If a registered nurse works for a care agency who deliver home care to clients, can they update the medication administration chart at the client’s home using a discharge summary/prescription with a new or altered dose of medications?

Answered by Sheila Scott

You don’t say if the nurse is working in the capacity of a care worker in the service user’s home. If she is working as a care worker, the answer is no. What the RN has done is called transcribing and is something that carries risk and should only be done in exceptional circumstances. The Royal College of Nursing in Medicines Management say, ‘Transcribing can be defined as the act of making an exact copy, usually in writing. Transcribing is the copying of previously prescribed medicines details to enable their administration. Organisational policies and procedures for transcribing must be underpinned by risk assessment. Such policies are clear about who can transcribe when it can be used, and the difference between transcribing and prescribing. Transcribing should not be confused with prescribing or badged as transcribing when in fact it is prescribing. Transcribing can only be used to make an exact copy of medicines that have already been prescribed, for example, patients own medicines that have been prescribed and dispensed by a pharmacy can be transcribed onto a Medicines Administration Record (MAR) chart so their administration can be recorded by the health care professional administering them. In clinical circumstances where transcribing occurs it must be underpinned by training, risk

assessment, an audit trail, and have processes in place to limit errors. Organisational safeguards should be in place to ensure that transcribed information is not inadvertently used as a prescription. Transcribing cannot include any changes to the medication, for example, the timing of, or titration of dose, as this becomes prescribing. For further information, please see the guidance on the administration of medicines in health care, available at rcn.org.uk/clinical-topics/ medicines-management/professional-resources Local policies that support both administrations and transcribing should also be referred to.’ I would suggest you undertake a fact find to understand why the RN did this if she has acted outside her role ie an employed care worker you may need to consider discipline procedures and a safeguarding referral. The NMC may also need to be notified depending on the outcome.