Managing medication

Linda NazarkoNurse consultant

https://uk.linkedin.com/in/linda-nazarko-1952a746

Aims and objectives To be aware of: Legal and professional responsibilities The five rights of medication How systems and processes can

improve safety How to reduce the risk of errors High risk medications Resident’s difficulties with medication

Legal responsibilites Care Quality Commission

Standards (2010) (outcome nine p104-109)

Regulation thirteen of the Health & Social Care Act.

National Institute for Health and Care Excellence (NICE) (2014) guidance on medication management in care homes.

NICE StandardsRecommendation CommentsResidents involved in care and treatment decision

Provide support to enable residents to make decisions. Record on care plan and update regularly

Care homes must have a written policy

Policy details of how the care home share information about medicines, keeps records on medication, manage drug errors, list and review medications, order receive, store, dispense and dispose of medicines

Prescribers should assume that people who live in care homes are able to make decisions about their own medicines.

If a prescriber is concerned about a person's ability to make such decisions, they should check whether the person is able to understand why, for example, a new medicine is needed before offering it.

Providers of health or social care services should have processes in place for sharing accurate information about a resident's medicines

This should include details of medicines that is recorded and transferred when a resident moves from one care setting to another e.g. from hospital to care home and care home to hospital

Commissioners and health and social care services should ensure a robust process is in place for identifying, reporting, reviewing and learning from medicines errors

Responsibility shared between health and social care.

Medication errors Older people vulnerable to adverse effects

medication

Between 5-15% of older people admitted to

hospital because ill effects medication

Around 40% of older people in nursing homes

may be prescribed medicines inappropriately

Stages at which errors occur

Prescribing and monitoring Ordering Dispensing Administration

Prescribing & monitoring

Medical history Good information from hospital Knowledge drug interactions Routine monitoring Minimise medication

Medication review50% require a review & 47% of reviewed medications discontinued. Problems identified:Side effectsNot takingIneffective treatmentUnnecessary treatmentInappropriate treatmentTreatment not indicated

Ordering

Consider lead person(s) to check stocks, order medication and ensure reviews carried out

Electronic prescribing coming

Dispensing Lack information Some research

-7% medication mis-labelled

Change working practices reduce errors

The five R’s of medication administration.

Right resident

Right medication Right route Right dose Right time

Medication administration errors

Nurse should follow procedures

If problems with procedures report it

If the system is broken we need to fix the system not shoot the messenger

Ways to reduce risk of errors

High risk medications Warfarin, Insulin, antiplatelet drugs such

as aspirin and clopidogrel, and oral hypoglycaemic drugs such as metformin high risk adverse reactions (Budnitz et al, 2011). The risks increase as the number of medications rise.

Potential drug interaction risk when patients are taking 2 to 3, 4 to 5, and 6 to 7 medications are 39%, 88.8%, and 100

Hypnotics Reduced

awareness Increased risk

falls, pressure damage, dehydration

Not for long term use

Diuretics Can affect renal

function Increase or

decrease potassium

Cause hypotension Increase risk falls Monitoring and

blood tests

Antipsychotics

Resident difficulties Large pills – hard

to swallow Dry mouth Swallowing

difficulties Adverse effects

Responding to difficulties

Key points Care home residents are vulnerable to

ADRS Home should have systems to enhance

safety Small changes can make a big

difference Work with person to overcome

difficulties

Thank you for listening

Any questions?