Despite being a relatively new professional role, the Registered Nursing Associate (RNA) has a key part to play, working alongside registered nurses and other healthcare staff, to ensure patient safety. The Nursing and Midwifery Council (NMC) provides a framework for professional practice and behaviour for nurses, RNAs and midwives in the form of The Code (NMC, 2018a). This clearly sets out several key principles, including those relating to ensuring patient safety, which guide the practice of the RNA.
RNAs have a duty to protect patients from harm. This includes identifying and mitigating risks, promptly reporting any concerns about patient safety, and collaborating with the wider healthcare team to ensure a safe care environment. More specifically, the RNA can contribute to patient safety through a variety of actions including, but not limited to, monitoring patients, infection control, communication, patient advocacy, documentation, collaborative working, and medication administration.
Within the Standards of Proficiency for Nursing Associates (NMC, 2018b), the NMC clearly states that the RNA has a role to play in safe medication administration (Box 1). The specific responsibilities of the RNA may vary, depending on the healthcare setting and their level of training and certification. Safe medication administration is crucial to prevent adverse events, improve patient outcomes, enhance the overall quality of health care and fulfil legal and ethical obligations. The RNA must adhere to best practice, employ effective communication, and continuously update their knowledge and skills. Safety in this area is not only a professional duty but also a moral imperative that RNAs must uphold to maintain the trust and wellbeing of their patients.
Box 1.Administration of medicines: key points from the Standards of Proficiency for Nursing Associates
- 3.15. Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies
- 3.16. Demonstrate the ability to recognise the effects of medicines, allergies, drug sensitivity, side effects, contraindications and adverse reactions
- 3.17. Recognise the different ways by which medicines can be prescribed
Source: Nursing and Midwifery Council, 2018b
When considering medication administration, the RNA has several responsibilities underpinned by the need to adhere to and practise within the law and national and local policy. Having sound pharmacological knowledge is essential to be able to provide a patient and their family with education about the medication being administered. The RNA needs to ensure that a patient has a clear understanding of their medication, which includes why the medication is needed, common side effects, the risks, the benefits, and alternative treatment options. Providing the patient with this information ensures informed consent is obtained in advance of any medication administration.
RNAs administer medication prescribed by other healthcare providers. It is essential that established protocols and safety procedures are followed to ensure that medications are administered correctly. This includes verifying the patient's identity, the right medication, dosage, and route of administration. Accurate record-keeping is essential in medication administration. RNAs are responsible for documenting each medication administered, including the date, time, dosage, route, and any adverse reactions or patient responses. This documentation helps in tracking a patient's medication history and ensuring accountability.
Errors can result in a patient experiencing severe harm, disability, or death. The causes of errors in medication administration are multifactorial and complex. They can be seen to occur when there are weaknesses in systems, human factors or environmental conditions that may impact at any stage within the process. The World Health Organization (WHO) (2017) identified three key areas of action to reduce the risk of errors: addressing polypharmacy, high-risk situations and transition of care. Both RNAs and registered nurses are guided by organisation policy and practice to implement steps to reduce the risk of medication errors. Distractions and interruptions can impact concentration, and therefore approaches used to reduce the risk may include using quiet areas and the wearing of ‘do not disturb’ tabards when undertaking medication administration.
It is important to acknowledge that there are numerous causes of medication errors, as well as preventive measures that can be implemented. The busy and often unpredictable clinical environment can be considered a high-risk situation; therefore, it is important that the RNA is cognisant of the risk and uses the resources available to them to reduce the risk. Acknowledging that risk exists and that errors can happen lends itself to promoting a culture of learning where monitoring, recognition and reporting in a blame-free culture can facilitate analysis of cause and amending of practice to improve the safety of patients.
The role of the RNA in ensuring patient safety is multifaceted and aligned with the principles of The Code (NMC, 2018a). Ensuring safe medication administration is a professional responsibility for the RNA in health and social care settings. It is essential to protect patient safety, provide high-quality care, and fulfil legal and ethical obligations. By implementing good practices, which include reporting, cause analysis and learning, the RNA can reduce the risk of medication errors and enhance the overall quality of patient care.