Medicines Management

A Nursing Perspective

Sandra Crouch, Michael Crouch, Carol Chapelhow

• Publisher: Routledge
• Year: 2014
• Print ISBN: 9780132217347
• eBook ISBN: 9781317904151
• Edition: 1
• Topic: Medicine
• Subtopic: Pharmacology

Medicines Management: A Problem-Based Approach uses patient scenarios to explore pharmacology and medicines management.The book provides the pharmacological background, and examines the other factors, which enable nurses to provide care to the patient. It will equip the new nurse with the skills they need to problem-solve, prioritise and make decisions while delivering effective care.

Part 1
Setting the scene

Chapter 1
The context of medicines management for adult nurses in today's NHS

Adult nurses working in the NHS have an increasing number of responsibilities in Arelation to prescribed medicines. Over the years these responsibilities have become more complex, with increasing amounts of time spent in fulfilling this role. One of the reasons for this is that healthcare is becoming ever more complex and frequently more expensive with our increasing understanding of how the body functions and technological advances. There have been calls for more effective medicines management to be recognised and addressed. Indeed, the Healthcare Commission (2007) highlighted research evidence in relation to hospital care when it stated that effective medicines management ‘reduces lengths of stay and rates of re-admission’. Given this requirement, it is important to recognise the main factors that influence effective medicines management from a nursing perspective. As a result, this chapter explores the changing nature of care in the twenty-first century. The key issues that are examined are lifestyle factors, altering demographics, increased migration, co-morbidity, increasing public expectations, and the innovations and developing technology that affect us all in some way and that are influencing the shape of the role that adult nurses play in medicines management in today’s NHS.

Learning outcomes

By the end of this chapter you should be able to:

• Describe the key sociopolitical developments that have led to the developing role of the adult nurse
• Identify clinical situations that require medicines management skills
• Discuss the key nursing developments that have resulted from changes in the NHS
• Discuss how developing technology and innovations will demand increasingly sophisticated medicines management skills.

Chapter at a glance

Recent influences on health in the UK

Factors influencing the development of adult nursing

Cultural transformation in the NHS

The rise of self-medication

Complementary medicinal products

Over-the-counter medicines and their relevance to nursing

Changing role of the adult nurse

Continuing spread of non-medical prescribing

Developing technology and innovations

Adverse drug reactions

Impact of new knowledge and understanding on the nurse's role in medicines management

Changing medicine administration processes

Evidence-based practice

Quick reminder

References

Recent Influences on Health in the UK

The demographic of the UK is changing. Increasing numbers of people are living longer, and consequently many of them are living with co-morbidities. Alongside this, large numbers of people from countries all over the world are working in the UK temporarily or migrating to the UK. Public attitudes have changed, and people now have greater expectations of the services and commodities that they buy and use; consequently, the expectations that individuals have about healthcare providers have changed too. In the first decade of the twenty-first century, we have lifestyles that are very different from the way people lived even 25 years ago. Much of this lifestyle change is a response to innovation and technology. For example, more of us use cars regularly rather than walk or cycle, few of us grow much of our own food, very few of us have jobs that are physically demanding, and many of us regularly take holidays in countries with a very high sun index or with endemic diseases such as salmonella, tuberculosis, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), malaria and typhoid. As a result of more accessible travel, the UK, along with many other European countries, probably has a much more multicultural population than it has ever had before. Throughout history, the UK has become home to a variety of immigrant populations. However, until recently, those who came in any number were predominantly from countries relatively close by, as travel for most of the world’s population was both difficult and expensive. In the past 30 years or so, travel has become much easier and considerably cheaper. As a result, the UK supports large numbers of people from all over the world. Some of these people bring health problems with them, such as tuberculosis. Many others adopt a Western lifestyle, which increases their risk of metabolic syndrome, hypertension, diabetes, coronary heart disease and stroke.

All of these events, many of them quite small in themselves, have changed and continue to reshape healthcare both in the UK and in the rest of the industrialised world. An integral part of the provision of healthcare is the prescription of medicines, which, until recently, was purely in order to help treat and manage a variety of diseases and disorders.

The rationale for the medicines management strategy in the NHS

Today, however, healthcare professionals frequently prescribe medicines not only to treat and manage ill-health but also as a preventive measure or to enhance what used to be seen as lifestyle difficulties, such as obesity, erectile dysfunction and smoking cessation. Nothing in life is risk-free, however, and many people take both prescribed and non-prescribed medicines ‘because it’s believed that the benefits will outweigh the associated risks’ (Healthcare Commission, 2007). It is important, therefore, that any risks of medicines are minimised as much as possible. This has resulted in the introduction of the policy of medicines management in the NHS, which is an essential part of a process that ensures not only that individual patient care is both successful and safe but also that the taxpayer gets value for money (Healthcare Commission, 2007).

The NHS will celebrate its sixtieth anniversary in July 2008. This anniversary may be used as an opportunity to reflect on and celebrate the organisation’s successes, which are too numerous to list here. However, there is no doubt that the anniversary will be also used to highlight the NHS’s failures in delivering healthcare to the people of the UK. