MW as scientist revision

Fitness to practice common allegations

prescribing and medicine management (25%):

Incorrect patient or clinical records, Drugs or medication records, Other record keeping issues, Care plan

Patient care (18%):

Not administering or refusing to administer medication, other drugs administered or med management error, administer incorrect dose, innapropriate or incorrect delivery of meds

Record keeping (12%):

Patient or clinical record, drugs or medication records, other record keeping issues, care plan

What is a drug?

A drug is a small molecule that changes how the body works by acting at the molecular level. it is not food it is any substance that is used to: 

Prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition

What are the 3 Categories of medicines classification terminology

GSL- General sale list

POM- Prescription only medicine

P- Pharmacy medicine

What is GSL?

General sale list:

It needs neither a prescription nor the supervision of the pharmacist. It can be obtained from retail outlets.

What is P?

Pharmacy medicine:

A medical product which is not a prescription. It can only be sold from pharmacies.

What is POM:

Prescription only medicine:

This can be sold or supplied in accordance with a prescription of an appropriate practitioner.

Example of med class

Drug+  dose + class

ibuprofen - 200mg tablets - gsl

ibuprofen - 400mg tablets - p 

co-codamol - 8/500mg tablets - p

co-codamol - 15/500mg tablets - pom

PGDs- Why did standing orders evolve?

Standing orders developed because doctors weren’t always available to write prescriptions

midwives and nurses needed to administer common medicines quickly

allowed faster care without waiting for a doctor

What was the 1997 government review about?

A UK wide review in 1997 looked at prescribing, supply and administration of medicines.

Goal- use of non medical professionals more effectively

it aimed to define when nurses, midwives and others could take on new roles with medicines

What did the crown report 1998 find and recommend?

Found inconsistencies in how medicines were supplied/ administered

Found legal uncertainty in using group protocols (e.g standing orders)

Recommended creating clear standards

led to development of PGD

Recommended that all group directives meet clear criteria and standards

What does PGD mean?

Patient group directives

What is a PGD?

A written instruction for the sale, supply or administration of licensed named medicines (e.g vaccines)

Used in specific situations

For groups of patients

Patients don’t need to be individually identified before treatment

Who are PGD’s used by?

Only used by trained and competent staff

Who’s name must be on the PGD?

The registrants name must be on the PGD.

Can drug administration of PGDs be delegated?

No.

Can students administer or use PGDs?

No. Students cannot use PGDs as in cant supply or administer.

If a medicine is covered by an exemption order is a PGD needed?

No.

When are PGDs used?

Most care should be patient specific- PGDs used only when clearly beneficial without risking safety.

If I administer PGD’S in one trust am I allowed to administer it in another?

No. PGDs are local (unit/ directorate'/ health board/ trust) not transferable across areas)

Who are PGDs created by?

Created by a multidisciplinary team: senior doctor, nurse/midwife and pharmacist.

Who can use the PGD?

Only named, trained nurses midwives can use it- must sign the PGD

Can you delegate PGD to other people?

No.

How often must PGDs be reviewed?

Must be reviewed at least every 2 years.

Is a PGD prescribing?

No.

Name examples of PGDS

Aspirin in high risk pregnancy such as high risk ASPRE

Vaccines such as pertussis or hep b

TXA in an emergency in a stand alone midwifery led unit

What is a medicine act exemptions and how do they apply to Registered midwives?

Legal permission under human medicines regulation 2012

Allows midwives to give certain medications without a prescription PGD or being a prescriber

These rules are called exmeptions

What does schedule 17 list?

Schedule 17 lists the exact professionals like paramedics, midwives, potriatrists etc) who have this right.

exemptions are specific to certain medicines only

what can midwives do under midwives exemption?

They can supply GSL, P and certain POMS

Must be within midwifery scope of practice

Aimed to improve care and speed up access to needed medicines

If a medicine isnt covered you need a prescription, PSD (patient specific directions) or PGD (patient group directives)

Are drugs given under the midwives exemption list prescribing?

No.

What are the medicines rules for Student midwives?

1. Can administer drugs under midwives exemptions (except controlled drugs) must be under direct supervision of a midwife (midwife must watch full process

2. Not allowed to give controlled drugs via exemption (e.g. diamorphine, pethidine, morphine)

3. Can administer and prepare controlled drugs only under direct supervision

4. Can administer prescribed drugs (incl. CDs) if prescribed by a doctor or prescriber must be under direct supervision

5. Registered nurses on shortened midwifery courses are student midwives they must follow the same rules so no prescribing.

