Category Archives: Feedback: Year 2

Feedback in Medication Management.

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This assessment must be undertaken by a Practice Assessor by the end of Part 2 where the student safely administers medicines to a group of patients/service users or a caseload of patients/service users in community settings.

During Part 2 the student should be developing their knowledge, skills and competencies in relation to the safe administration of medicines. This assessment should normally be undertaken with a small group of patients/service users or caseload. Professionalism underpins all aspects of the student’s performance.

The student must be allowed a number of practice opportunities to administer medicines under supervision prior to this assessment.

The student must work within the legal and ethical frameworks that underpin safe and effective medicines management and work within national and local policies.

Regulatory requirements: Future Nurse: Standards of Proficiency for Registered Nurses (NMC 2018), The Code (NMC 2018), A Competency Framework for all Prescribers (The Royal Pharmaceutical Society 2016)

The aim of this assessment is to demonstrate the student’s knowledge and competence in administering medications safely.

Learning outcomes

The student is able to:

1. Apply knowledge of pharmacology, how medicines act and interact in the systems of the body, and their therapeutic action.

2. Carry out an initial and continued assessment of people receiving care and their ability to self-administer their own medications.

3. Prepare medications where necessary, safely and effectively administer them via common routes, including all injection routes where appropriate, maintain accurate records and be aware of the laws, policies, regulations and guidance which underpin medicines management.

4. Safely and accurately perform medicines calculations for a range of medications.

5. Coordinate the process and procedures involved in managing the safe discharge, move or transfer between care settings of the person.

6. Maintain safety and safeguard the patient from harm, including non-adherence, demonstrating understanding of the Mental Capacity Act (DH 2005) the Mental Health Act (DH 1983, amended 2007), where appropriate.

Competency

 

Yes – Achieved

No – Not achieved

1. Is aware of the patient/service user’s plan of care and the reason for medication, demonstrating knowledge of pharmacology for commonly prescribed medicines within the practice area.

2. Communicates appropriately with the patient/service user. Provides clear and accurate information and checks understanding.

3. Understands safe storage of medications in the care environment.

4. Maintains effective hygiene/infection control throughout.

5. Checks prescription thoroughly: Right patient/service user; Right medication; Right time/date/valid period; Right dose/last dose; Right route/method; Special instructions.

6. Checks for allergies, demonstrating an understanding of the risks and management of these as appropriate: Asks patient/service user; Checks prescription chart or identification band.

7. Prepares medication safely. Check expiry date. Note any special instructions/contraindications.

8. Calculates doses accurately and safely: Demonstrates to assessor the component parts of the calculation; Minimum of 3 calculations undertaken.

9. Checks and confirms the patient/service user’s identity and establishes consent. (ID band or other confirmation if in own home).

10. Administers or supervises self-administration safely under direct supervision. Verifies that oral medication has been swallowed.

11. Describes/demonstrates the procedure in the event of reduced capacity and non-adherence.

12. Safely utilises and disposes of equipment.

13. Maintains accurate records: Records, signs and dates when safely administered.

14. Monitors effects and is aware of common side effects and how these are managed.

15. Uses appropriate sources of information e.g. British National Formulary.

16. Offers patient /service user further support/advice/education, including discharge/safe transfer where appropriate.

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16/16 Mark(s)

Practice Assessor feedback

 

Bertha managed to give oral medications correctly to three patients with minimal supervision. On her next placement, she needs to be able to access Medusa on the intranet to she could prepare IV medications correctly.

The student must complete the Reflection on Meeting Medicines Management (Part 2) form following this assessment.

 

placement Interview Placement.( Feedback)

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This can be completed with a practice supervisor or your practice assessor.

Student to identify learning and development needs (with guidance from the Practice Supervisor / Practice Assessor)

Learning and development needs

 

. How to advocate for patients with brain injury conditions who are not able to communicate and anticipate needs.

. Tracheostomy care, how to suction patients with a tracheostomy , how to perform routine stoma care, routine tracheostomy tube change.

