In this article
Administering medication can involve and include several tasks.
For the purpose of this article we will look at the following tasks and responsibilities when we discuss administering medication:
- Receiving and storing medication.
- Checking prescription information and expiry dates on medications.
- Ensuring hand hygiene is maintained by all parties handling medications.
- Ensuring appropriate PPE is used.
- Reminding pupils to take medication.
- Supporting pupils to access medication.
- Assisting pupils to dispense their medication, e.g. opening containers/blister packs.
- Supporting pupils to measure the correct dosage of medication.
- Supporting pupils to consume or apply medication.
- Supporting pupils to assemble and use equipment needed to take medications, e.g. nebulisers or space chambers for inhalers.
- Giving pupils emergency medications.
- Monitoring pupils for side effects after taking medications.
- Recording activities involving medication.
There are several different pieces of legislation that set out the legal requirements for the handling and administration of medicines in schools, including:
- The Children and Families Act (2014).
- Health and Safety at Work etc. Act (1974).
- Misuse of Drugs Act (1971).
- School Premises Regulations (2012).
- Education Act (1996).
The Children and Families Act (2014) places a duty on the governing bodies of schools to ensure that pupils with medical conditions are properly supported and have access to a full education.
As part of this duty schools must have arrangements in place to ensure that pupils who need medication during school hours can be supported to access and take this medication safely.
Staff are not expected to know or remember all the relevant legislation; however, they are expected to know and follow the school’s medication policy. This will ensure that staff have acted within the boundaries of the law.
What are the consequences of not following relevant legislation and guidance?
Failing to follow legislation and guidance can have very serious consequences for everyone involved including: the pupil, the school, the staff member and their colleagues.
Consequences for the pupil
Not complying with legislation can lead to unsafe medication handling and administration practices which can increase the likelihood of a medication error occurring.
Medication errors could mean pupils are given the wrong medication, no medication, or too much medication, all of which could lead to the pupil becoming seriously unwell or in serious cases could lead to death.
Consequences for the school
Failure to follow legislation will lead to poor quality services which would lead to poor Ofsted inspection ratings and a poor reputation. Where there are significant or repeated breaches in following legislation there could also be fines or prosecutions.
Consequences for the staff member
Where an individual staff member has failed to follow legislation or school policies and procedures, they could be in breach of their contract of employment.
As a result, failure to comply could lead to disciplinary action and dismissal. Depending on the nature of the issue it could also lead to the staff member being barred from working with children or vulnerable people in the future.
The roles and responsibilities of administering medication in school
Most pupils at some stage of their school career will need to take prescribed or over-the-counter medications to help treat or manage a medical condition.
Administering and storing medication will always carry a level of risk. Most medications can be given at intervals which can be planned around the school day, e.g. antibiotics which must be taken three times a day could be given at home on a morning before school, after school and before bedtime.
It is therefore reasonable for schools to work with parents/carers and healthcare professionals to see whether the medication can be administered outside of school hours.
Medication should only be administered during school hours when it is necessary, and the medication cannot be given before/after school.
In relation to administering medication there are the following roles and responsibilities outlined within the legislation:
- Parents/legal guardians have the primary responsibility for their child’s health and wellbeing.
- Governing bodies of schools are responsible for ensuring pupils with medical conditions are supported and have access to a full education.
- Headteachers are responsible for ensuring that policies are implemented, and all staff are aware of the policy and their role in relation to supporting pupils with medical needs.
- School staff must ensure pupils are supported to access and take medication safely when it is needed during school hours.
- Teachers do not have a legal or contractual duty to administer or supervise pupils taking medications; however, they can take on this role voluntarily.
- Support staff in schools may be contracted to administer medications.
Any staff member involved in administering medications either as part of their employment contract or voluntarily is responsible for ensuring they follow the school’s policies and procedures when administering medication to pupils.
What is a school medication policy?
Every school must have a detailed policy in place that explains the school’s approach to managing pupils’ medical needs and outlines the procedures in place to safely manage medication needs.
The policy must include:
- Details of parents/carers’ duty to inform the school of medical needs and how to do this.
- A procedure to follow when a parent/carer informs the school of a medical need.
- How individual pupil’s medical needs will be recorded.
- Specific staff roles and responsibilities in relation to managing pupils’ medical needs and medications.
- The school’s policy on administering non-prescription / over-the-counter medications.
- How medication should be delivered to school and stored in school.
- When and how class teachers will be made aware that a pupil has medical needs.
