Medication Paperwork

Practitioners Name:
Area of Practice:
Supervisor:
Drug Administration Start Review Start Date:
Objectives
Each Practitioner must have specific objective set according to their personal learning
needs. These will be achieved on a one to one basis with your practice development
practitioner / mentor.

Drug Administration Learning / Training Needs
Identified performance issue/s raising concerns
Give a description incident and contributing factors
Training / Learning Needs as identified by Supervisor
Training / Learning Needs as identified by Practitioner
Signature of Practitioner: Date:
Signature of Supervisor: Date
Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310
Revision No: 7.1 Next Review Date: 01/02/2019 Title: Management of Medication Errors
Do you have the up to date version? See the intranet for the latest version
Page 2 of 12
Preliminary Discussions
Outline of discussion re areas of drug administration for development
Specific learning requirements agreed.
Signature of Supervisor: Date
Page 3 of 12
Interim Discussion
As part of the ongoing learning process, those practitioners undergoing more than
4 weeks of development must have an interim interview at 2 weeks.
Points for Discussion
Areas Developed
Areas for further Development
Signature of Supervisor: Date:
Page 4 of 12
Interim Discussion
As part of the ongoing learning process, those practitioners undergoing more than 4
weeks of development must have an interim interview at 2 weeks.
Points for Discussion
Areas Developed
Areas for further Development
Page 5 of 12
Development to be attended
This must take place with all drug administration errors
Training to be Date Signature Feedback / Signature of

undertaken and Comments Supervisor
venue
Medicines
Management
Drug
Administration
Course
Supervised
Practice
Relevant
Policies and
Procedures
Page 6 of 12
Supervised Practice Record
All practitioners must undertake 10 supervised practices in Drug Administration. This will
be extended if deemed necessary by Practice Development Practitioner / Supervisor/
Mentor.
Supervised Outline of Observation PD / Date Feedback
Practice mentor
signature
10
Page 7 of 12
Reflective Practice
On completion of your drug administration development programme all practitioners

must undertake a piece of reflective practice. The piece must be minimum of 500 words
outlining your experiences during the incidents, it must demonstrate how as a result of
this review and reflections upon your professional practice your actions influence
outcomes and patient safety within drug administration and the need to work within your
scope of professional practice to maximise patient safety. (Insert additional pages as
required)
Page 8 of 12
Final Interview Record
Development to be reviewed at the end of training / learning / supervised practice.
Supervisor feedback on competency review of practitioner:
Practitioner Feedback on competency review of their practice and confidence to

administer medications:
Page 9 of 12
APPENDIX 5: PROCESS FOR MONITORING COMPLIANCE
Minimum requirement to Process for Responsible Frequency Responsible Responsible Responsible
be monitored monitoring individual/ of individual/ group/ individual/ group/ individual/group/
e.g. audit group/ monitoring committee for committee for committee for
committee review of results development of monitoring of
action plan action plan and
Implementation
a) How medicines are Audit Pharmacy Annually Medicines Divisional Medicines
prescribed Department Management and Governance Management and
Incident Review Committees Incident Review
Committee Committee
b) How the organisation Audit Pharmacy Annually Medicines Divisional Medicines

makes sure that all Department Management and Governance Management and
prescription charts are Incident Review Committees Incident Review
accurate Committee Committee
c) How medication errors Audit Clinical Learning from Learning from Learning from
are reported (Included in Governance Risk Annually Incidents and Incidents and Risks Incidents and Risks
Incident and Patient Risks Committee Committee Committee
Reporting Safety Manager
Audit)
d) How the organisation Audit Clinical Learning from Learning from Learning from
learns from medication (Included in Governance Risk Annually Incidents and Incidents and Risks Incidents and Risks
errors Investigatio and Patient Risks Committee Committee Committee
n of Safety Manager
Incidents
Audit)
e) How a patient’s Audit Quality Managers Quality Managers Quality Managers Quality Governance
medicines are managed Annually Committee
on handover between
care settings
Page 10 of 12
APPENDIX 6: EQUALITY IMPACT ASSESSMENT FORM
Department Service or Policy Date Completed:
GROUPS TO BE CONSIDERED
Deprived communities, homeless, substance misusers, people who have a disability, learning disability, older people, children and
families, young people, Lesbian Gay Bi-sexual or Transgender, minority ethnic communities, Gypsy/Roma/Travellers, women/men,
parents, carers, staff, wider community, offenders.
EQUALITY PROTECTED CHARACTERISTICS TO BE CONSIDERED
Age, gender, disability, race, sexual orientation, gender identity (or reassignment), religion and belief, carers, Human Rights and social
economic / deprivation.
QUESTION RESPONSE IMPACT
Issue Action Positive Negative
What is the service, leaflet or policy See Purpose
development?
What are its aims, who are the target
audience?
Does the service, leaflet or policy/ No
development impact on community
safety
 Crime
 Community cohesion
Is there any evidence that groups No
who should benefit do not? i.e. equal
opportunity monitoring of service
users and/or staff. If none/insufficient
local or national data available
consider what information you need.
Does the service, leaflet or No
development/ policy have a negative
impact on any geographical or sub
group of the population?
How does the service, leaflet or No
policy/ development promote equality
and diversity?
development explicitly include a
commitment to equality and diversity
and meeting needs? How does it
demonstrate its impact?
Does the Organisation or service No
workforce reflect the local
population? Do we employ people
from disadvantaged groups
Will the service, leaflet or policy/ No
development
i. Improve economic social
conditions in
deprived areas
ii. Use brown field sites
iii. Improve public spaces including
creation of green spaces?
development promote equity of
lifelong learning?
development encourage healthy
lifestyles and reduce risks to health?
development impact on transport?
What are the implications of this?
policy/development impact on
housing, housing needs,
homelessness, or a person’s ability to
remain at home?
Page 11 of 12
APPENDIX 6: EQUALITY IMPACT ASSESSMENT FORM
Are there any groups for whom this No
policy/ service/leaflet would have an
impact? Is it an adverse/negative
impact? Does it or could it (or is the
perception that it could exclude
disadvantaged or marginalised
groups?
Does the policy/development No
promote access to services and
facilities for any group in particular?
policy/development impact on the
environment
 During development
 At implementation?
ACTION:
Please identify if you are now required to carry out a Full Equality Yes No (Please delete as
Analysis appropriate)
Name of Author: Date Signed:
Signature of Author:
Name of Lead Person: Date Signed:

Signature of Lead Person:
Name of Manager: Date Signed:

Signature of Manager
Page 12 of 12

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Practitioners Name:

Drug Administration Start Review Start Date:

Give a description incident and contributing factors

Training / Learning Needs as identified by Supervisor

Training / Learning Needs as identified by Practitioner

Signature of Practitioner: Date:

Signature of Supervisor: Date

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

Specific learning requirements agreed.

Signature of Practitioner: Date:

Signature of Supervisor: Date

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

Points for Discussion

Areas for further Development

Signature of Practitioner: Date:

Signature of Supervisor: Date:

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

Points for Discussion

Areas for further Development

Signature of Practitioner: Date:

Signature of Supervisor: Date:

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

Training to be Date Signature Feedback / Signature of

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

On completion of your drug administration development programme all practitioners

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

Supervisor feedback on competency review of practitioner:

Practitioner Feedback on competency review of their practice and confidence to

Signature of Practitioner: Date:

Signature of Supervisor: Date:

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

b) How the organisation Audit Pharmacy Annually Medicines Divisional Medicines

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

Name of Lead Person: Date Signed:

Name of Manager: Date Signed:

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/310

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