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Nursing associate employers to name safety critical drugs administered

Health Education England (HEE) has released guidance for nursing associates and their employers, stating that employers should name the 'safety critical' medicines that associates will be expected to administer, as well as all controlled drugs.

Safety critical drugs are those that include a higher risk of harm, HEE clarified, and could include warfarin, insulin, methotrexate, digoxin, lithium and opioids, as well as those new drugs known as black triangle medications, which require monitoring for adverse effects.

'While nursing associates should not be precluded from administering these medicines, caution should be exercised to overtly promote a patient safety culture.

'Employing organisations should take appropriate steps to assure themselves and the CQC that practising nursing associates have the qualifications, competence, skills and experience to undertake the activities required of them,' the guidance said.

HEE also said that it will work with employers and NHS England to develop proposals for nursing associates to be able to supply and administer medicines using patient group directives (PGDs).

'Providers consider nursing associates should be able to administer some medicines under PGDs as this would be advantageous to patient care without compromising on safety. Examples of this include immunisations as part of a national programme (for example the influenza vaccine) and - upon completion of competency - using a saline flush following the insertion of a cannula', the document states.

The guidance, released Tuesday, said that it is not practical to list all medications that nursing associates will work with, as the role goes across many sectors, but that naming the safety critical ones will help to ensure that the right training is given across the board.

HEE clarified that this is not just for controlled drugs, as many other medications such as warfarin and insulin can cause patient safety concerns if not administered correctly.

This comes after outcry from the nursing workforce when it was revealed by a leaked draft version of HEE’s curriculum for nursing associates in 2016, that associates will be able to give controlled drugs.

However, it has since been highlighted that unregulated roles such as healthcare assistants (HCAs) are in some cases already giving out controlled drugs and other higher risk medications.

The guidance also noted that understanding of the administration routes for medications is as important as the medications themselves in regards to patient safety.

It therefore recommended that the Nursing and Midwifery Council, as regulator of the role, should require all nursing associates to be taught oral, topical, subcutaneous, per rectum and inhaled routes of administration as 'core' proficiencies.

If associates will be expected to use different routes, such as enteral or intramuscular, these should also be defined in a 'robust' organisational policy in which associated risks have been assessed, the guidance said.