Discuss about the Health Care Strategy in Australia.
Nursing homes in Australia report various problems associated to medication, which impact the outcome of the elders. The factors that expose elders to Adverse Drug Reactions (ADRs) are pharmacokinetics, pharmacodynamics and Polypharmacy. Most of the ADRs occur because nursing assistant staff in aged care centers lacks sufficient knowledge on medications. Lack of adequate information on drugs leads to overdose, omission or giving out wrong medicines. In this paper, a health care strategy will be developed to educate nursing staff on medication. The specific strategy is the Safe and Effective Use of Medicine (SEUM) and will consist of 5Rs. Nursing assistants will be informed about the right drug, right patient, right time, right route and right dose. Besides, the nursing assistants will be trained on the side effects of drugs. When the nursing assistants are educated about medicines, they will adhere to better prescription practices, which will improve the health of elders in nursing homes.
There is a need to minimize Adverse Drug Reactions (ADRs) in the nursing homes around Australia. Safe and effective use of medicines (SEUM) will solve the challenges associated with inappropriate use of medicines. This strategy will first identify knowledge gaps in the prescription drugs among nursing assistants in nursing homes. The nurses will then be educated on the best practices for giving out medication to prevent adverse outcomes based on the 5Rs. The primary aim of the strategy is to improve the health of the elders in aged care facilities. In the long-term, this strategy will gain traction and success in improving the quality of life (QOF) for seniors in nursing homes.
Adverse Drug Reactions (ADRs) are a major problem in nursing homes. Empirical evidence suggests that there are high-risk medications in aged care facilities. Based on the studies done since2002, about 2 to 3 percent of Australian hospital admissions are drug-related. Hospital reports indicate that incidents connected to medications are the second most common kind of incidents after falls. The most prevalent medication errors are overdose and omission. Studies indicate that most of these medicine errors occur due to patient factors (Roughead & Semple, 2009). Another study conducted between 2003 in Australia showed that ADRs account for the most common ADEs. They further found that majority of the ADEs were severe and required hospitalization (Nair, Chalmers, Peterson, Bereznicki, Castelino, & Bereznicki, 2016). These studies insinuate that older adults in aged care facilities have higher chances of experiencing ADRs.
The most common causes of Adverse Drug Reactions (ADRs) are amplified drug impacts, side-effects, drug-disease interaction, drug-drug interaction and drug-nutrient. Multiple comorbidities are common in adults, which require them to take several drugs. One study involving 412 patients aged over 72 years found that there was an increase in the number prescribed and non-prescribed medications. The mean medications per patient were above three drugs. The study further found that only 11.4 percent of these patients received a clear explanation of the prescribed drugs. Even most of these patients did not have a clear knowledge of the side effects of the medications (Chan, Wong, So, Kung, & Wong, 2013).
Interaction of these drugs can cause adverse reactions. Lack of a proper diet may also cause adverse impacts for elders. Anaphylactic shock is caused by the administration of sensitive drugs. Penicillin is the leading cause of anaphylaxis. Respiratory depression is caused by barbiturates or analgesics when administered with an alcoholic compound. Hypotension might be caused by calcium channel blockers or oxidase inhibitors (Galbraith, Bullock, & Manias, 2007).
There are several risk factors for Adverse Drug Reactions (ADRs). The primary risk factors are advanced age, comorbidity, and polypharmacy. Inappropriate medication has also been cited as a leading risk factor for ADRs (Nair, Chalmers, Peterson, Bereznicki, Castelino, & Bereznicki, 2016). Many other factors play a major role in the development of ADRs. Most of these elements are client related, socially related and medicine related. Age, for example, has an important effect on the occurrence of ADRs. Elders have higher chances of experiencing ADRs than other age groups. Alcohol consumption also has a fundamental effect on the occurrence of ADRs (Alomar, 2014).These factors increase the risk of ADRs mainly in adults.
Non-compliance with treatment is also another factor that occurs in elders. Social, economic, and patient-centered factors result in medication non-compliance (Jin, Sklar, Oh, & Li, 2008). Biological impacts of aging including altered cognition and special senses lead to medicine non-compliance. Social circumstances also result in medicine non-compliance. Some of the social factors include living alone, insufficient social support, and illiteracy level impacts medication adherence. Perceptions about medications play a critical role in medication noncompliance. Some elders might perceive medicines as less helpful or completely unhelpful. In this case, ADRs might arise due to non-compliance with treatments.
The proposed strategy will have two primary elements. First, the health literacy of the nursing assistants in aged care facilities will be evaluated. This part is motivated by the fact that some nurses lack sufficient knowledge on giving out medication which results in medication errors. Nursing assistants who have inadequate knowledge on prescription drugs might be the primary cause of medication errors in nursing homes.
A health literacy test will be performed before enrolling nursing assistants into the training system. Second, the nursing assistants in the nursing homes will be educated on medications. This health strategy has been developed based on the fact that medication education is required to improve the use of medicines in nursing homes.
The medication education will consist of “5R” including the right patient, right drug, the right route, the right dose and the right time. Additionally, the nursing assistants will be educated on the side effects of various drugs that are administered in aged care facilities.
Nursing assistant staff should be informed on giving out medicine to the right patient. Due to a high number of elders in nursing homes or confusion, the nursing assistants might give medicine to a wrong patient.
Elders tend to experience multiple illnesses which result in polypharmacy. Polypharmacy refers to the prescription of numerous drugs for one patient, and it is linked to ADRs. Studies have identified that doctors fail to inform patients, which results in the lack of sufficient education (Rambhade, Chakarborty, Shrivastava, Patil, & Rambhade, 2012). When the nursing assistants are educated on the right medicine, the risk of giving out the wrong medicine will be reduced significantly.
