Medication administration is a complex process and needs your full attention. A lot of mistakes can happen if you are not careful.

It was a lovely Sunday morning, and as I traveled to work I hoped that we would be fully staffed. Often on weekends, people call in sick and we are often short-staffed. The work is the same, whether there are four or two people on duty, and all people need to have their medication on time, have their meals and a wash, etc.

I started my drug round and came to Mr. TS, an insulin dependent patient. I checked his blood sugar and prepared to administer the insulin. I had just 5 units left in the pen, but he needed 20 units. I checked everywhere for the stock of insulin – the trolley, the stock cupboard – I couldn’t find any anywhere. I knew I could not leave this person without his insulin, so I administered the 5 units I had left. What do to next?

Three people could have prevented this error: the person who had done the monthly medication ordering, the person who took the last pen from the fridge, and the person administering the previous dose of insulin. Someone was to blame for the circumstances that I faced, but it was pointless to try to find the guilty person. I had to try to get more insulin as soon as possible.

Because it was a Sunday, I was not able to phone the GP surgery, or the pharmacy to deliver more, so the only option was to call the out-of-hours doctor. I rang them and naturally they were not very happy about the situation, but they were willing to help. They asked me to fax the latest copy of the FP10 (insulin prescription) to see the type of insulin Mr. TS required, and then made an urgent prescription.

I now needed to send someone to collect the prescription … but who? We were already short-staffed, and I couldn’t leave my unit. I spoke with another nurse from another unit and asked her to keep an eye on my unit also while I sent to pick up the insulin. If something major were to happen while I was away that could be a big problem, as I was not supposed to leave. However, if I didn’t administer the insulin there would be another big issue as a patient should not miss their insulin dose, particularly for these stupid reasons – it is a medical error!

Sometimes you need to think outside the boxes and do the best you can for your patient. This story also underscores the importance of ordering enough quantity of medication to last the whole cycle.

In the end, I got the prescription and advice about adjusting the insulin dose for a different time of day. We kept the patient under observation and he was fine. All the nurses in the unit received a rough supervision.

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In Nursing homes, the medication cycle has 28 days. Prescriptions for regular monthly medication must be ordered by day eight in your 28-day cycle.

If a GP leaves a prescription in the home, the prescription can be faxed to the Pharmacy and the original prescription handed to the driver when the medication is delivered. Urgent prescriptions can be faxed to most pharmacies and they will collect the original when delivering the medication.

Controlled drug prescription cannot be faxed as the Pharmacist must see the prescription before any medication can be supplied. You can still fax the prescription to the pharmacy for them to be able to check the medication is in stock. In some cases, an exception can be made, but the pharmacy driver will not leave the controlled drugs (CD) medication unless the original script is being given there and then.

In the period from day 25 (receive medication from the supplier) and day 28 (last day of the medication cycle), staff needs to perform the following accuracy checks:

• Check accuracy and quantity of medication against new MARs
• Check accuracy and quantity of medicines against labels
• Check new MARs against old MARs: check medicines and allergies

If there are no discrepancies, then all you need to do is to store the medication stock appropriately in accordance with manufacturer’s guideline/ legislation (CD cabinet, fridge).

If there are discrepancies you need to take action to remedy them and ensure correct medication is in place for day 1:

• Contact pharmacy to inform of discrepancy/ missing item
• Contact pharmacy to inform of allergy discrepancy
• Contact pharmacy to obtain new MARs if necessary or hand write MARs and double sign
• Contact surgery if prescription is needed for the missing medication

In the day 28 you need to check any medication remaining from the current cycle:

• If the medication cannot be carried forward, dispose of excess stock in line with your home policy.
• If the medication can be carried forward, count stock to be carried forward and add to new MARs