Drug Administration

Patient group directions (PGDs) allow nurses and other non-medical staff to give drugs before a patient has been seen by a doctor (DoH 2000). There is little evidence for extending PGDs to authorise nurses and others to administer cardiac arrest drugs in hospital, though some trusts utilise group directives to permit the administration of adrenaline/epinephrine for patients with acute anaphylaxis (NHSE North West 2003). Undertaking an advanced course in resuscitation does not automatically authorise nurses or other non-medical healthcare professionals to administer drugs during resuscitation without prescription. Practitioners should be aware of and be guided by local policies for the administration of drugs and infusions. The fact that the patient has suffered cardiac arrest should not compromise the usual standards for the administration of medicines as, in spite of the emergency situation, incorrect administration of drugs can make matters worse. The pre-filled syringes for different drugs may look similar and are of a standard size. The urgency of the situation and the need for a rapid response to a request for a drug should not excuse careful checking (Nursing and Midwifery Council 2002).

Table 10.1 Drugs and tracheal route (reprinted with permission from Resuscitation Council UK 2000).

Drugs that can be administered Drugs that cannot be administered via the trachea via the trachea

Adrenaline/epinephrine

Vasopressin

Atropine

Lignocaine (lidocaine) Naloxone

Calcium salts Sodium bicarbonate Amiodarone

Cardiac arrest trolleys must contain first-line drugs, ideally in the form of pre-filled syringes (see Chapter 3). There have been calls for a standardised format for drugs kits (Jowett et al. 2001) but in the absence of this, staff should familiarise themselves with the contents of drug boxes on cardiac arrest trolleys. There are two types of syringes in common usage.

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