Administration of Medication and Polypharmacy - Essay Example

ADMINISTRATION OF MEDICATION due: Administration of Medication Medication administration is the process of preparing, providing and assessing the effectiveness of prescription and non-prescription medicines (Parthasarathi, Nyfort-Hansen, & Nahata 2004, p. 426). This paper will discuss the administration of medication in a community setting. The community setting provides community nursing care that concentrates on all elements of health. In particular, community health services give the public critical evidence-based nursing that enables individuals to stay in their environment and home when possible while undergoing therapy. These individuals receive health education and health care according to their personal needs. Primary care nursing encompasses all conditions, age, and health care needs that can be provided effectively and safely in the patient’s surrounding (Peate, Wild & Nair 2014, p.82). The service user in the given community setting is a 50-year-old type-2 diabetic male patient in need of medical attention. Type 2 diabetes is a chronic condition of glucose homeostasis that is presented by the impaired insulin action and hyperglycemia. In addition, the disorder is characterized by increased rates of hepatic glucose production and insulin secretion. The medication that he is taking is metformin, 500mg BID. However, the patient is not compliant in his drug taking routine. This is because he occasionally forgets to carry his medicine when going to work. The patients also does not check his blood glucose level at home, implying that he is not able to determine if he is on the right track. From the information given by the patient, diabetes runs in the family where a sister aged 45 has Type 2 diabetes and mother who is deceased also had the same type of diabetes. The patient confesses that he cannot understand why he has the disorder since he keeps off sweets and candies but enjoy eating burgers and French fries. In a period of one year, he had gained 10 kilos despite the fact that he engages in cycling and exercises. After a thorough assessment, the patient’s blood pressure ranges between 128/70-144/90 which is slightly high. The NMC code of conduct states that a patient under a nurse’s care should be capable of trusting the health professional with his wellbeing and health. For this to happen, a health professional must ensure that the care of the patient is his or her first priority by respecting his dignity and acting towards him as an individual. In addition, a health professional should always give high quality care and practice (NMC 2008, p. 2). In addition, a nurse should honor a patient’s right to confidentiality. On this note, a nurse makes sure that a patient is aware about why and how details are shared by those who will be giving his care (NMC 2008,p. 3). From the perspective of values and priniciples, a nurse should maintain a precise professional boundaries. In such a case, a health professional should decline hospitality or gifts that may seem to encourage privileged treatment. In addition, as a nurse, a clear and active sexual divide always with a patient under care, carers and his families (NMC 2008, p.4). In addition, a health professional should obtain a consent from a patient before initiating examination and any sort of treatment. According to NHS Choices (2014), consent to treatment is the basis where an individual provides the authorization before receiving any form of assessment or medical treatment. This is performed on the foundation of the initial discussion with a health professional (NHS Choices, 2014). From this perspective, the priority for the nurse is to assure the patient that everything will be taken care of, in his best interest to obtain his confidence. Nevertheless, for a consent to be termed as valid, it must be voluntary. This means that the decision to consent or decline is made solely by the patient who is not subjected to duress by either family, staff or friends. In addition, the patient must be informed about the type of therapy inclusive of the risks and benefits. On this point, the patient should be advised on other appropriate therapies and the consequences of rejecting the treatment. In such a case, a medical professional should not hide details on the grounds that it may upset a patient. Lastly, the patient should have the capacity to give consent, implying that they comprehend the details provided to them and can utilise it to make an informed resolution (NHS Choices 2014, para 7). After obtaining consent from the patient, oral antidiabetic class of drugs will be prescribed to manage type 2 diabetes. The nature of the illness is complex and treatment consists of lifestyle adjustments, treatment with one or more drugs and monitoring of blood glucose levels (Lilley, Collins, Snyder & Savoca 2014, p. 522). The patient is prescribed glyburide/metformin initial dosage 2.5mg/500 or 5mg/500mg twice a day in the morning and evening. It is important to adhere to the correct dosage in order to avoid hypoglycaemia. The medication can be titrated in a measure of no more than 5mg/500mg up to the minimum effective dosage to obtain enough blood glucose control. The maximum dosage for a day is 20mgmg/2,000mg daily. The patient is motivated to store his medication appropriates and safely for instance away from hot rooms and out of reach of children. If the medication given is in solution form it is kept in the fridge. The storage place is noted in the patient’s record for easy access by a member of staff when the regular nurse is not present (NMC 2010, p. 22). Safe administration of medicines is critical and the need for a health professional and nurse to have a factual understanding about the medicine. Factual information includes the intended use, reason for the action and the expected side effects. A health professional should also know about any special caution when administrating the drug and the normal dose limit. Before initiating any drug administration, it is paramount for a nurse or health professional to take note of ant history of adverse reactions, important changes in the condition of the patient and allergies. The aspect of allergies is important because in many cases patients with a history of allergies are at high risk of encountering additional allergies, hence a need for close monitoring. In addition, appropriate care should be taken when preparing any medicine for administration. First, it is compulsory to check the drug to make sure