- How pupils and staff access medication.
- Whether children are permitted to keep any medication with them during the school day, e.g. inhalers for asthma.
- What records must be kept relating to medication.
- What medication checks and audits will be completed and by whom.
- What to do in the event of a pupil becoming seriously unwell.
- What to do in the event of a pupil having an adverse reaction to medication.
What are individual Health Care Plans
To ensure that accurate and detailed records are kept, schools are expected to create Individual Health Care Plans (IHCP) for pupils with long-term medical conditions and needs. The government has provided an example IHCP and information on what they should contain in the statutory guidance ‘Supporting pupils at school with medical conditions’ (December 2015).
IHCPs should be completed with the pupil and their parent/carer and should contain the following information:
- The pupil’s information: name, date of birth, class, home address and medical diagnosis.
- Next of kin contact information: name, relationship to child, contact telephone numbers.
- GP: name, address, contact number.
- Contact names and numbers of any consultant, hospital clinic or other named medical professional involved.
- Which staff members will support the pupil.
- Information about the medical condition and how it affects the pupil, e.g. symptoms, side effects, impact on daily life, triggers, daily support needs.
- Information on how the medical condition may impact on the pupil’s learning and development.
- Any medications needed: name of medication, dosage, how and when medication is taken, possible side effects.
- Arrangements needed for school trips/events.
- Any potential emergency situations: warning signs/symptoms, steps to take in the event of an emergency.
- Who was involved in writing and agreeing the plan.
- Date plan was written, when and how often it will be reviewed.
The importance of written consent
As well as having an Individual Health Care Plan (IHCP) schools must also have written consent from the parent/carer to administer medication. The consent form must include specific information about the medication including the name, dose, time, method, and any special instructions.
Schools may wish to use the written consent to also document the agreement for how the medication will be delivered to school, e.g. that the medication will be handed to a specific member of staff.
Schools can only administer medication which is in its original container and is clearly labelled. For prescription medication the label must have been printed by the dispensing pharmacy with the medication’s name, child’s name and details, GP’s name, date of issue, dosage and instructions and expiry date.
Schools should have a clear policy on how they will manage over-the-counter or non-prescription medications. School staff can administer non-prescription medication when they have written consent from the pupil’s parent/carer.
It can be beneficial for schools to seek permission to be able to administer some non-prescription medications in the event of a child becoming unwell during the school day. For example, administering children’s paracetamol (e.g. Calpol) to a pupil who has developed a high temperature can prevent them from becoming more seriously unwell.
Schools may choose to specify which non-prescription medications are appropriate and can be administered, e.g. children’s paracetamol or antihistamines.
As with prescription medication, school staff can only administer non-prescription medications that are supplied in the original container.
Consent from the pupil
As well as written consent from the parent/carer, staff should seek verbal consent from the pupil before administering medication.
It’s important that medication is administered in a private setting, away from distractions and that the pupil’s confidentiality is maintained. Some pupils may not like taking medication, so talking to them beforehand and agreeing a method can avoid difficulties administering the medication, e.g. having a drink ready for the pupil to have afterwards to help deal with any unpleasant taste.
Seeking consent and promoting the pupil’s independence as much as possible is likely to make the process easier for the pupil and the staff member and help to avoid issues such as pupils spitting medication out (something that can be more common with younger age pupils).
Promoting independence and allowing pupils to do as much of the process for themselves as possible will support pupils to become more responsible and independent in managing their own medications. For pupils with long-term medical conditions this can be important for building their level of self-confidence and sense of responsibility over their own wellbeing.
The importance of school procedures
It is essential that schools have very clear procedures for parents/carers, pupils and staff to follow when a pupil needs medication to be administered during the school day.
It is usually a headteacher’s responsibility to work with the school’s governing body to develop a policy and procedure for how the school will support pupils with medications.
It is then the headteacher’s role to implement the policy.
This should include:
- Identifying named staff who are responsible for creating Individual Health Care Plans (IHCP) for pupil’s who need medication.
- Ensuring that the staff involved in handling and administering medications are sufficiently trained and competent.
- Establishing a robust communication and information sharing procedure to ensure that all relevant staff are aware of the pupil’s medical needs and how to support them.
- Identifying named staff who parents/carers must report medical needs to.
- Clear processes for storing and handling medication.
The importance of medication policies and procedures
Schools must ensure that they have written medication policies and procedures in place for staff and parents/carers to follow. The policies and procedures should be written with reference to the relevant legislation and guidance.
