Medicine Management Skills for Nurses. Claire Boyd

      Older Adults

      Ageing can influence many aspects of absorption, distribution, metabolism, and excretion (ADME) with excretion the most affected. This is because by the age of 65, the human kidney is almost a third less efficient than younger adults. This can lead to drugs not being cleared as efficiently from the kidneys, building up, and causing toxicity. Another cause for concern is the effects and side‐effects of some drugs which may contribute to falls in frail adults due to postural hypotension and other factors.

      

Postural hypotension

      A form of low blood pressure that happens when you stand up from sitting or lying down. Symptoms include dizziness, fainting (syncope), confusion, or blurred vision.

Patients being admitted to hospital from the community, on any of these ‘high risk drugs’ should be reviewed by a Doctor or Pharmacist and all staff should be made aware of this risk factor. Table 1.2 shows some of these drugs to be made aware of.

Table 1.2 Drugs which may contribute to falls.

Drug class	Indications	Examples of drugs
Antipsychotics	Psychosis delirium	Haloperidol, Promazine, Trifluoperazine, Quetiapine, Olanzapine, Prochlorperazine. Risperidone
Antidepressants	Mood	Amitriptyline, Trazodone, Fluoxetine, Citalopram. Paroxetine, Sertraline
Hypnotics (sedatives)	Insomnia	Zopiclone, Zolpidem
Benzodiazepines Hypnotics (sedatives)	Insomnia, agitation	Diazepam, Lorazepam, Temazepam, Nitrazepam
Anti‐hypertensives	High blood pressure	Ramipril, Lisinopril, Perindopril, Valsartan, Hydralazine, Bisoprolol, Atenolol, Propranolol
Antidiabetics	Diabetes	Glibenclamide, Glipizide, Metformin, Sitagliptin
Opiates	Pain	Codeine, Tramadol, Morphine, Fentanyl, Buprenorphine, Oxycodone
Diuretics	Heart failure, fluid overload, hypertension	Bendroflumethiazide, Furosemide, Bumetanide, Amiloride
Nitrates	Cardiovascular disease	Isosorbide mononitrate, Glyceryltrinitrate (GTN) Nicorandil
Parkinson's Medication	Parkinson's disease	Co‐Beneldopa, Co‐Careldopa, Selegline Hydrochloride, Pramipexole
Non‐steroidal anti‐inflammatory drug (NSAIDS)	Pain, inflammation	Ibuprofen, Naproxen, Diclofenac
Antimuscarinics (anticholinergics)	These are mentioned in other classes, e.g. for urinary incontinence	Procyclidine, Oxybutynin, Tolterodine, Amitriptyline
Aminoglycosides	Infection	Vancomycin, Gentamicin
Antihistamines	Allergies, itch	Chlorphenamine, Hydralazine, Cetirizine

ADMINISTERING DRUGS SAFELY

      Drug Administration Competence

      Many hospitals have drug administration competencies for staff to ‘prove’ that they are competent in the clinical skill of drug administration. Only when these competencies have been signed off can a nurse administer medications alone. Also, the student in healthcare, i.e. Registered nurse, Nursing Associate, etc. will need to be signed off in their medicines management competencies as part of their pre‐reg training. Appendix 1 shows an adaption of a typical section of post‐reg medicines management competencies.

      Calculations Competence

      Also, in order to be able to administer intravenous medications, qualified staff are required to pass a drug calculations test to prove mathematical ability, as poor mathematical skills have been indicated in medication errors with the misplacement of the decimal point leading to a tenfold error overdosing or underdosing. Many healthcare environments also set calculation tests during the interview stage.

Activity 1.4 shows a sample question of the sort that you may be expected to answer in one of these tests. Don't worry if your reaction to answering these questions is

we'll go through this in Chapter 4.

Activity 1.4

      Drug calculations sample question.

      A drug is presented as 5 g in 500 ml A patient weighing 70 kg is prescribed 10 mg/kg/h of the drug.

      1 How many milligrammes per hour of the drug does the patient need?

      2 How many millilitres per hour do you set the infusion pump?

      

To first work out how much of the drug the patient requires according to their body weight we use the formula weight (kg) × dose, and then using the formula:

       But remember to keep the decimal units the same throughout the formula.

      Reports and Safety Alerts

      In order to alert health carers of the problems around drug administration, the Department of Health and National Safety Patient Agency (NPSA) issue reports and safety alerts, perhaps when mistakes have been made for shared awareness:

       Problems with missed doses,

       Promoting safer use/monitoring of patients on anticoagulant therapy (e.g. warfarin for deep‐vein thrombosis [DVT]),

       Promoting safer measurement and administration