that it is prescribed in UK. Secondly, when retrieving the medicine, it is significant to ensure that it has been stored in a suitable facility, for instance, fridge or contrast warmer and shielded from direct sunlight. Thirdly, the area used for mixing drugs should be well lit with hand washing facilities in place. Fourth, the drug label should be inspected when removing the medicine from the store and when preparing the drug for administration. When inspecting the label, a nurse should include an expiry date, the name of the drug and dosage. The guidelines for preparation of medicines are given by the COSHH (control of substances hazardous to health). A common guide to ensure hat the patient is safe in the administration of drugs is to check the ‘six Rs’. Six five Rs stands for the right medication, right patient, right route, right time, right documentation and right amount (Hogston & Marjoram 2011, p. 107). Right medication implies that after a nurse checks the prescription, he or she should choose the right medication, cautiously checking the container labels. In addition, a nurse should be able to prepare the correct amount of drug using the correct measurement system such as milliliter or milligram. In order, to attain maximum treatment effectiveness, the health professional specifies the number of times within a duration of 24 hours. According to NMC (2008, p.4), the health professionals should be sure to identify the patient whom the drug is to be administered. The right route means the specific manner in which the drug is administered. There are various routes that are used to administer drugs that rely on the onset of action, duration of action, the rate of absorption, control of dose and the chemical nature of the drug. Different routes include oral, nasogastric tube, and parenteral. The consequences of unhygienic medicine preparation is polypharmacy. Polypharmacy occurs when patients receive their medications in the wrong way. In most cases, the patients undergo unnecessary pain or harm, and some die because of these errors. The most reported error includes wrong frequency, dose, medicine and omission of drugs (Ogston-Tuck 2013, ch.1). These drugs are administered according to NMC drug administration guidelines. According to NMC standard 1, the registrants should administer and supply drugs, according to specific direction for safety in the administration of medicine. In addition, NMC standard 2 proposes that a registrant should check any guidelines on how to administer a medicinal product. NMC standard 6 demands that registrants must make sure all medicines are stored according to the patient’s information leaflet (NMC 2010, p.5). In addition, NMC standard 6 states that registrants should store drugs as per the summary of drug characteristics document placed in dispensed UK-licensed medication (NMC 2010, p. 6). Standard 8 of NMC state that a registrant must be sure to identify the patient whom the medicine is administered for professional accountability and best interest of the patients (NMC 2010, p. 6). Standard 8 of the NMC guidelines describes the procedure of administration. It states that a registrant performing his or her accountability in the best interests of the patients should look into various aspects. First, a registrant should be precise of the identity of the patient who is to receive the medicine. Second, it is the role of the registrant to examine if the patient is allergic to the medicine before administration. Thirdly, a registrant must be knowledgeable of the treatment use of the drug to be provided, its appropriate dosage, contra-indications, side effects and precautions. In addition, a nurse should be informed about the patient’s care plan. Moreover, a registrant must inspect the dispensed medicine label to ensure the writing is unambiguous and clear. Furthermore, the guidelines direct that a registrant should check the expiry date of the drug to be administered where it is available. Also, a nurse should measure the weight to determine the correct dosage, timing, route and administration. Likewise, a health professional should withhold or give medication based on the patient’s co-existing treatments and condition. For example, there are some medications that cannot be administered if pulse is below a certain figure. In the event of contra-indications, a registrant should contact an authorised prescriber as soon as possible. A prescriber is consulted where a patient has an allergic response to the medication. Consequently, when an assessment of the patient shows that the drug is not good for a patient, a prescriber is notified. Lastly, a registrant should maintain an accurate, precise and a prompt register of all the medication refused by the patient, administered and deliberately withheld and ensure that the signature is legible and explicit. In the event that the task of administering drugs is delegated, a registrant should make sure that the record is created. In a situation where the medication is not administered, there should be a supporting reason indicating the reason. The only medication allowed to be administered with a single signature include pharmacy (P), prescription only medicine (POM) and general sales list (GSL) (NMC 2010, p. 7). In addition, a registrant should examine a patient’s ability to self-administer medication and must act on grounds of the patients’ state in terms of safety to others and self. From this perspective, the role of the registry is to make sure that only the prescribed medicines that fulfill the set standards are received by the patient. Records in such a case are maintained on the basis of the environment in which the patient is receiving care. The patient is regularly evaluates using local policies to guarantee that the patient is capable of self-administer and should be noted in their records (NMC 2010, p.26). Covert drug administration is defined by the common law and strengthened by the Human Rights Act 1998, where medicine is disguised in drink or food. This technique is applied to a group of patients who refuse to take medication because of their health status. The NMC 2001a, 2001b, and 2008a provides a position statement. The statement states as a general principle, by disguising medication in drink or food, the client is being led to think that they are not taking medication when in the real sense they are. The registered midwife, nurse or health visitor should ensure that whatever they are doing is in the best welfare of the patient and be responsible for this decision. Therefore, convert