Policies and procedures should provide staff with step-by-step guidance and all the information they need to be able to safely handle and administer medication.
Effective policies and procedures help to:
- Ensure staff are working in compliance with legislation.
- Provide organisation and promote effective communication.
- Provide staff with support and guidance.
- Reduce the risk of medication errors occurring.
- Provide parents with information to follow.
- Set expectations and standards for everyone involved.
Accountability vs responsibility
When it comes to medication handling and administration it’s important that we’re clear on what a staff member is accountable for and what they are responsible for.
- Accountability means accepting responsibility or liability for the outcome of your actions. Staff must be able to explain and give reasons for their actions and decisions.
- Responsibility is having a duty to do a defined set of tasks or functions and carrying out those tasks to the best of your ability. Being responsible for handling and administering medication means that a staff member must have some knowledge so must be trained and supervised until competent.
In reference to medication administration this means that:
- A staff member may be responsible for administering medication.
- They are responsible for doing this to the best of their ability.
- They are responsible for carrying out this duty in line with the school policy.
- They are accountable for the outcome of any actions they take which were not in line with the school policy or the training they’ve received.
The importance of accountability
Accountability is particularly important when it comes to medication handling and administration as it means staff are responsible for:
- Only carrying out tasks they have been trained to.
- Keeping their knowledge up to date.
- Never carrying out tasks they are not trained in.
- Being aware of the limitation of any training they have had.
- Following school policies and procedures.
- Reporting any concerns.
When a staff member has been made responsible for administering medication, they are accountable for the outcome of this. This means that they should not delegate the task to other staff members who may not be trained or competent.
What are medication errors?
There are many ways to minimise the risk of a medication error occurring; however, they may still occur. Medication errors can lead to minor symptoms and inconvenience or could have very serious consequences and can even lead to death.
Medication errors could be:
- Forgetting to administer a medication.
- Giving the wrong medication.
- Giving too much or too little of a medication.
- Giving a medication the wrong way (i.e. via the wrong route).
- Giving medication at the wrong time.
If you make a medication error, you must never ignore it or try to cover it up. This will lead to more harm to the pupil and more serious consequences for yourself and the school.
Managing a medication error
School medication policies must contain a clear procedure for staff to follow in the event of a medication error occurring. Staff should be supported and encouraged to be open and transparent when it comes to errors, so the focus should be on what they can do to prevent a more serious situation developing.
In the event of an error staff should:
- Stay calm.
- Check all the information again to be clear on what the error is.
- Report the error to a more senior/experienced staff member.
- Ask the senior staff member to come and check the pupil.
- Contact the pupil’s parent/carer to inform them of the error and agree next steps.
- Arrange for advice to be sought from the pupil’s GP.
- Document the error on the Medication Administration Record (MAR).
- Complete an incident report.
If at any point after the medication has been administered the pupil starts to show signs of being unwell, staff should call 111 for immediate advice and support.
If the pupil loses consciousness, experiences difficulties breathing, or shows any other signs of serious illness staff should call 999.
The importance of training
As this unit has illustrated, administering and handling medication is a responsibility that staff and schools should take seriously, as when not done safely and to a high standard there can be severe consequences for everyone involved.
By completing training on the handling and administration of medication staff will be more knowledgeable and confident. They will have a good understanding of the procedures to follow to safely administer medication and how to significantly minimise the risk of medication errors occurring.
Being able to administer medication quickly and effectively in emergency situations, e.g. during an asthma attack or a seizure, can prevent a pupil from becoming significantly unwell and can even save lives.
Having good training in place and robust policies and procedures ensures that the school environment is accessible and inclusive and there are reduced barriers to pupils accessing learning.
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The administration of prescribed medication in schools is carried out by staff who volunteer and who are trained. Except in an emergency, only individual staff members who have volunteered and been trained will administer prescribed medication to students.
One of the recommendations to reduce medication errors and harm is to use the “five rights”: the right patient, the right drug, the right dose, the right route, and the right time.
School staff can administer non-prescription medication when they have written consent from the pupil's parent/carer. It can be beneficial for schools to seek permission to be able to administer some non-prescription medications in the event of a child becoming unwell during the school day.
- collect the medication record.
- collect the medication and dropper/measuring glass.
- collect the child and make feel comfortable.
- ask another staff member to be the witness.
- work your way through the medication record recording relevant details.
- Medication administration. ...
- Right Individual. ...
