Medicines Optimization in Healthcare

Introduction

It is term coined by the United Kingdom Medicines and Healthcare Products Regulatory Agencies (MHRA) which denotes the following – “The clinical, cost-effective and safe use of medicines to ensure patients get the maximum benefit from the medicines they need, while at the same time minimising potential harm.” According to the version of the National Prescribing Centre, 2002 it is defined as the optimisation of the medicine by using a system of procedure and behaviours which determines that how a medicine should be managed by the NHS and the patients. The nurses should satisfy the following conditions to prescribe the medications:

The nurse or the midwife should be engaged to a healthcare facility provisioning services in a health care setting.

The medicine product has to be prescribed during the usual course of the service within a health care setting by the employed or registered nurse.

The prescription of the medication should be issued within the general course of provision prevailing in that healthcare setting (BRADY, et al, 2009; Choo, et al, 2010).

The major factors associated with the scope of practice of the nursing which includes the following: the competence level of the nurse, the responsibility of the nurse and the prevailing autonomy of the nurse, the contribution of the nurse in the development of the profession, the support offered by the nurse concerning the professional practice, delegation and the service provided by the nurse in the emergency situation. The medicine management aspect for nursing care to children is very crucial as nurses should demonstrate the efficient skill of medicine management and calculation of dose of the medicine while administration. The nurses should monitor the response of the children to the prescribed medication, the management of the risk associated such as the human error. They should work as a team with the children and their families for providing effective care. The nursing intervention concerning the medicine management to mental health problems associated adults to understand the needs of the person who is prescribed with medication, to assess the positive effects and the adverse effects of the medicines, and the information exchange. Mental health nurses are playing the most important part of medication management as they can prescribe and administer medication, can give advice to the patient and their families, should communicate with the other healthcare staffs regarding medication and also assessing the outcome of the medication. Similarly the patients with learning disability may face problems to communicate about the preferences of medicines, the possible effects and side effects of medicines. The nurses should play the role regarding these activities and they also need to communicate with the clinicians becoming the spoke person of the patient. They also need the appropriate medicines to augment their mental and physical health so any kind of Medication Administration Errors (MAEs) which are frequent and can have serious implications (ABA, 2000; McGill, et al, 2006; Hemingway, et al, 2014; Dickens,2006) .

Understanding the fundamental principles of pharmacology within the nursing practice:

Based on the evidence of the best practice the preparation and the administration of the medication should be done by that particular nurse. Midwives should also retain the accountability of the administration of the medication administered and do not demand the monitoring of their work by any other colleague. Double-checking of the medications is mandatory in case of application of medication of high alertness. It significantly reduces medication errors and ensures good at the same time safe medication management. The drug Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) and it is a first member of the propionic acid derivatives which is administered to patients suffering from pain, fever and inflammation. It is considered as the safest conventional drug by the spontaneous adverse drug reaction reporting system. The drug non selectively inhibits the cyclo-oxygenase-1 (COX-1) and Cyclooxygenase-2 (COX-2) which are required for the synthesis of prostaglandins. The drug reported to have prominent analgesic and antipyretic role. The associated adverse reactions with the use of this drug are gastric discomfort, nausea, rash, swelling of face, throats and arms, loss of appetite and vomiting. The nurses should check the vital signs and the laboratory findings of the patient prior to administration of the drug. The drug is usually applied in the dose of 400 to 800mg three times per day. The drug can be administered orally and the peak concentration of the drug is achieved in the serum within 1-2 hours. The drug is insoluble in water with PKa value of 5.3.The drug is rapidly transformed in the body with a serum half life of 1.8-2 hours and the entire drug (about 90%) is eliminated from the body within 24 hours after the last administration of the drug through the urine. It remains about 99% protein bound and the extensive metabolism of the drug takes place in the liver and the little portion that gets excreted remains unchanged. The drug can be administered in the fasting conditions or before meals which will yield the same serum concentrations within the same time. If the drug is administered after meal, there is a reduction of the rate of absorption. All of the above information should be accurately documented as per the local health service guidelines. The education of the patient and their relatives about the uses of the medicines should be carried out in a comprehensive way. Information regarding the mechanism of action of the medicines, the possible side effects, symptomatic features of the adverse reactions, the possible interaction of the medicines with other medications and the food intake, the instructions and the precautions to follow regarding the route, time, and way of administration of the medicines, the importance behind adhering to the prescribe therapy and reporting after the regular follow up are the part of nurse’s role with respect to medication management. The nurses should discuss about withholding the medicine which has shown any adverse reactions or if the patient refuses to take the medicine with the concerned clinician (Bushra, et al, 2010). Patients with renal failure condition had no effect on the metabolism of the drug as it gets rapidly eliminated because of metabolism.

