There are several possible ways of obtaining a urine speci-men from a baby:
•
A clean catch: aiming to catch the specimen in a sterile bowl or pot. This can be tricky, unreliable, and time consuming, but remains the method of choice.•
Use of a sterile adhesive specimen bag. This can cause excoriation to the skin and can be contaminated by faeces.•
Use of urine collection pads. Placed in the nappy, they too can be contaminated.|
17| Chapter
Principles of elimination management: obtaining urinary and stool specimens
SUMMARY
•
Specimens should be obtained, labelled and dispatched correctly.•
A catheter specimen is taken from the recognized port using an aseptic technique, causing minimaldisruption to the closed drainage system.
•
An MSU is the middle part of the voided urine, the bladder should be at least half full before collecting the specimen.•
Urinary specimens from babies may be obtained using a specimen bag, a ‘clean catch’, sterile suprapubic aspiration or a newer bladder stimulation technique.•
Stool specimens from the woman are obtained from a clean bedpan; from the baby, they are obtained from the baby’s nappy.•
Using the scoop, place the stool sample in the specimen pot, illing approximately one-third of the container, and seal the lid.•
If any parasite is visible, aim to place all of it in the pot.•
Dispose of equipment, wash and dry hands, label and dispatch specimen, document indings (including stool classiication) and act accordingly.PROCEDURE: stool specimen (baby)
•
Gain parental consent•
Observe the baby for signs of straining (to obtain a fresh specimen).•
Decontaminate hands, using non-sterile gloves, ill one-third (if possible) of the stool specimen pot with the stool taken from the baby’s nappy. Avoid contamination with urine if possible.•
If the stool is too wet and has been absorbed, efforts should be made to catch the sample in a sterile foil bowl on the next evacuation.•
Remove gloves, wash and dry hands.•
Label and dispatch specimen (immediately for some screenings), indicating whether contamination with urine was likely.•
Document indings and act accordingly.Figure 17.2 Bristol stool classiications. Type 1, separate hard lumps; type 2, lumpy sausage; type 3, sausage but with cracked surface; type 4, smooth sausage; type 5, soft blobs; type 6, mushy/luffy; type 7, watery, no solid.
1. Separate hard lumps 2. Lumpy sausage 3. Sausage but with cracked surface
4. Smooth sausage 5. Soft blobs
6. Mushy/fluffy 7. Watery, no solid
ROLE AND RESPONSIBILITIES OF THE MIDWIFE These can be summarized as:
• explaining the procedure and gaining consent
• ensuring correct specimen collection and dispatch
• knowledge and application of infection control and standard precaution protocols
• correct documentation and action on results.
Dimech, A., Dougherty, L., Forsythe, C., et al., 2011. Doughty, L., Lister, S.
(Eds.), The Royal Marsden Hospital Manual of Clinical Nursing Procedures, eighth ed. Wiley Blackwell, Chichester, pp. 618–622, 684–690. (Chapter 11).
Dolan, V., Cornish, N., 2013. Urine specimen collection: how a multidisciplinary team improved patient outcomes using best practices.
Urol. Nurs. 33 (5), 249–256.
Gilbert, R., 2006. Taking a midstream specimen of urine. Nurs. Times 102 (18), 22–23.
Herreros Fernandez, M., Merino, N., Garcia, A., et al., 2013. A new technique for fast and safe collection of urine in newborns. Arch. Dis.
Child. 98 (1), 27–29.
Leaver, R.B., 2007. The evidence for urethral meatal cleansing. Nurs.
Stand. 21 (41), 39–42.
Lifshitz, E., Kramer, L., 2000. Outpatient urine culture. Arch. Intern. Med. 160 (16), 2537–2540.
Loveday, H., Wilson, J., Pratt, R.J., et al., 2014. epic3: National Evidence-Based Guidelines for Preventing Healthcare – Associated Infections in NHS
Hospitals in England. J. Hosp. Infect.
86 (Suppl. 1), S1–S70.
NICE (National Institute for Health and Care Excellence), 2008. Antenatal Care Routine Care for the Healthy Pregnant Woman. CG 62. NICE, London. Available online: <www.nice .org.uk> (accessed 4 March 2015).
Rowley, S., Clare, S., 2011. ANTT: an essential tool for effective blood culture collection. Br. J. Nurs.
(Intravenous supplement) 20 (14), S9–S14.
REFERENCES
SELF-ASSESSMENT EXERCISES
The answers to the following questions may be found in the text:
1. Discuss at least six considerations that form good practice for specimen collection.
2. Describe how a catheter specimen of urine is obtained.
3. Why is a midstream specimen of urine so named?
Describe how one is collected.