- Right Medication. ...
- Right Dose. ...
- Right Time. ...
- Right Route. ...
- Right Documentation. ...
- Right Response.
Frequency – how often a medication must be given. MAR – medication administration record. Route – how a medication is given. Time – when the medication is scheduled on the MAR.
- Parenteral – Intravenous, intramuscular, subcutaneous.
Pupils can only be given one dose of paracetamol during the school day. If this does not work contact the parent or carer again. 2. The responsible member of staff must witness the pupil taking the paracetamol and make a record of it.
School staff may administer a controlled drug to the child for whom it has been prescribed. Schools should keep a record of all medicines administered to individual children stating what, how and how much was administered, when and by whom.
There is no legal or contractual duty on teachers to administer medicine or to supervise a pupil taking it.
- Right patient. Check the name on the prescription and wristband. ...
- Right medication. Check the name of the medication, brand names should be avoided. ...
- Right dose. Check the prescription. ...
- Right route. ...
- Right time. ...
- Right patient education. ...
- Right documentation. ...
- Right to refuse.
Nurses' responsibility for medication administration includes ensuring that the right medication is properly drawn up in the correct dose, and administered at the right time through the right route to the right patient. To limit or reduce the risk of administration errors, many hospitals employ a single-dose system.
Today, 10 laws are emphasized to reduce the incidence of medication error: right patient, right drug, right dosage, right time, right route, right to refuse (patient and nurse), right knowledge, right questions or challenges, right advice, and right response or outcome  . ...
Student nurses can, under direct supervision, administer medicines that have been prescribed, with the exception of medicines that are to be supplied or administered as part of a patient group direction (PGD).
In every case, a physician must first verify the medication and dosage before authorizing the administration. Additionally, the physician must be physically present in the facility when the medication is administered.
At each safety checkpoint, the medication is verified with the patient's electronic MAR, confirming the right patient, right medication, right dose, right route, and right time. The third and final safety check is completed at the patient bedside, prior to medication administration.
- Eight Rights of. Medication Administration. ...
- The Right Medication. Right medication: includes verification of the medication order with the label on the prescription drug. ...
- The Right Time. ...
- The Right Dose. ...
- The Right Route. ...
- The Right Position. ...
- The Right Documentation. ...
- The Right to Refuse.
To help reduce the risk of medication errors, nurses are taught the “Five Rights of Medication Administration.” Also known as the "5Rs”, these principles help to ensure the right drug, right dose, right route, and right patient, at the right time.
At each safety checkpoint, the medication is verified with the patient's electronic MAR, confirming the right patient, right medication, right dose, right route, and right time. The third and final safety check is completed at the patient bedside, prior to medication administration.
This includes the traditional: right patient, right medication, right dose, right route and right time. However, the additional five are stressed as equally important: right assessment, right to refuse, right teaching, right evaluation and right documentation.
Most health care professionals, especially nurses, know the “five rights” of medication use: the right patient, the right drug, the right time, the right dose, and the right route—all of which are generally regarded as a standard for safe medication practices.
This procedure provides the process for administering medications to students when they are attending school or school-related activities, in accordance with the advice of the student’s prescribing health practitioner or as an emergency first aid response. Having clear, documented workplace procedures to manage the administration of medications facilitates safe systems of work that ensure student and staff safety, and supports schools to meet legislative requirements, including those relating to health and to work health and safety.