What are controlled drugs? + examples

Controlled drugs are medicines that can cause addiction or harm or be misused illegally

Pethidene, diamorphine, diazepam

Which 3 laws govern controlled drugs?

Governed by

1. Medicines act 1968

2. Misuse of drugs act 1971

3. Misuse of drugs regulations 2001

How many practitioners are required to administer controlled drugs who must they be and what should happen?

2 practitioners:

one must be a registered nurse or midwife

both must be present the entire process

What is the 2 step administration process?

1. Drug cupboard check

2. Bedside check with patient

What must you do with the controlled drug register?

1. Both sign when drug is removed (verifying drug and dose)

2. the nurse who is administering must sign the “given” coloum

If only part of an ampoule is given/ used what must the midwife do?

Record the amount given and the amount discarded

Both midwives must witness and sign

What are the 2 main checking steps for controlled drugs?

1. At the Controlled drugs cupboard, check drug, dose, expiry and patient details

2. At the patients bedside- confirm identity, recheck dose, administer drugs

What if only part of an ampoule is used+ what if the dose is titrated?

if using part of an ampoule:

record amount given and amount discarded. both witnessed and signed by two registered midwives

if titrated record actual dose and wastage after administration

what must be recorded in the controlled drug register 5 things?

1. date and time

2. dose adminstered

3. route of administration

4. name/ signature and printed name of midwife/ nurse who gave the drug midwife/nurse who witnessed it

5. Update stock balance

What checks must the midwife complete before administration (6 things)?

1. check drug name

2. reconcile stock with register balance

3. confirm patient name and dose with prescription

4. check route and rate of adminstration

5. check expiry date

6. reconcile stock again after preparation

What check must the midwife complete at the bedside before administration? (11 things)

1. ask patient to confirm name and date of birth if possible

2. check wristband: name, date of birth, hospital number vs prescription

3. check for allergies to the drugs

4. check date and time of adminstration

5. check drug name

6. confirm dose matches prescription

7. verify drug details from original packaging

8. check volume, bolus or infusion

9. confirm route and rate of adminstration

10. check expiry date and time

11. sign and date prescription chart and patient record both midwives must sign

How must unused liquids be destroyed?

use a self setting compound to secure before disposal

How should unused tablets be destroyed?

crush before disposal

How should unused capsules be destroyed?

open and empty contents

How should unused part used doses be destroyed?

Empty into blue lidded pharmaceutical waste bin

How must unused syringes/ vials/ infusion bags be destroyed?

Empty contents into blue lidded bin

How must unused patches be destroyed?

Fold in half and place in blue lidded bin

How must expired stock be destroyed?

Must be returned to pharmacy (includes patients own controlled drugs)

What are the 8 rights?

1. right patient

2. right medication/ drug

3. right dose

4. right reason

5. right route

6. right response

7. right documentation

8. right time

9. right to decline

What must the midwife do/ be?

Be confident

be aware of the plan of care

be aware of allergies/ known adverse drug reactions

observe medications being taken by the patient. never leave medicines for self administration.

When it comes to documenting medication what must you do/ remember? (5 things)

1. keep accurate

2. detailed and timely records

3. always document on the trusts digital prescribing platform

4. confirm allergies or NKDA are recorded

5. If medicine is given under midwives exemptions this must also be recorded on the digital platform

What 1 thing must you always check before giving a medication? (red wristband)

That the patient has no drug allergies or is not allergic to the drug you are giving

If medicine is given under midwives exemptions where must it be recorded?

If medicine is given under midwives exemptions this must also be recorded on the digital platform

What should you do it an error or near miss occurs and what is it called?

Always declare any errors or near misses this is called the professional duty of candour

Be open, honest and report truthfully

What causes most medicine errors?

1. Drug calculation or dosage mistakes

2. poor handwriting/ abbreviations

3. failure to identify or record allergies

It is usually avoidable and due to human error

How can risks be minimised?

1. follow all safe practice covered in training

2. maintain and update knowledge and skills

3. practice within professional guidelines local policy and legal limits

4. engage in ongoing training

What are the responsibilities of employers?

1. Provide training, policies and guidelines

2. ensure robust reporting systems

3. promote a culture of openness

4. encourage communication and learning from errors

What immediate actions should be taken during a medicines error or near miss? (3 things)

1. stop giving the drug if safe to do so

2. inform the midwife in charge and the doctor

3. report via the trusts incident reporting system

What is your duty to the woman and how should it be reported?

Duty of candour:

1. Apologise to the woman

2. explain clearly what happened

documentation:

1. record the incident in the woman’s notes

Does a woman have the right to accept or refuse any treatment?