4. List the ways a urine specimen may be obtained from a baby.
5. Describe how a stool specimen is obtained from a woman.
6. Summarize the role and responsibilities of the midwife in relation to specimen collection.
Principles of drug administration: legal aspects, pharmacokinetics and anaphylaxis
Chapter
Self-assessment exercises 152
References 152
LEARNING OUTCOMES
Having read this chapter, the reader should be able to:
•
discuss the responsibilities of the midwife in relation to drug administration, particularly identifying the legal framework that the midwife works within and the autonomous administration of medicines under Midwives Exemptions•
identify the classiications of drugs and discuss briely the implications of using them ‘off label’•
discuss the nine ‘rights’ of safe medicineadministration and the full information required for a correct prescription
•
describe the safe administration of controlled and all other classiied medicines (in this text: known as non-controlled drugs)•
highlight the process for the supply, storage, and surrender of controlled drugs in the hospital and community settings•
discuss briely the issues that should be considered when women self-medicate•
understand how drugs are absorbed, distributed, metabolized, and excreted, for both pregnant women and neonates•
recognize the signs and symptoms of anaphylaxis and discuss the management of this condition.This chapter considers the legal regulations covering drug administration by the midwife. It includes guidelines for the safe administration of medicines, including controlled
18
CHAPTER CONTENTS
Learning outcomes 143
Legislation 144
Midwives Exemptions 144
Which medicines may be given under
‘Midwives Exemption’? 144
The administration of any medicine 144
Prescriptions 145
Patient group direction 145
PROCEDURE: administration of a
non-controlled drug 145
Self-administration of medicines 146
Controlled drugs (CDs) 146
PROCEDURE: obtaining a supply of controlled drugs – midwives supply
order 147
Administration of controlled drugs 147 PROCEDURE: administration of a
controlled drug 147
Role and responsibilities of the midwife 148
Summary 148
Pharmacokinetics 148
Adult pharmacokinetics 148
Neonatal pharmacokinetics 150
Summary 150
Anaphylaxis 150
Signs and symptoms 150
Management of severe anaphylaxis 151 Role and responsibilities of the midwife 151
Summary 152
circumstances (see Midwives Exemptions below). Some-times medicines may be used in a different way from what they were originally licensed for, e.g. given via a different route. When a medicine is used in this way (‘off label’ or
‘off licence’), the prescriber and dispenser take full respon-sibility for its use (NMC 2007), recognizing that it is a risky action to undertake. It can also mean that gaining informed consent is more dificult. Medicines should always be stored according to the guidance on the label and, in hos-pitals, in agreed storage facilities (in locked cupboards or fridges, with only approved staff able to carry or access the keys).
Midwives Exemptions
Under the Acts of Parliament that govern midwifery prac-tice, midwives are given exemption to supply medicines, in the course of their professional practice, that are on the P and GSL lists, and some items that are POM. Midwives exemptions were previously called standing orders, but this term is no longer applicable. Midwives should be clear that they can only administer medication if they are familiar with its use, dosage, side effects, precautions, contraindica-tions and method of administration (NMC 2007, Anon 2010). This administration does not need a prescription, a patient-speciic direction (PSD) or a patient group direction (PGD) (see below). If, however, the medicine is not on the exemptions list then one of these will be required.
Which medicines may be given under ‘Midwives Exemption’?
The full Midwives Exemptions POM list can be viewed on the NMC website (NMC 2011). Examples include diclofenac, hydrocortisone acetate, miconazole, nystatin, phytomena-dione, sodium chloride 0.9%, cyclizine lactate, anti-D immunoglobulin, pethidine hydrochloride, oxytocin, and lidocaine. Student midwives were, from 2011, permitted, when under the supervision of a sign-off mentor, to admin-ister the medications on the Midwives Exemption list, except for controlled drugs (NMC 2011). Being supervised by a sign-off mentor means in this context that the student must be physically watched administering the medicines.
Student midwives may participate in the preparation and checking of controlled drugs if they are again being directly supervised by a sign-off mentor.
The administration of any medicine
Medicines, prescribed and given correctly, can make a sig-niicantly positive difference to patients. However, given incorrectly, the harm caused can have far-reaching conse-quences both in human and monetary terms. Matthew drugs, and guidelines for the management of anaphylaxis.
Pharmacokinetics aids the midwife’s understanding of drug administration, this is discussed for both the woman and the baby.
Effective drug therapy needs the appropriately researched and manufactured medicine to enter, get around and ulti-mately leave the body. The action of the medicine and the effects on the person should be as expected (Jordan 2010).
This all suggests that safe and effective medicine adminis-tration is a complex issue, beginning long before the midwife administers the medicine to the woman.
Some drugs in the maternal circulation do not pass through to the fetus during pregnancy and labour, as the placenta acts as a barrier. However, some drugs are able to pass through the placental barrier and can have an effect on the fetus (e.g. pethidine). Drugs may also pass from the maternal circulation to the baby via breast milk. This chapter does not consider fetal pharmacokinetics or drugs and breastfeeding, as the reader is directed towards the growing number of books that look speciically at these issues.