make the SMP available to all staff communicate school processes to assigned officers and health support staff about safely administering medically authorised medication to students in accordance with all instructions (e.g. pharmacy label/medication order/Action Plan/school processes) and the Restrictive practices procedure (for 'as-needed' medication as a non-emergency response) follow approval processes for students who self-administer their medication as per the Guidelines for the administration of medications in schools have processes in place to ensure assigned officers and health support staff safely receive and store students’ medication, and dispose of it when required ensure assigned officers and health support staff are trained in administering medications as relevant to their roles ensure staff who supervise students are offered emergency first aid training as needed ensure documentation, recording and reporting processes are met in relation to the administration of medications determine the school's system for storing students' emergency first aid medication so that it remains with the student at all times, and communicate this system to staff and students determine and communicate the school's processes to ensure emergencies requiring the administration of medication are responded to appropriately and without delay (including situations when relief staff may be involved) communicate relevant requirements about medication management appropriately to parents/carers review the SMP: as soon as practicable following a review incident at least five years after the date of commencement or date of previous review.. have knowledge of the school's SMP safely receive and store students’ medication, and dispose of if required safely administer medically authorised medication to students prepare relevant documentation and accurately record the administration of medication notify the principal/delegate if there is a medication administration error, or if medication is stolen, misused or diverted from the person to whom it was prescribed.. have knowledge of the school's SMP access OneSchool records to note which students have health needs that require medication, including those who are at risk of asthma and anaphylaxis follow the school's system to ensure that students’ emergency first aid medication is with them at all times assist a student requiring emergency first aid medication if required accurately record the administration of emergency first aid medication following administration notify the principal/delegate if there is a medication administration error, or if medication is stolen, misused or diverted from the person to whom it was prescribed.. provide information to the principal/delegate about the student’s health condition/s, including written information from qualified health practitioners, at enrolment or on diagnosis, and provide updated information when any information changes complete the Consent to administer medication form when medically authorised medication is to be administered to a student refer to the information for parents to ensure all documentation required for the safe administration of the medication is provided to the school ensure that enough well-maintained equipment, in-date medication and consumables, labelled clearly with the student’s name, are supplied collect unused medication from the school when it is no longer required or has expired discuss with the school administration if the student may be able to be responsible for self-administration of their medication and complete Section B on the Consent to administer medication form provide the Request for additional medication advice to the student's prescribing health practitioner and return the requested document/s to the school as soon as possible.. Principal/delegate: develops and reviews the SMP (using the SMP exemplar and referring to the guide as necessary) considers completing relevant topics of the Administration of medication in schools (AMS) online training course available on the Learning Place (DoE employees only) to support the development of school processes allocates time for assigned officers and staff to complete relevant topics of the Administration of medication in schools (AMS) online training course arranges and allocates time for staff who supervise students to complete anaphylaxis and asthma management training, including practical training in the administration of emergency first aid medication advises staff that they are provided with the same indemnity and legal assistance as all state employees, in accordance with the Queensland Government Indemnity Guideline .. The principal/delegate will determine and communicate who (e.g. the principal/delegate, assigned officer or health support staff) will be responsible for: contacting the pharmacy identified on the label to confirm the medication has been prescribed, if the pharmacy label is the only form of medical authorisation and the prescribing health practitioner’s name is not listed requesting that the parent/carer contact the pharmacy identified on the label to seek clarification, if the pharmacy label is the only form of medical authorisation and the instructions on the pharmacy label are not legible or easily understood requesting that the parent/carer seek clarification from the prescribing health practitioner if the information on the pharmacy label contradicts the information on the consent form or the medication order/Action Plan.. If principal/delegate approval is required: the principal/delegate will: refer to the Guidelines (Appendix 4: Risk assessment for determining self-administration) and, in consultation with the parent/carer/student and student’s health team, consider the factors and risks involved in safe self-administration of medication approve student to be responsible for possession and self-administration of medication when it is considered that the student can confidently and competently undertake safe self-administration of medication at school record any discussions with the parent/carer and student in OneSchool as a Record of Contact ensure relevant staff are aware of students who are self-administering and self-managing their medications notify staff that they should be trained and prepared to administer emergency medication to the student as a first aid response if required.. If principal/delegate approval is not required (i.e. for self-administration of asthma medication only): the parent/carer/student will advise the school administration that they allow the student to be responsible for self-administration of their asthma medication the principal/delegate will: note those students who are self-administering asthma medication notify staff who supervise these students that they should be prepared to administer asthma medication to the student as a first aid response if the student’s symptoms compromise their ability to self-administer it consult with parent/carer/student if the decision for the student to self-administer their own asthma medication needs to be overturned due to health or safety issues and explain the reasons why overturn the parent/carer/student decision if health or safety risks cannot be controlled or minimised effectively if self-administration is overturned, ensure processes for staff administration of medication to the student are undertaken.. For a student with health needs, health support staff will: follow the student's Emergency Health Plan or Action Plan and any other written instructions from the prescribing health practitioner regarding the administration of the student’s medication if required, immediately phone emergency services (000), request ambulance services, stay on the phone and follow the advice given follow the relevant incident management actions and timeframes in the Health safety and wellbeing incident management guideline (DoE employees only).. The principal/delegate establishes and monitors procedures for safe and appropriate storage of medications (refer to the Guidelines Appendix 1: Considerations for storage of medications) to ensure that: medication is stored in the original containers according to the manufacturer's instructions and special instructions from the pharmacist or prescribing health practitioner (including medication which needs to be stored below 25 ºC); medication required for an emergency response is stored in a safe, unlocked location where it is always easily accessible to authorised people in the event of an emergency; medication is stored (other than medication required for an emergency response) in a: non-portable, locked space such as cupboard/cabinet reserved for medications only; or secure fridge (if required) with authorised access only; or location determined by the principal/delegate to meet the student’s individual health needs.