Nursing assistants in nursing homes should know the right dose of a specific drug. One study involving 44, 344 incidences found that 60.9% of the medicine errors occurred due to improper dosage (Zakharov, Tomas, & Pelclova, 2012). Nursing assistants of nursing homes will be educated on the accurate dosage of the medicines that have been prescribed.
The route of administration is very important in reducing medical errors. Medication administration errors happen often and have higher chances of leading to adverse harm and death (Westbrook, Rob, Woods, & Parry, 2011). The nursing assistant staff should have sufficient knowledge of how the drug will be administered. Oral and intravenous are the most common routes of administration. Nursing assistants will be informed of the right administration route of the prescribed medicines.
Nursing assistants practicing in aged care facilities should know the right time to give out medication. The nurses should give out drugs at different times depending on the condition of the patient. As such, nursing assistants at aged care facilities will be educated on the right time to give out drugs.
Nursing assistant staff can play an important role in reducing the occurrence and impact of the medical errors in nursing homes. One study found that patients lack information on the side effects as well as warnings on drugs (Singh, Singh, Kumar, Bhandari, Kaur, & Dureja, 2013). Nursing assistants will be educated on proper medication practices to prevent adverse side effects.
The safe and effective use of medicine (SEUM) will have several impacts on the well being of the elders in aged care facilities. The main effect of this strategy will be improving the health of the elders in nursing homes. Specifically, the nursing assistants will be in a position to make informed decisions when giving out medications. When nursing assistants are educated on medicines, they will be in a position to influence the elders’ treatment plans. The nursing assistants will decide which drug they should give out at a specific time and in the right dose. It is evident that informed nursing assistant staff has prevented numerous medication errors and medical professionals should encourage patient involvement in medication safety. Cohen further notes that care facilities have an obligation of making patients aware of errors as well as the steps that have been put in place to prevent medication errors (Cohen, 2007). Another impact will be preventing the hospitalization of the elders in aged care facilities. As discussed in a previous paragraph, medication errors are a leading cause of hospitalization. This occurrence will be prevented through proper education. Patients can notice observable issues that occur due to medication errors (Britten, 2009). The last effect will be preventing and lowering mortality. Adherence to medication will be improved, which will, in turn, prevent adverse outcomes such as death.
The safe and effective use of medicine (SEUM) will offer nursing assistants with the skill and education required to promote healthy behaviors in nursing homes. The goal of the strategy is to help the elders to live with their conditions. In the long term, the strategy will have an objective of preventing future health complication, reducing the reliance on health care services and lowering general costs to the health care system. The intention of the strategy to the health care providers will be enhancing the awareness of the need for nursing assistant staff education.
Conclusion
This scholarly paper has developed a healthy strategy known as the safe and effective use of medicine (SEUM). Nursing assistants in aged care facilities require comprehensive knowledge of the medicines to prevent Adverse Drug Reactions (ADRs) and improve the elders’ outcomes. The proposed strategy will be based on the 5Rs, the right medicine, the right route, the right dose, the right time and right patient. The health care strategy will also comprise of education on side effects of drugs. As discussed in this paper, the strategy will comprise of two main elements which are the evaluation of health literacy level and actual education. Nursing assistants in nursing homes will be educated on medication based on their literacy level. This strategy will improve the health of the elders in the short-term and lower mortality level in the long-term.
References
Alomar, M. J. (2014). Factors affecting the development of adverse drug reactions (Review article). Saudi Pharmaceutical Journal , 22 (2), 83-94.
Britten, N. (2009). Medication errors: the role of the patient. British journal of clinical pharmacology , 67 (6), 645-650.
Chan, F. W., Wong, F. Y., So, W. Y., Kung, K., & Wong, C. K. (2013). How much do elders with chronic conditions know about their medications? BMC geriatrics , 13 (59), 59.
Cohen, M. R. (2007). Medication Errors. American Pharmacist Association.
Galbraith, A., Bullock, S., & Manias, E. (2007). Fundamentals of pharmacology. Melbourne: Pearson.
Jin, J., Sklar, G. E., Oh, V. M., & Li, S. C. (2008). Factors affecting therapeutic compliance: A review from the patient’s perspective. Ther Clin Risk Manag , 4 (1), 269-286.
Nair, N. P., Chalmers, L., Peterson, G. M., Bereznicki, B. J., Castelino, R. L., & Bereznicki, L. R. (2016). Hospitalization in older patients due to adverse drug reactions –the need for a prediction tool. Clinical interventions in aging , 11, 497-505.
Rambhade, S., Chakarborty, A., Shrivastava, A., Patil, U. K., & Rambhade, A. (2012). A Survey on Polypharmacy and Use of Inappropriate Medications. Toxicology international , 19 (1), 68-73.
Roughead, E. E., & Semple, S. J. (2009). Medication safety in acute care in Australia: where are we now? Part 1: a review of the extent and causes of medication problems 2002–2008. Australia and New Zealand Health Policy , 6 (1), 18.
Singh, J., Singh, N., Kumar, R., Bhandari, V., Kaur, N., & Dureja, S. (2013). Awareness about prescribed drugs among patients attending Out-patient departments. Int J Appl Basic Med Res , 3 (1), 48-51.
Westbrook, J. I., Rob, M. I., Woods, A., & Parry, D. (2011). Errors in the administration of intravenous medications in hospital and the role of correct procedures and nurse experience. BMJ Qual Saf , 20 (12), 1027-1034.
Zakharov, S., Tomas, N., & Pelclova, D. (2012). Medication errors—an enduring problem for children and elderly patients. Upsala journal of medical sciences , 117 (3), 309-317.
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