Background In a hospice inpatient unit (IPU), registered nurses (RNs) raised concerns about time taken to administer controlled drugs impacting on patient waiting time for pain and symptom control and limiting the time available for other RN activities.
Aim To enhance person-centred practice around pain and symptom control by using a practice development (PD) approach to implement single nurse controlled drug administration (SNCDA) in a hospice IPU.
Method A Practice Development approach using collaboration, inclusion and participation (McCormack, Manley & Titchen, 2013) was used throughout.
A literature review and staff engagement sessions to elicit an overview of values and beliefs informed policy, procedure and risk assessments.
A programme of education was developed in collaboration with the MDT including facilitated critical reflection.
Programme implementation phases
IPU managers undertook programme
Self–selecting Band 5 RNs undertook programme
Joint working with another local hospice which has offered a peer review and ensured sustainability of the education programme.
Claims, concerns and issues (Guba & Lincoln, 1989) exercise around prescribed medication with all RNs.
Patient and family experience with pain and symptom medication sought through direct engagement and review of general hospice feedback
Focus groups with RNs
Review of CD administrations procedure pre– and post–implementation
Mapping against the Person–centred Practice Framework (McCance & McCormack, 2017).
Results RNs described moving through a period of anxiety to feeling overall confidence, autonomy, safety, trust and eventual sense of liberation and empowerment through the process. They reported reduced waiting and quicker response times for patients requiring controlled drugs since the commencement of the SNCDA programme. In a 24 hour period 14 hours of nursing time was released for other activities.
Conclusion SNCDA has a positive impact for patients and RNs in supporting pain and symptom management. A PD approach supported staff to embrace SNCDA and enhanced person-centred practice.
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