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It is the manner in which a medicine is administered that will determine to some extent whether or not the patient gains any clinical benefit, and whether they suffer any adverse effect from their medicines.. The bioavailability of the drug; How the drug is given (route of administration).. The equivalent IV dose is 1mg.The route of administration and its formulation (tablet, capsule, liquid) can clearly influence the bioavailability of a drug.. Routes of administration:. Topical administration The topical application of medicines has obvious advantages in the management of localised disease.. While the use of transdermal drug administration is not without its problems - for example, some preparations can cause local skin reactions - many patients find it a welcome alternative to taking tablets.. By altering the formulation of the drug, the period over which it is released can be influenced.. Considerations when preparing an intravenous injection or infusion:. For many years the standard method of medicines administration in the healthcare settings such as hospitals and nursing homes has been based on nurses interpreting a prescription and giving the relevant medicine in the required dose via the required route.
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Still, there are some general RN duties you can expect regardless of employer.. As mentioned before, RN nurses can provide care in a variety of healthcare settings.. A registered nurse’s job description can vary quite a bit depending on the environment and specialty they’re in.. Critical care nurses’ responsibilities include caring for dying patients, inserting life-saving IVs and injections, and educating families on issues such as life support and caring for people with brain injuries.. Ambulatory care is the term applied to nurses who take care of patients outside of hospital settings.. So what does a registered nurse do?
This article explores the medication errors and the phenomena of nurse distractions. Nurses are intimately involved in the medication administration process. Even though the parameters of selection, dosing, compounding, and dispensing medication remain under the purview of other allied health professionals, the nurse represents the last safety checkpoint between the medication and the patient and efforts should be directed toward removing obstacles which are negatively impacting this process. It has long been suspected that nursing distractions whether by patient, family, coworkers or others, are facilitating the occurrence of errors in the hospital setting. There are practices which are discussed which may ameliorate this threat to some extent if employed consistently and judiciously.
The nurse can then retrieve the medication, scan the patient’s armband and determine that it is the correct patient and then scan the medication to insure that it is the correct dose, then administer the medication to the patient followed by timely documentation of the process in the electronic health record (Gann, 2015).. This process can be inordinately cumbersome especially considering the nurse may have 4 or 5 other patients who also require medications not to mention other aspects of patient care which do not involve medication administration such as toileting, ambulation, dressing changes, safety checks, and patient/family teaching.. This type of interruption makes it difficult to maintain the ordered timeliness of the medication delivery since the nurse will have to manage the existing emergency, and then go back to the patient, and likely initiate the medication administration process all over again or return in the middle of the process, thus increasing the chance that the nurse will omit a critical step in this process and possibly cause an error.. Some hospitals have implemented a system where if a nurse is at the medication dispensing machine, calculating a medication, titrating or adjusting an intravenous drip, or is in the patient/medication scanning phase of the medication administration process, it is understood that they are not to be interrupted (Bower, Jackson & Manning, 2015; Bravo, 2016; Cloete, 2015).. Tucker & Spear (2010) found that when physician’s interrupted nurses during medication administration to relay redundant messages such as “I have written new orders” often had the effect of making the nurse feel frustrated and demeaned as they are well-aware of the need to check for new orders and the procedure for checking new orders is hardwired into their daily practice.. Finally, some hospitals have the nurses wear a lighted lanyard which blinks when the nurse is involved in medication administration or medication calculation or titration (Umeda, 2014).. A bundle for reducing nurse interruptions while administering medications might include the following elements: 1- a checklist to ensure that all elements had been covered, 2- clearly delineated areas dedicated to medication procurement and preparation, 3- staff education regarding the importance of not interrupting the nurse during these times, 4- an item of clothing clearly marked or visible which is worn by the nurse during medication administration, 5- no more than two individuals permitted in the medication room at a time, 6- patient, family and visitor education regarding the importance of not needlessly disturbing the nurse while procuring and administering medications, 7- electronic notification to the front desk of the unit that a nurse is involved in medication administration and 8- health unit secretary training on not forwarding calls to the nurse while engaging in medication administration.