administration is allowed in a special situation to prevent a patient not in a position to make an informed consent to receive essential treatment. An adult of sound mind has a legal right to decline therapy, even is the act will severely influence his health or make short his life. Hence, a medical professional should honor a refusal by a competent individual, in the same manner as a consent. Failing to respect the patient’s wishes may result to civil trespass as well as a breach of his human rights. The exception is provided in the Mental Capacity Act 2005 legislation. The Mental Capacity Act states that when a patient is proven to be incapable of giving consent, or the request of a mentally challenged individual is against his best interests, then a registered health professional should examine his needs and suggest the best therapy or care (NMC 2008, p. 3). Screening for type 2 diabetes includes testing for blood glucose testing, pre-screening through waist circumference measurement and questionnaire. In addition FPG (fasting plasma glucose) test is carried out to determine diabetes ad the normal blood sugar is between 70 and 100 milligrams per decimetre for patients with diabetes. In addition, a urine glucose test can be used where blood glucose test is unavailable (Qiao 2012, p.32). Kardex medication is used in a health care facility, which is stored in a medication cart or a locked cabinet at the patient’s bedside. This document contains medications that is administered to a patient. The medication kardex consists of a permanent record of a patients’ medications. A patient care kardex gives an easy access to information about task-oriented interventions such as I.V. Treatment and medication administration. When documenting on a medication kardex, a nurse should include the administration time, medication route, frequency, initials, the dose and the date. In addition, it is paramount to indicate when to administer the starting dose and the specific number of doses as administered and the stop date. The kardex is filled using the standard abbreviations approved and accepted by a health facility (Lippincott & Wilkins 2008, p. 157). Generally, when patients are hospitalised, their medications are reviewed and recorded on the Kardex or medicine chart. These medicines are checked by a pharmacy technician, and if they are suitable standards, the patient is permitted to continue using them while in the ward. In such a case, medicines supplied by a community pharmacy are indicated on the medication record as PO (patient’s medicines). An additional label is added to the PO medicine if the dosage is changed on admission. The scope of practice for dropping tablet is to motivate cooperation in a system of integrative medicine. These precautionary and cooperative attitudes are detailed in the UK Healer’s code of conduct (2013a). The code requires health professionals to respect ethical-legal principles, for instance, patient confidentiality, recognition of an individual limits and respect for the medical profession. From previous experience in a nursing home, the unused medicine and equipment are disposed off according to DHSSPS guidelines and legislative requirements. They are detailed in Minimum Standard 37, Criterion 37.6, and DHSSPS Nursing Homes Minimum Standards 2008. The guidelines state that disposal and destruction of medications that are no longer needed is carried out by competent and trained staff. In addition, a record of the disposed medicines is maintained by a nursing home. Moreover, the NMC guidelines ‘standards for medicines management’ (2008), standard 21 direct that all medicinal substances must be discarded in accordance with law. Medications that are no longer required are either sent back to the pharmacy for eradication or disposed through a licensed waste management corporate. It is illegal for a patient to get rid of unwanted medication by draining them down the toilet or sink. From this point of view, the patient or carer should take back the medication to the community pharmacy. Where it is not possible, the medication is put in sharps box marked with the name of the drugs (NMC 2010, p.35). In case of a possible medicine administration error, nurses should always report immediately to the nurse in charge or line manager who reports to the relevant parties and RQIA. This is described by NMC 2010b that advocates for an environment of honesty and openness in occurrences of medication error. This is because errors cannot be reversed, and the patient is the one that suffers. The full details required when reporting a medical error to RQIA include details of the occurrence and investigation. The report includes elements that led to the error and the measures put in place to prevent the possibility of the event recurring (NMC 2010, p.37). According to NMC guidelines, incidents and errors need a careful and exhaustive research at the local environment to take full account of the situation and setting and the attitude of the health professional responsible (NMC 2010, p. 37). Bibliography LILLEY, L. L., COLLINS, S. R., SNYDER, J. S., & SAVOCA, D. (2014). Pharmacology and the nursing process. St. Louis, Mo, Elsevier/Mosby. LIPPINCOTT WILLIAMS & WILKINS. (2008). Complete guide to documentation. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins. http://www.r2library.com/public/ResourceDetail.aspx?authCheck=true&resid=626 OGSTON-TUCK, S. (2013). Introducing Medicines Management. Routledge. NHS CHOICES. (2014). Consent to treatment. Retrieved May 24, 2015, from http://www.nhs.uk/conditions/consent-to-treatment/pages/introduction.aspx NMC. (2008, May 1). The Code: Standards of conduct, performance and ethics for nurses and midwives. Retrieved May 27, 2015, from http://www.nmc.org.uk/globalassets/sitedocuments/standards/the-code-a4-20100406.pdf NHS Choices. (2014, June 3). Consent to treatment. Retrieved May 27, 2015, from http://www.nhs.uk/conditions/consent-to-treatment/pages/introduction.aspx NMC. (2010, April). Standards for Medicine Management. Retrieved May 25, 2015, from http://www.nmc.org.uk/globalassets/siteDocuments/NMC-Publications/NMC-Standards-for-medicines-management.pdf NMC. (2015, January 29). The Code Professional standards of practice and behaviour for nurses and midwives. Retrieved May 25, 2015, from http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf QIAO, Q. (2012). Epidemiology of Type 2 Diabetes. Sharjah, Bentham Science Publishers. http://public.eblib.com/choice/publicfullrecord.aspx?p=1046407 Read More