Legal and Ethical Frameworks to Medication Management:

The medicines can be prescribed after following the guidelines of NICE, national policies of Medicine and Healthcare Product Regulatory Agency. Recent updates on the legal bodies permitting the power to the nurse for prescribing medication according to the laws mentioned by Irish Medicines Board Act (Miscellaneous Provisions) Act, 2006 (No. 3 of 2006) and Medicinal Products (Prescription and Control of Supply) (Amendment), Regulations 2007 (SI 201 of 2007). Moreover based on the guidelines of the 2007 Regulations it gives the power to health service provider regarding the other conditions that could limit the prescribing authorisations of the nurses/midwives. It is also stated that the An Bord Altranais registration number otherwise known as the Personal Identification Number (PIN) should be mentioned in the prescription. The Misuse of Drugs (Amendment) Regulations, 2007 (SI 200 of 2007) detailed about the prescription norms of the controlled drugs by the nurses. Further information about the prescribing practice of the nurses is mentioned in the Practice Standards for Nurses and Midwives with Prescriptive Authority (An Bord Altranais, 2007). Therefore the Irish Medicines Board (Miscellaneous Provisions) Act, 2006, Medicinal Products (Prescription and Control of Supply) Regulations, 2003 and 2005 and the Misuse of Drugs Acts, 1977 and 1984 related regulations authorizes the nurse concerning the possession, supplying and administration of the medicinal products to the service users. The Pharmacy Act, 2007 declares about the pharmacy regulation which includes the authority for sale and the further supply of the medications. The Medicine Act, 1968 formulates the legal framework for the manufacturing, licensing, prescribing and administration of the medicines as per the guidelines of NMC code, 2007 (ABA,2000; ABA et al, 2005; Bulechek, et al, 1999). According to the guidelines of MHRA, the drug ibuprofen cannot be prescribed in high doses for patients suffering from cardiovascular diseases. If the patient is using the prescription ibuprofen then no one else should take the medication. It is also important to keep a note of all the medicines that the patient is consuming with the drug ibuprofen be it vitamins or any dietary supplement.

Safe administration of Medication:

The nurses should verify the prescription order prior to the administration of the medication. Any possible doubts regarding the medication have to be clarified during that particular time with the concerned clinicians. The expiry date of the medicine has to be ensured prior to the administration. Five rights of safe administrations are followed by the nurses:

1) The right medication: the prescription order should be matched with the labelling of dispensed medicines. The drug ibuprofen will be administered by the nurses mentioned at the appropriate dose as mentioned by the physician. The best practice indicates about the use of the generic name (ibuprofen) of the medication always. Motrin and Advil are the few brand names of the drug ibuprofen.

2) The right patient: the nurses should be confident about the uniqueness of the person concerned with the specific medication. The medication record number or the identification band should be checked. The nurses should ask the patient to state their name and age before administration of the medicines as these parameters are ensuring the correct identity of the patient. The group of patients that had been administered with the drug ibuprofen were suffering from the pain of rheumatoid arthritis (RA). The nurses should check the photograph of the patient prior to the administration the drug to the patients. Approximately 1% of the patients suffering from RA administered with ibuprofen reported about the gastrointestinal bleeding.

3) The right dosage: The nurses should check the dose of the medication based on the age, size and vital signs of the patient. The drug ibuprofen should not be administered more than the recommended dose. The usual dose of ibuprofen is 400 to 800 mg about three times per day.

4) The right form: The nurses should also ensure about the right form and route of administration of the medication that has to be prescribed. In case any information is not available on the label of the medication or in the prescription then it should be discussed with the clinician or the medication can be provided through other routes. The drug ibuprofen can be administered either orally or by intravenous application at the above mentioned doses. The group of patients had been administered with the drug via oral route.

