Medication management is an important aspect of the health care. High risk medicines are highly likely to cause significant patient harm or death in case of misuse or medication error. Every hospital is obliged to ensure medicine safety to reduce cost, minimise ethical and legal issues. Administration of medicine is needed to ensure professional accountability while balancing the effectiveness of medical treatments (Holmqvist, Ekstedt, Walter, and Lehnbom 2018). Safe mediation management increases patient safety and decrease repeated hospitalisation. Good medication management improves patient outcomes. The assignment reviews and monitors the policies associated with medication management and safety. It then discusses the impact of these policies on health and safety. The assignment then provides reflection from personal practice.
In UK medication management and prescription of medicine re regulated by complex of framework of policy, legislation and standards. HQIP commissioned the National Clinical Audit and Patient Outcomes Programme (Simpson et al. 2015). This program conducts audit to ensure there is compliance to the medication management standards (Nursing and Midwifery Council 2015). All the nurses and midwifes in UK are mandated by the Nursing and Midwifery Council (NMC). The NMC standards ensure safe practice in terms of medication administration and prescription. Adherence to the standards will ensure that the patent is benefitted (Nursing and Midwifery Council 2015). Prescription of drugs must consider the efficacy, safety, cost-effectiveness, drug interactions and side effects. Medication management is considered an vital part of the treatment. It is an important measure of professional performance for those who are registered to care for patients (Nursing and Midwifery Council 2015).
The Human Medicine Regulations 2012 is the law related to the human use of the medical products. The authorisation of the product includes a comprehensive regime for the manufacture, sale, supply distribution, advertisement and pharmacovigilence of medical products. It governs the manufacture and import of the medical products (Farre et al. 2017). The NMC standards also regulate the supply of the medicines in addition to its administration. These standards ensure that the supply of the medicines is in alignment with the prescription forms, medication charts, exemption of medicines Act, patient group discussions, and home remedy protocols (Nursing and Midwifery Council 2015). Nurses are responsible for on time reporting of medication error and following events of the patients. Lack of reporting leads to medication errors that are left unnoticed.
Other than that the NHS England proposes the directives for reporting the medication errors. It also conducts clinical audits to identify the incidents of medication errors (England.nhs.uk 2018). These clinical audits ensure that the professionals are accountable for consequences of medication administration (EnglandNHS 2018). The standards mandate that the practioners consider any allergic reaction the prescribed medication, ensure right dosage is given to right patient with right route of administration (England.nhs.uk 2018). The nurses and midwifes are responsible to report any harm due to medical products. In short the clinical audits are the source of improvement in the medication services. Medication errors have been attributed to the shortage of the nurses when compared to number of patients (Ashcroft et al. 2015). To minimise the issue more number of training and learning opportunities are provided by Health Education England (England, N.H.S. and Care Quality Commission 2014).
Effective medication management by following the national guidelines and legislations accelerates patient safety. On the other hand the non-adherence results in potential harms such as adverse drug reactions due to medication error or wrong dosage. It may result in repeated hospitalisation, comorbidities, delayed recovery, and decreased patient outcomes (Ashcroft et al. 2015). Nurses are the front line staff caring for the patient and hence directly impact the patient’s health and safety. According to Baqir et al. (2014) a very low nurse is to patient ratio, lack of flexible shift time, long shift hours are found to be factors contributing to medication error. Further, inappropriate establishment of patient identity in case of similar names or confusion due to similar drug names are known to be common issues. Medication error also occurs due to nurse burn out and fatigue (Baqir et al. 2014). Several governments in UK are focussing on the supply of adequate nurses to minimise mediation error due to low nurse to patient ratio.
As per literature, there is need of quality training and education programs for practioners on safe usage of mediations to prevent adverse events. For instances, taking two medications at a time may have side effect due to drug interactions. Use of NSAIDS is also associated with the allergic responses in several patients (Zhou et al. 2016). Training will allow practioners in marinating drug safety and stay committed to promote greatest good of the patient. Training and education of nurses and midwifes have been noted with positive impact on patient health. Such programmes allow nurses to work with confidence (McLeod et al. 2017). Conducting regular feedback session is another effective means to learn the barriers of practioners in delivery safe medication regime. Regular audits and feedback session ensures culture of safety in the organisation (Holmqvist, Ekstedt, Walter and Lehnbom 2018). With these feedbacks it is easy to perceive the knowledge, attitude and beliefs of the nurses in regards to medication safety. Based on feedbacks, various strategies may be tailored to motivate nurses to stay committed to health and safety (EnglandNHS 2018).
.In addition the nurses are obliged to adhere to the hand hygiene policy guided by The National Institute for Health and Care Excellence (NICE). Before contacting the patient for medication administration, the nurses may perform hand hygiene. It will help decrease the rate of infection and increase patient safety (Nhs.uk 2018). These guidelines along with the WHO are five moments of hand hygiene are similar. There is an increasing rate of health care associated infections and most are preventable. These protocols act as risk management by reducing the risk of infection when contacting the patient for administration of prescribed medication (Salmon, Pittet, Sax and McLaws 2015).