Yes

True of false you can give a physical examination or treatment without valid consent?

False. You must always have consent.

If a woman lacks capacity who must consent come from?

A legal representative.

What must a woman be given clear information on before she gives valid consent? (3 things)

1. test/ treatment options

2. what each involves

3. risks vs benefits

How can you ensure a woman’s consent is truly informed?

Has the woman received enough information to make a clear decision 

As a midwife what should you consider when giving information about treatment options?

Midwifes responsibility

Do you fully understand the risks and benefits and the side effects of the medicine

is the information you are going accurate balanced and free from personal bias

support the woman to make her own personal informed choice not influenced by your preferences

How can you tell if a lady has understood the information which you have given her?

1. confirm understanding by asking her to explain in her own words

2. look for signs of confusion or hesitation

3. ask if English is her first language

What is one thing we should remember about even fluent speakers?

They may not understand medical terms

If a lady does not speak English what should we be offering?

An interpreter or language line

Can a woman refuse treatment or medication?

Yes. women have the right to legally refuse treatment or medication

Can a woman refuse treatment or medication if it is life saving or benefits the baby?

Yes. the mothers right to withhold consent is absolute.

Does the fetus have legal rights?

The fetus has no legal rights.

What are some examples of maternal consent? (6)

1. rhesus negative mother refuses anti d

2. Jehovahs witness refuses blood products

3. mother refuses vitamin k for baby

4. history of ppl but refuses 3rd stage medication

5. gestational diabetes- non compliant with insulin/ medication

6. 21 days overdue- refuses induction of labour

If a woman receives medical advice is her right to consent or refuse legally protected ?

yes

What is your role when a woman refuses care?

give accurate unbiased evidence based information

support evidence based decision making

If a woman refuses care or declines treatment what must documentation include?

1. full details of discussion

2. clear personalised care plans

3. options+ contingency plans

4. ask woman to sign the plan - best practice 

who can you get support from?

professional midwifery advocate or trusted colleague

ensure all staff involved are aware of the plan

What is the legal age of consent?

16

Does consent depend on age?

No, it depends on competence

What is Fraser guidelines?

Specific criteria for assessing under 16s especially in sexual/ reproductive health used in maternity too

True or false: a 16 year old might need parental consent if not competent

true

True or false a 13 year old could consent if competent

true

under 16s can consent/ refuse if they show sufficient understanding for contraception parental consent is not needed if the minor is competent what is this based on?

1986 legal case.

What is the gillick competence?

tests if a minor can make their own healthcare decision

What is the difference between Gillick competence and Fraser guidelines?

Gillick competence is a general legal principle for a Childs capacity to consent to any legal treatment.

Fraser guidelines are a more specific set of criteria to do with sexual health and contraceptive. assessing to see if a minor can consent

When might a woman lack capacity?

If she has learning difficulties or severe mental health disorders

What law covers when a woman may lack capacity?

Mental health act 2005

What are the 5 principles of the mental health act 2005?

1. assume capacity unless proven otherwise

2. take all steps to support decision making before assuming lack of capacity

3. making an unwise decision does not equal lack of capacity

4. any decision must be in her best interest

5. choose the least restrictive option (protects right/ freedom)

What is your responsibility with knowledge, record keeping and prescriptions?

1. keep skills and knowledge up to date

2. clear accurate records

3. clarify any abbreviations on prescription

What should you ensure before giving a drug?

Never give a drug if unsure about use, see, route

Ask for a second check on calculations done independently

What rules apply to parenteral and controlled drugs?

all parenteral (non - oral) medications need to be checked by 2 people

controlled drugs need 2 signatures

what if you’re unsure about a medicine or dose?

question the prescriber

still unsure get a second opinion

what’s your role after an error"?

be open and honest

report promptly- early action limits harm

learn from mistake and share with others

be a reflective practicioner

always role model safe practice

What are the 4 stages of embryology?

Zesty men blow everything

zygote, morula, blastocyst, embryo

what happens to the fertilised ovum (zygote) immediately after fertilisation

it undergoes mitosis (cell division)

how many cells are present at the morula stage?

12 cells

what important event begins at the morula stage?

the cells start communicating with each other and form the blastocyst

at approximately how many days after fertilisation does the blastocysts enter the uterus?

around 4 days

where does the blastocysts embedd after entering the uterus?

into the decidua (lining of the uterus)

what are the two main structures formed from the blastocyst cells?

trophoblast- forms placenta and chorion

inner cell mass - develops into the fetus

from what point to what point is the conceptus called an embryo?

from implantation to 8 weeks gestation