5) The right time: the drug ibuprofen was administered just before the meal and about three times a day at the prescribed dose. The drug can be administered orally and the peak concentration of the drug is achieved in the serum within 1-2 hours. The drug is rapidly transformed in the body with a serum half life of 1.8-2 hours and the entire drug (about 90%) is eliminated from the body within 24 hours after the last administration of the drug through the urine. The drug can be taken with food or milk to prevent gastric discomfort. Therefore the nurses should keep a detailed record of the time of the medication administration. (Otero, et al, 2014; Deans, et al, 2005; Bushra, et al, 2010).

Ordering, storing, dispensing and disposal of medicines:

The drugs ibuprofen tablets should be stored within an enclosed light resistant container within the temperature of 15 – 30• C (room temperature) and away from excess amount of heat and moisture to keep it safe from the other medicinal products ensuring additional safety. This medication should be kept out of reach of the children. The unneeded medications should be disposed off in such a manner so that children, pets and other people should not access the medicine or accidentally consume the product. This particular medicine cannot be flushed down the toilet. The most preferred way to get rid of the medication is through the medicine take-back program. The drugs should be stored in a locked container so that the children cannot access the medicine (Saville, et al, 2001).

The patient group direction is a legal framework that permits the registered health professionals to administer certain medications to a specified group without any consultation of a doctor or nurse prescriber. It is a written instruction for the administration of medicines by the health professionals to the group of the patients who meet the criteria of PGD. The following controlled drugs can be included in a PGD are Schedule 2: Morphine and diamorphine, Ketamine; Schedule 3: Midazolam, Schedule 4: All drugs except the anabolic steroids; Schedule 5: All drugs. The drug ibuprofen is a suitable choice for PGD (Kaufman, et al, 2010; Ngo, et al; 2010).

Disadvantages and advantages of working in partnership with the service users for medicine management:

Self administration of medication denotes the situation when a patient residing at a care home can take their own medicines as every patient have the right to choose and manage their own medicines. The associated advantages of self medication are that the patient gets used to take the medicines in presence of the nursing staff and knows the relevant information about the drug. Therefore, the patient develops the habit of managing their own medication before being discharged from the hospital. The family members possessing the valuable information about the drug can be utilized in an effective way. The disadvantages of self medication administration are that the medicines have to be dispensed in different bottles by the pharmacist which is a labour intensive task. Sometimes the patient does incorrect diagnosis, delays in taking medical advice, adverse drug interactions, wrong administration and wrong dose of medication. If the patient forgets to take ibuprofen at the right time then the medication should be taken as soon as possible. The drug ibuprofen should not be administered by self as it can be cause severe adverse condition when administered with other medication. The nurse should educate the patient and families about the medication, adverse reaction of medication, about the importance of dosage of medication and adherence of strictness to prescription. The verbal communication should be reinforced with a written documentation. The carers and the family members of the patient should also participate in the self administration of medication (Manias, et al, 2004; Saville, et al, 2001).

Application of the mathematical skills to calculate doses of the prescribed medication:

The nurses should have strong capability of the mathematical calculations as wrong calculation of the drug dose can lead to potential medical errors. The administration of over dose of ibuprofen may result in dizziness, fast movement of the eye, slower rate of breathing and bluishness of the lips, mouth and nose. Therefore, to avoid any medication errors the dose has to be administered at the right amount by calculation. During this time the mathematical calculation ability of the nurses plays the role as the dose has to be titrated against the response. According to the guidelines of the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) any nurse should not be extremely dependent on the calculators during preparation of the drugs (Haigh, et al, 2002; Wright, et al, 2005; Saville, et al, 2001).

Working as a team to deliver effective patient care by the nurses:

Now days the healthcare organisation is operating with a multidisciplinary approach to provide effective patient care to the people. The nurses would have to work with the physicians and the specialists so that an organised and complete care could be provided. The teamwork is very important as it results in effective communication between the patient and the healthcare staff such as doctors, nurses and other staffs which has produced positive outcome regarding the patient care service and well being of the patient. The other factors such as ageing populations and the rising cases of chronic diseases such as diabetes, heart related disease, cancer are pressurising the medical health team to take up a multidisciplinary approach. Moreover, the teamwork also reduces the potential chances of medical errors and ensures patient safety. Due to effective communication with the medical health team the patient and their families feels very much at ease and satisfied with the healthcare organisation.