I value and respect all types of the health care activities. I do take all sorts of precautions when it comes to medication management as I am committed to culture of safety. I help people to stay safe and ensure the affordability of the medicines. As the nurse practioner, I have several responsibilities such as monitor and prevent any acts of medication error, immediately report any incidents of medication accidents, and maintain transparency. I had to engage in open and honest communication about medication error with other nurses which made me more reliable. I value dignity, integrity and caring behaviour. I belief in equality of the patients and delivering care tailored to their specific needs. I have learnt to balance the personal values with the patient’s values and that of organisational goals. It helps me set good example for my fellow nurses and my subordinates. Therefore, I try to meet the needs of the culturally diverse patients during medication administration. It helped me deliver the patient-centered care while fulfilling my role in medication management of a 68 year old dementia patient. It includes preventing the reuse of needles and other materials after administration of drugs. My role was to ensure that the nurses done glove before handling syringes and make sure of safe disposal. I was able to value needs of the patients and educate her on medication effects and impact of following prescription guidelines. It had led to patient satisfaction and quick recovery. I would like to say that the result was guided by my values, commitment to safety, critical thinking and patient-centered nature.
On the other hand it is also my responsibility to ensure that all the medications with expired date are removed and packed for safe disposal. To increase the safety of medicine, I do participate in the evidence based practice to learn new drugs and its effectiveness for concerned care. It helps me keep updated and improve patient outcomes. My virtue of adherence to the professional standards, code of ethics and code of conduct makes me more diligent in my work. My virtue of punctuality such as reporting on time, on time medication administration and addressing any adverse drug affects on patients. It is also my responsibility to ensure that the nurses follow the hand hygiene policy while contacting the patient for mediation administration. It has increased my credibility of practice.
Conclusion
It can be concluded that in health care medication management is a vital aspect of treatment. It is an important measure of the health and safety culture. It is the responsibility of the health care practioners to promote patient safety at all levels by minimising in juries, side effects and comorbidities. There are various national guidelines and legislations in place to prevent medication error and associated harm. However, lack of compliance to these rules and regulations have increased rate of medication error, comorbidities and mortality. There is a need of regular audit to identify such non-compliance and ensure penalty. It will lead to strict adherence to the NICE and NHS guidelines and consequently medication safety culture.
References
Ashcroft, D.M., Lewis, P.J., Tully, M.P., Farragher, T.M., Taylor, D., Wass, V., Williams, S.D. and Dornan, T., 2015. Prevalence, nature, severity and risk factors for prescribing errors in hospital inpatients: prospective study in 20 UK hospitals. Drug safety, 38(9), pp.833-843.
Baqir, W., Crehan, O., Murray, R., Campbell, D. and Copeland, R., 2014. Pharmacist prescribing within a UK NHS hospital trust: nature and extent of prescribing, and prevalence of errors. Eur J Hosp Pharm, pp.ejhpharm-2014.
England, N.H.S. and Care Quality Commission, 2014. Health Education England, Monitor. Public Health England, Trust Development Authority.
England.nhs.uk.,2018. Stage Three: Directive Improving medication error incident reporting and learning [online] Available at: https://www.england.nhs.uk/wp-content/uploads/2014/03/psa-sup-info-med-error.pdf [Accessed 8 Jul. 2018].
EnglandNHS., 2018. NHS England » Clinical audit. [online] England.nhs.uk. Available at: https://www.england.nhs.uk/clinaudit/ [Accessed 8 Jul. 2018].
Farre, A., Heath, G., Shaw, K., Jordan, T. and Cummins, C., 2017. The role of paediatric nurses in medication safety prior to the implementation of electronic prescribing: a qualitative case study. Journal of health services research & policy, 22(2), pp.99-106.
Holmqvist, M., Ekstedt, M., Walter, S.R. and Lehnbom, E.C., 2018. Medication Management in Municipality-Based Healthcare: A Time and Motion Study of Nurses. Home Healthcare Now, 36(4), pp.238-246.
McLeod, S., Mulder, C., McGregor, M., Katz, A., Singer, A., Liddy, C., Barry, A., Eibl, J., Klein, D., Holmes, S. and Viner, G., 2017. Family Medicine Forum Research Proceedings 2016Do urine cultures in the emergency department change management of young women with symptoms of uncomplicated urinary tract infection? Ontario data support Starfield’s theory on practice quality and costHome-based primary care for frail eldersMeasuring the social determinants of health with linked administrative dataUsing big data to understand medication adherence in ManitobaUnderstanding patient referral wait times in OntarioDevelopment of a pharmacist …. Canadian Family Physician, 63(2), pp.S1-S108.
Nhs.uk., 2018. NICE highlights how hand washing can save lives – Health News – NHS Choices. [online] Available at: https://www.nhs.uk/news/2014/04April/Pages/NICE-highlights-how-hand-washing-saves-lives.aspx [Accessed 8 Jul. 2018].
Nursing and Midwifery Council., 2015. Standards for medicines management. [online] London: Available from https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-medicines-management.pdf.[Accessed on 08 July 2018].
Salmon, S., Pittet, D., Sax, H. and McLaws, M.L., 2015. The ‘My five moments for hand hygiene’concept for the overcrowded setting in resource-limited healthcare systems. Journal of Hospital Infection, 91(2), pp.95-99.
Simpson, J.C., Moonesinghe, S.R., Grocott, M.P.W., Kuper, M., McMeeking, A., Oliver, C.M., Galsworthy, M.J., Mythen, M.G. and National Enhanced Recovery Partnership Advisory Board, 2015. Enhanced recovery from surgery in the UK: an audit of the enhanced recovery partnership programme 2009–2012. BJA: British Journal of Anaesthesia, 115(4), pp.560-568.
Zhou, L., Dhopeshwarkar, N., Blumenthal, K.G., Goss, F., Topaz, M., Slight, S.P. and Bates, D.W., 2016. Drug allergies documented in electronic health records of a large healthcare system. Allergy, 71(9), pp.1305-1313.
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