. Percutaneous endoscopic gastrostomy (PEG ): Gastrostomy tubes, types, the reason for the patient having a peg, peg stoma care, rotation of the tube, enteral feeds , enteral medication administration and water flushes .

. Continence care: patients who are double incontinent , catheter care, indwelling catheters; and suprapubic catheters.

. Skin care: learn about tissue viability, types of dressings and how to perform wound care .

Medicine administration via different routes : Oral PO , via PEG , injections ( IM / SC), and IV administration

. Vital signs for patients with brain injuries and NEWS trigger action.

Taking available learning opportunities into consideration, the student and Practice Supervisor/Practice assessor negotiate and agree a learning plan.

Outline of learning plan

 

All the above learning points are achievable within placement in BIS ( Brain Injury Service ).

Objectives : f

For student to be able to learn about normal parameters for vital signs and NEWS score—triggers and actions , frequency of repeating observations, and escalation . To be able to recognise when a patient is in distress / pain and to advocate in patient`s best interest when they lack capacity .

To learn about medication administration : drug calculations , preparing medications , learning about commonly used drugs, and administering medications under supervision according to guidelines .

To be able to perform PEG stoma care , advance and rotation of bumper retained tube , types of PEG tubes , indications for gastrostomies , and associated risks.

To learn about continence care and methods to support patients that are doubly incontinent , to learn about UTI , constipation , fluid balance and catheter care .

To be able to perform tracheostomy care, such as changing stoma dressing or tape , recognising if a stoma is healthy or has any abnormalities , observing tracheostomy suction and care, as well as routine changes of the tubes,.

To learn about tissue viability and wound care .

How will this be achieved?

 

Will be achieved theoretically and also by practice .

Student Bertha will work alongside nursing staff to enable learning.

Date and time of next interview (optional)

 

21 Mar 2024 00:00

If this interview is carried out with the Practice supervisor, please complete the following:

learning plan for placement agreed by the Practice Assessor (if applicable)

 

Practice Assessor’s name (if applicable)

 

Alina-Maria Lica

Practice Assessor’s email (if applicable)

 

alica@rhn.org.uk

Additional feedback from Practice supervisors.

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From day one, Bertha has been very keen to learn. She has good communication skills with patients and staff, and she has maintained her professional values. She is proactive with her clinical skills.

 

Providing feedback is crucial for their professional development and growth. It is essential for guiding nursing students on their journey to becoming competent and compassionate healthcare professionals; thus, this feedback is given to Bertha

Your Feedback

 

I supervised her in providing care to the patients, such as preparing the medications, giving the medications via gastrostomy tube and taking observations. She was also able to observe and participate in a bladder washout and bladder scan. The steps were explained to her, along with the rationale, through an exchange of question and answers.

Registered Nurse. practice supervisors to Bertha.

Your Feedback

 

Bertha effectively communicates patient information to doctors and works well with a multi-disciplinary team, including family members.

Bertha communicates well with all the patients and with co-workers. She has developed good interpersonal relationships with all the staff.

She gives patients emotional support when they need care. She takes the initiative to help everyone in the ward and communicates any concerns.

Arrianne Simundo, Charge Nurse

Your Feedback

 

Bertha is willing to learn new skills in the ward.

Today, she had the opportunity to do cough assist on one of our patients. I showed her how to do it once and she was able to perform it to our patient on 2 occasions with supervision. She also keeps practicing the skills she has already learned, like taking physiological observations, giving medications via PEG tube, doing buried bumper checks, and preparing and calculating medications. She is not afraid to ask questions and is willing to take on tasks that are new to her, which is a good quality for becoming a future nurse.

Practice under supervision to deliver care to patients who don’t have the capacity to administer drugs and water through their percutaneous endoscopic gastrostomy (Peg care). Patient has no capacity. I still have to gain consent from the patient and explain what tasks I am going to perform to the patient before I can carry out the task. I administer medications and water through peg feed. Before administering medication, I need to wear my PPE, stop the feeding nutrition, and flush the tube with 100 ml of water to see if it is not blocked. I also need to connect food nutrition to the peg.