The Nursing Pan London Assessment Document (PAD) 2.0 is designed to ensure that the student nurses are trained successfully to meet up the desires of the Future Nurse: Standards of proficiency for registered nurses (NMC 2018). The role of the midwives during the 21st century is to offer care for people of all age and all settings such as those having complicated mental, physical, cognitive and behavioural demands (Valentine, et al, 2015; Manias, et al, 2015).

References:

ABA, A.B.A., 2000. Review of scope of practice for nursing and midwifery: final report/An Bord Altranais. -3663.

BRADY, A.M., MALONE, A.M. and Fleming, S., 2009. A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal of nursing management, 17(6), pp.679-697.

Choo, J., Hutchinson, A. and Bucknall, T., 2010. Nurses' role in medication safety. Journal of nursing management, 18(7), pp.853-861.

McGill, P., Papachristoforou, E. and Cooper, V., 2006. Support for family carers of children and young people with developmental disabilities and challenging behaviour. Child: Care, Health and Development, 32(2), pp.159-165.

Hemingway, S., 2014. Medication management in mental health: nurses’ perceptions of their work with service users and carers. Mental Health Nursing, 34(6), pp.18-23.

Dickens, G., Doyle, C. and Calvert, J., 2006. Reducing medication administration errors in learning disability nursing. Nurse Prescribing, 4(11), pp.470-474.

ABA, A.B.A., 2005. Review of nurses and midwives in the prescribing and administration of medicinal products: final report/[An Bord Altranais, National Council for the Professional Development of Nursing and Midwifery]. -3632.

Bulechek, G.M. and McCloskey, J.C., 1999. Nursing interventions: Effective nursing treatments. Saunders.

Otero, M.J., Moreno-Gómez, A.M., Santos-Ramos, B. and Agra, Y., 2014. Developing a list of high-alert medications for patients with chronic diseases. European journal of internal medicine, 25(10), pp.900-908.

Deans, C., 2005. Medication errors and professional practice of registered nurses. Collegian, 12(1), pp.29-33.

McGuinness, M.L. and O’Halloran, S., National Policy for Nurse and Midwife Medicinal Product Prescribing in Primary, Community and Continuing Care.

Valentine, M.A., Nembhard, I.M. and Edmondson, A.C., 2015. Measuring teamwork in health care settings: a review of survey instruments. Medical care, 53(4), pp.e16-e30.

Manias, E., 2015. Communication relating to family members' involvement and understandings about patients' medication management in hospital. Health Expectations, 18(5), pp.850-866.

Haigh, S., 2002. How to calculate drug dosage accurately: advice for nurses. Professional nurse (London, England), 18(1), pp.54-57.

Wright, K., 2005. An exploration into the most effective way to teach drug calculation skills to nursing students. Nurse Education Today, 25(6), pp.430-436.

Nursing and Midwifery Council (Great Britain), 2008. Standards for Medicines Management: Safeguarding the Health and Wellbeing of the Public Through Professional Standards. Nursing & Midwifery Council.

Bushra, R. and Aslam, N., 2010. An overview of clinical pharmacology of Ibuprofen. Oman medical journal, 25(3), p.155.

Saville, D.J., 2001. Influence of storage on in-vitro release of ibuprofen from sugar coated tablets. International journal of pharmaceutics, 224(1-2), pp.39-49.

Manias, E., Beanland, C., Riley, R. and Baker, L., 2004. Self‐administration of medication in hospital: patients’ perspectives. Journal of advanced nursing, 46(2), pp.194-203.

Kaufman, G. and Fernandes, T., 2010. Developing patient group directions for medicines management. Nursing Standard (through 2013), 24(48), p.50.

Ngo, S.N., Stupans, I., Leong, W.S. and Osman, M., 2010. Appropriate use of non‐prescription ibuprofen: a survey of patients' perceptions and understanding. International Journal of Pharmacy Practice, 18(1), pp.63-65.

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