Applied medicines management

medicine

• Substance applied to the body to restore or preserve optimum heath

• Contain active ingredients which, if used correctly make people better

• Can cure or arrest disease, relieve symptoms and ease pain

• Medicine support - any support that enables for a person to manage their medicines

GSL

General sales list medicines - medicines that can be bought without a prescription

examples

• asprin, paracetamol

P

pharmacy only medcines - bought at pharmacies - behind the counter under the supervision of a pharmacist

examples:

• co-codamol, lactulose solutiom. emergency contraception

POM

Prescription only medicines - medications that can only be obtained with a valid prescription from a licensed healthcare professional.

examples:

• naproxen, amoxicillin. atrovastatin

CD

Controlled drugs - drugs that have the potential to be abused or stolen and are subject to strict regulations regarding their production, distribution, and usage.

Drug stock balance sheet must be in place prior to administration

Dispose of patches appropriately - CD destruction kit - should be recorded on stock balamce sheet - new patch on different area and date written on patch

examples: diazepam. methadose, fentanyl, pregablin

indications

circumstances where medicines should be given

contra-indications

circumstances when medicine shouldnt be givedue to potential harm or adverse effects

special precaution

Specific guidelines to ensure safe use of a medicine in particular populations, such as those with certain health conditions.

medicine brand names

chosen by original manufacture on the basis it can easily be pronounced

medicines generic name

 The name given by manuacturer who developed the medication - usually the active ingredient

administration - how must it be done?

• Must be done in accordance with prescription, patient specific direction and patient group direction (for instance over 40's etc)

• Non-prescription only drugs  - administered accordance to locally written and agreed policies or protocols (your discretion)

• Good practice for a second checker

• Must have a good understanding of medicine being administered and seek advice if necessary

• Its important to understand benefits and limitations of the routes of administration

routes of administration

• Drops (eyes, nose ears)

• Oral

• Urinary tract or vaginal

• Inhalation

• Injection

• rectal

• buccual and sublingual routes - for emergencies

transdermal administration

• emollients

• Sooth, relieve itch, producing an oily layer on skin's surface which traps water beneath

• It helps restore the skin’s barrier function with emollients, prevents irritants, allergens and bacteria from entering the skin.

• Finger tip units.

capsules vs tablets

• tablets - longer shelf life, accommodate for higher doses, and can have an imprint code

• capsules - faster acting but expire quicker

• frequency of both depends on:

  • how the drug is ADME

  • how long the therapeutic window is (stability in the bloodstream)

responsibility and risk of delegation

• When delegating to a non-registered healthcare professional the registered nurse maintains overall responsibility for patient and is accountable for their own actions

• Registered nurses should ensure that the person whom delegating has sufficient training, competence and experience

• Clear procedure for communication must be available at all times for answering queries  or escalation of concerns of unregistered staff

level one - self medicate

A category of medication management where individuals can safely manage their own healthcare needs without professional intervention.

Assessed to be mentally and physically competent

level two - physically assisted self medication

A category of medication management where individuals receive assistance with taking their medication but still participate in self-administration. This level is for those who may require help due to physical limitations but can make their own healthcare decisions.

level three - complete medication management

A category of medication management where individuals require complete assistance in taking their medication and rely on healthcare professionals for this process due to significant challenges in self-administration.

assessed to be not mentally competent

storage of medication

• always be stored in the original container, drawer or cabinet

• If the individual is self-managing or assisted, safe storage advice should be provided

• Any labelling must not be changed

• Medication cannot be administered from monitored dosage systems filled by carers or family members

• Monitored dosage systems cannot always be supported by community pharmacies 

 

6 R’S

1. right DRUG

2. right DOSE

3. right TIME

4. right ROUTE

5. right to REFUSE

6. right PERSON

What to do when prepping medication?

• Prescribing information contained in the MAR/prescription/authorisation sheet must be checked

  • Topical information should be applied according to body map.

  • All oral liquids must be measured using graduated medicine cups, graduated spoons, or oral syringes.

  • Consent must be obtained

  • Half a glass of water.

  • Do not mix together.

  • Must be observed.

  • If refused, encourage but return to the prescriber.

ommited or delayed medication

• Time-critical medicines are administered as close to the prescribed time as possible and should never be omitted without a valid reason.

  • Timeliness of administration is critical, and failure to provide it can cause harm.

  • The reason for refusal must be documented in the notes or patient record.

  • The patient should be discussed with a medic, and the incident must be reported in the Datix system if an omission or significant delay in administration occurs.

examples of time critical meds

• Parenteral dose of anti-infective medications (IV antibiotics)

• Insulin

• Regular Parkinson's meds

• Regular opioid analgesia

• Anticoagulation

• Anti epileptic meds

transcribing

is the process of accurately recording a prescription or medication order from one document to another, ensuring all details are correct to facilitate safe administration.

can only be used to make exact copy - cannot include changes to medications

medication errors and adverse reactions

Refers to mistakes in prescribing, dispensing, or administering, which can lead to harmful effects on patients, including unexpected side effects or negative responses to drugs.

A medical professional should:

• Try to retrieve medication if possible.

• Observe the patient for any ill effects and record the patient's vital signs as appropriate.

• Follow the instructions/advice given by the doctor.

• Inform the patient/carer of the action taken.

• Document the incident and the action taken.

• Follow the trust medication error protocol and report the incident via the Datix system within 24 hours.

cytotoxic

Drugs that are harmful to cells and are used in chemotherapy to treat cancer require special handling and safety precautions.

Cytotoxic medication can cause harm to the person administering if not administered correctly

Suitable protective clothing must be worn

If a drug contaminates the skin or mucous membranes, was immediately

Waste must be disposed of in 'purple lidded' cytotoxic bins

drug interactions

• synergistic = when the effect of a drug is increased

• antagonism = the effect of a drug is decreased

black triangle drugs

new drugs on the market, period of monitoring for 5 years

documentation

Recording must be done in black ink;

any errors should be crossed out with a single line, and initials, date, and time must be documented.

yellow card scheme

a system for reporting suspected adverse reactions to medicines, vaccines, medical devices, and other healthcare products in the UK

when to use:

• Suspected adverse reactions to medicines

• Incidents involving medical devices: 

• Defective or counterfeit medicines or medical devices :

• Serious suspected adverse drug reactions (ADRs)

• ADRs in children and elderly individuals. 

• Any other safety concern related to a healthcare product

BNF/patient leaflets

contain info on:

• indication

• Contraindications and cautions

• Allergy and cross-sensitivity

• Side-effects (listed from very common to frequency unknown)

• Patient and carer advice

• Other drugs in class

• Medicines (the drug in all the forms on the market – including branded versions)