Also check the patient’s vital signs and news score.

Your Feedback

 

Bertha performed her best today in administering medication under my supervision.

We discussed the correct way to administer liquid medication through PEG.

Discussed the 5 R’s of drug administration.

Drug calculation is also important, and she performed it well.

Learning from other feedback.

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Reflect on your learning in outreach/short placements or with members of the multi-disciplinary team who are supervising your learning.

Where the learning took place

The name or description of the practice area

MDT Meeting Room, Devonshire ward

When the learning took place,

You can provide a single date or date range

25/03/2024

Who you learn from?

You can list one or more people or provide a team name

Kate Frost Occupational Therapist Senior, Adele Tomlinson Clinical fellow.

Student reflection

 

I had the opportunity to meet with multidisciplinary teams to review patient progress in their treatments. I learned how the MTD teams discuss patients who are yet to be discharged and patients who need another review. The meeting involves a doctor, a social worker, nurses, a dietician, and a psychotherapist.

I gained knowledge on how patient cases are reviewed. The patient’s EEG is reviewed due to the risk of seizures, not to wean. This can be kept under review, and if necessary, levetiracetam would be reduced first if we felt it was inhibiting potential behaviours.

The patient must complete ciprofloxacin treatment, which is an ongoing, vulnerable chest. Also, patients need more behavioural support from therapy staff. MDT has plans for the patient by calling the patient’s father to discuss the EEG and refer the patient to a salivary clinic for botox.

Due to their situation, I learned in the MDT meeting that the team can reduce the patient’s medication. This patient’s Cipro medication is to be continued for two weeks, and the cough assist was ongoing yesterday after nebulisers and thick and clear secretions. I also learned how the MDT discusses patient discharge and ongoing treatment after the patient is discharged from rehabilitation.

Practice Supervisor’s comments:

 

Bertha was able to have the opportunity to participate in the MDT case reviews, which is very helpful in knowing our patients more as the discussion is about overall patient care, from doctors’ point of view to therapy team to nursing team, sharing valuable information on how to help improve patient’s overall health and progress during their rehab phase here in Devonshire ward.

It is a very good experience for her as she will be able to learn how nursing staff would escalate/share what they know about patients during 24 hours of care and also be able to share about patient’s guidelines to see if they work, if they’re manageable for the team and the patient, and if they’re not,  with doctor’s appointments and for any medication adjustments.

Bertha enjoyed participating in the meeting, as she was able to learn a lot about patients and how the MDT works together as a team.

Learning from other feedback.

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Reflect on your learning in outreach, short placements or with members of the multi-disciplinary team who are supervising your learning.

Where the learning took place

The name or description of the practice area

GYM session

When the learning took place,

You can provide a single date or date range

21/03/2023

Who you learn from?

You can list one or more people or provide a team name

Sydney Lai, occupational therapy.

Student reflection

 

I had the opportunity to observe an occupational therapist assessing a 56-year-old patient who had suffered from an acquired brain injury stroke. During the observation, I learned about the methods used by occupational therapists to evaluate stroke patients. I discovered that occupational therapy focuses on improving motor control and hand function in the affected upper limb after a stroke to help patients perform their daily self-care tasks more efficiently.

Occupational therapy interventions are tailored to maintain or enhance the soft tissue properties of the upper limb. For instance, stretching is a technique used to reduce spasticity and improve the patient’s overall condition. This specific approach in occupational therapy is crucial to enhancing motor control and hand function in the affected upper limb. Occupational therapy teaches stroke patients strategies to manage cognitive, perceptual, and behavioural changes and prepares the home and work environment for their return.

Practice Supervisor’s comments:

 

Bertha spent a morning shadowing several occupational therapy rehabilitation sessions. These included sessions in the gym aimed at improving upper-limb strength and cognitive function. Bertha showed her interest in the role of an occupational therapist by asking appropriate questions.

