Safe drug administration in midwifery
Adequate risk assessment by the midwife prior to the administration of medicines is crucial. No medicine should be administered without considering the possibility of error or an adverse reaction. Midwives are in a unique position in respect of the midwives exemptions, and must be clear regarding their professional accountability in this respect. This article highlights the main clinical aspects of the safe administration of medicines in maternity care and provides key points for safe clinical practice.
Safe drug administration is an NHS priority and fundamental standard of the Care Quality Commission (CQC, 2016); this is important because midwives' errors in drug administration are reflected in Local Supervising Authority (LSA) investigations, often culminating in supervised practice (Nursing and Midwifery Council (NMC), 2014). Drug errors have also accounted for maternity claims in excess of £8 million (NHS Litigation Authority, 2012); hence, the clinical discussion in this article is focused on clinical aspects affecting safe drug administration.
The NHS has sought to reduce errors in drug administration (National Patient Safety Agency (NPSA), 2009; NHS England, 2014) and, in spite of the NHS ‘never event’ strategy (NHS England Patient Safety Domain, 2015), little is known about the extent of drug errors in maternity care since the earlier work of Birch and Culshaw (2003). However, 86 086 medication incidents were reported to the National Reporting and Learning System (NPSA, 2009) in the period 2005–10, which provides safety guidance on drug errors. Hospital trends for drug errors have been reported between 3–8% (Cousins et al, 2012); however, the reliability and accuracy of reporting systems has been questioned (Dückers et al, 2009). Drug errors may include preparing, administering and monitoring the effects of drugs (NHS Commissioning Board, 2013; NHS England, 2014); this is crucial, because at least one third of errors occur during administration i.e. at the interface of midwifery care (Smeulers et al, 2015).
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