NMC Code Section 18: Medicines Administration

Section 18 of the Code covers medicines.

“Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations.”

Sub-clauses:

• 18.1 Prescribe, advise on, or provide medicines if you are suitably qualified and legally permitted to do so.
• 18.2 Keep to appropriate guidelines when giving advice on using controlled drugs and recording the prescribing, supply, dispensing or administration of controlled drugs.
• 18.3 Make sure that the care or treatment you advise on, prescribe, supply, dispense or administer for each person is compatible with any other care or treatment they are receiving, including (where possible) over-the-counter medicines.
• 18.4 Take all steps to keep medicines stored securely.
• 18.5 Wherever possible, avoid prescribing for yourself or for anyone with whom you have a close personal relationship.

Medicines errors are the most common patient safety incidents in UK healthcare. Section 18 is the section behind every dose round, every prescription review, every controlled drug check.

What it means in practice

The five rights of medication administration (right patient, right drug, right dose, right route, right time) are the operating framework. Chapter 89 covers them in detail.

For each medication you administer:

• Check the patient’s identity: wristband, name, DOB.
• Check the prescription: name of drug, dose, route, frequency, signed by prescriber.
• Check the drug: name, dose, expiry, appearance.
• Check for allergies and interactions: patient record, BNF.
• Document immediately: drug, dose, route, time, signature.

Controlled drugs require additional steps: witnessed administration, balance check, entry in the controlled drugs register.

Common breaches

• Wrong-patient administration: usually a failure to check identification.
• Wrong-drug administration: wrong drug taken from cupboard or stock.
• Calculation errors: drug calc errors, especially in paediatrics or critical care.
• Missed doses: drug not given when due, sometimes without documentation.
• Controlled drug discrepancies: counts not matching, witness signatures missing.
• Self-prescribing or prescribing for family (where the registrant is a prescriber).

The serious cases that reach fitness-to-practise tend to involve harm: a missed antibiotic that led to deterioration, an incorrect anticoagulant dose causing bleeding, a controlled drug diversion.

CPD that maps to Section 18

• Medicines management training: mandatory in most NHS trusts.
• Drug calculations: covered in Chapter 88.
• Pharmacology updates: relevant to your area of practice.
• Controlled drugs training: for nurses handling CDs.
• Prescribing CPD: required for nurse prescribers (separate framework).
• Specialty drug knowledge: oncology, paediatrics, mental health, etc.

Common reflective account themes

Strong Section 18 accounts describe:

• A medication near-miss caught by checking, and the protocol change that followed.
• A drug calculation you almost got wrong, and the slowing-down that fixed it.
• A controlled drug discrepancy you identified.
• A drug interaction you spotted that the prescription hadn’t accounted for.

Where Section 18 connects to other sections

• Section 6 (evidence-based practice): prescribing follows current evidence.
• Section 13 (limits of competence): only administer drugs you know.
• Section 19 (reduce harm): medicines safety is harm reduction.

The next chapter covers Code Section 19 on reducing the risk of harm.