previously attempted suicide while competent now refuses treatment in the hospital, consent is generally required.
  • However, if the patient is deemed a danger to themselves or others due to their illness, treatment can be provided under the Mental Health Act following the same process as in scenario 3.
  • In such cases, involving the patient in treatment decisions and exploring less restrictive options is crucial.
  1. Risk to public health:
  • In specific situations where an infectious disease poses a significant risk to public health (e.g., rabies, cholera, TB), compulsory isolation or treatment might be authorized under public health legislation, even without the individual’s consent.
  • This is a rare measure and requires strict legal criteria to be met.
  1. Severely ill and living in unhygienic conditions:
  • Generally, consent is required for treatment even if the patient lives in unhygienic conditions.
  • However, if the patient lacks capacity to consent and their living conditions pose a serious risk to their health, intervention might be possible under specific legal frameworks like the Mental Health Act or safeguarding procedures for vulnerable adults.
Important notes:
  • These are general guidelines, and the specific details and legal requirements may vary depending on the individual situation and applicable legislation.
  • It’s crucial for healthcare professionals to consult the NMC Code, and relevant legislation, and seek legal advice when necessary to ensure ethical and lawful practice.
  • The NMC website offers resources and guidance on consent and other ethical aspects of nursing and midwifery practice: https://www.nmc.org.uk/standards/code/
Different levels of self-administration of medicines as outlined by the UK NMC. Here’s a breakdown of each level in more detail:
Level 1 (Dependent):
  • At this level, the patient is not able to safely administer their own medication and requires full supervision from a nurse.
  • The nurse will be responsible for preparing, administering, and documenting all medication administration.
  • This level is typically for patients who are:
    • Unconscious or have impaired cognitive function
    • Have complex medical conditions or require high-risk medications
    • Are unable to understand or follow medication instructions
Level 2 (Shared):
  • In this level, the patient takes on some responsibility for administering their own medication but still requires supervision from a healthcare professional.
  • The patient may be able to:
    • Take oral medications independently under supervision
    • Use certain devices like inhalers or nebulizers with guidance
    • Apply topical medications like creams or ointments
  • A healthcare professional, such as a registered nurse or pharmacist, will typically:
    • Provide education and training on safe medication use
    • Supervise the patient during medication administration
    • Document the administration process
Level 3 (Independent):
  • At this level, the patient is deemed competent and safe to administer all their medications without supervision.
  • This level requires a thorough assessment by a healthcare professional to ensure the patient understands:
    • The names, doses, and schedules of their medications
    • Potential side effects and interactions
    • Proper storage and disposal methods
    • How to recognize and report any concerns
  • The patient will be given full custody of their medications, often stored in a bedside locker.
Level 2/3 (Partial Self-administration):
  • This level allows for flexibility where the patient takes responsibility for administering some medications independently (Level 3) while requiring supervision for others (Level 2).
  • This may be suitable for patients who are comfortable with certain medications but need support with others due to complexity or potential risks.
  • As with Level 2, a healthcare professional will provide training and supervision for the medications requiring oversight.

It’s important to remember that these levels are not rigid categories and can be adapted to individual patient needs and preferences. The ultimate goal is to promote patient autonomy while ensuring safe and effective medication management.


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