Nursing associate drugs guidance aims to ‘calm the waters’

They spoke to Nursing Times ahead of the publication this week of a series of recommendations for trusts and other healthcare employers about how future nursing associates should be involved with medicines management.

“If you just focus on controlled medicines, then medicines like insulin and warfarin…are then not given the focus”

Sam Donohue

In its new guidance, Health Education England has recommended that it should be down to employers to name the “safety critical” medicines those in the new role will be expected to give while working within their organisation. This is in addition to outlining any controlled drugs they will be giving.

HEE clarified that safety critical drugs were those that include a higher risk of harm and could include methotrexate, warfarin, insulin, digoxin, lithium and opioids, as well as those new to the market, known as black triangle medications.

• Employer must name ‘safety critical’ drugs given by nursing associates

Previous plans that associates should be able to give controlled medication, leaked in a draft version of HEE’s curriculum for associates in 2016, sparked a wave of criticism due to suggestions of patient safety risks.

• Nursing associates will be able to give drugs unsupervised
• U-turn on controlled drug administration by nursing associates

But in an interview with Nursing Times, the senior nurses who led the development of the HEE guidance as part of a group of nursing experts, said it had been highlighted that healthcare assistants were in some cases already giving out controlled drugs – as well as other higher risk medication.

Urging employers to name the whole set of “safety critical” drugs that their nursing associates will be expected to use would also encourage them to focus on the greater range of additional training that would be required, they said.

“There was a lot of the noise around controlled medicines, but actually drugs such as insulin and warfarin are given routinely by non-regulated roles and carry a higher risk,” said HEE’s senior nursing policy manager Sam Donohue.

She added: “When we are looking at controlled medicines and how they are administered now, especially in community palliative care services and social care, then we have got people who are taking tablets that are controlled medicines and patches that are controlled medicines.

“The group spoke a lot about this as they wanted to calm the waters – and this is what I meant about broadening it to the safety critical [drugs],” said Ms Donohue.

“If you just focus on controlled medicines, then medicines like insulin and warfarin that are routinely provided are [then] not given the focus of the additional education and training that happens for people to do that,” she warned.

“I know there was concern [about controlled drugs] but directors of nursing were saying, ‘this isn’t new, people are doing this already’. What we want is some guidance to support organisations to make sure they’ve got all the right checks and balances internally,” she said.

In addition, Nursing Times asked HEE whether universities should be required to teach trainee nursing associates about certain “safety critical” medicines during their two-year programmes.

“I know there was concern [about controlled drugs] but directors of nursing were saying ‘This isn’t new, people are doing this already”

Sam Donohue

HEE chief nurse Lisa Bayliss-Pratt said the group of experts had decided against drawing up a list that all trainees should receive training on, because the types of medication associates needed to learn about would depend on where they were based.

“We can’t be prescriptive about teaching everybody every last thing, because it doesn’t work like that,” she said. “But we want associates to be as well educated as possible about all of the medicines that they’re involved with as part of the care they are providing to the people they are looking after.”

In its new guidance published on Tuesday, the national workforce planning body highlighted that the threat to patient safety was not just down to the type of medication, but the route of administration as well.

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

If employers expect associates to use different routes, such as enteral or intramuscular, it should be defined in a “robust” organisational policy in which associated risks have been assessed, stated HEE’s guidance.