Feedback from Practice Assessor Final interview Reflection.

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Knowledge

 

Bertha has learned quite a lot of background knowledge regarding patients with brain injury and how to care for them day to day. She does not hesitate to ask questions when she is not familiar with things or information, which is a good attitude as a nurse. She also always participates to Therapy sessions in order to observe how the PT, OT, or SLT assess patients level of care needs and capacity to help themselves. Bertha has also been attending some in-house hospital training in order to expand her knowledge and skills relating to brain injury. She has been doing well during her shifts.

Skills

 

Bertha has learned numerous skills like cough assistance, PEG care, administration of PEG medications and suctioning. She has been performing all these skills day to day during her shifts and has mastered them. She also knows the indication why these are being done for the patient. Bertha is easy to work with and knows how to deal with patient needs independently with minimal supervision. She has performed routine PEG care daily, which is part of our morning medication rounds routine. She is also able to operate the feeding pump, suction machine and Cough assist equipment with minimal supervision.

Attitudes and values

 

Bertha enjoy working in the ward with our patients. She is very dedicated and proactive in all her shifts. She also never hesitates to lend a hand to other staff members when the need arises, which is a very good trait in becoming a professional nurse. She also always shows compassion, kindness and empathy for each and every patient. She has good working relationship with all staff members and is able to work with anyone in the ward. Her attitude towards working in the ward is very good, as she always thinks positively and upholds RHN values every time she works. I enjoy working with her during our shifts together.

Learning and Development Needs: To be agreed between the Practice Assessor and the student.

Practice Assessor to identify specific areas to take forward to the next placement

 

Bertha should continue to practice the skills she has learned here in RHN in order to fully master her skills, especially in tracheostomy care and suctioning and in gastrostomy care and medication administration. It will help her professional growth and enhance more her knowledge and learning as she continue on to her other placements.

Feed back from Practice Assessors Midpoint Interview Reflection.

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Knowledge

 

Bertha has exhibited a good amount of knowledge with regards to patients with brain injury through her research and through attending MDT meetings and trainings provided in the hospital. She is very keen to learn new things and work with our patients. She is able to identify NEWS 2 scores that need attention and refers immediately to the staff nurse.

Bertha is also a fast learner when it comes to doing daily routines for our patients, like doing buried bumper checks, suctioning orally and tracheostomy patients, and other routines that we do for patient care. She also learned about tracheostomy care and weaning during the course of her placement, which is one of the vital things that we do for patients whom we aim to decannulate.

Skills

 

Bertha has acquired numerous skills in Devonshire ward during her stay. She has learned to do PEG care and administration of medications, feed, and flush via PEG/gastrostomy tube and balloon water change. She was able to receive tracheostomy care, suctioning, and participate in those cares as part of her daily routine. She was also able to learn how to do bladder scans, washes, and daily suprapubic catheter care for patients who have suprapubic/indwelling catheters.

Bertha is very eager to participate in daily patient care and does not hesitate to try things for the first time. She also does not hesitate to ask questions when she is unsure of something, which is a good attitude for a nurse in order to learn and grow.

Attitudes and values

 

Bertha is able to showcase a good attitude and values in her placement in RHN. She has good character and is able to work well with anyone in the wars, may it be a patient, a relative or staff member. She values the importance of good nursing care and is able to work well under a busy environment. She also takes the initiative to do nursing tasks with minimal supervision. She observes RHN values, which are an integral part of our nursing care. She is an excellent student and she can perform well under any circumstances.

Ongoing learning and development needs: The student is to identify their learning and development needs for the remainder of the placement and negotiate with their Practice Assessor how these will be achieved.

Learning and development needs

 

Bertha will continue to practice what she has already learned in the ward to master her nursing skills and for her professional growth.

How will these be achieved?

 

To apply it onto her daily nursing routines when in the ward.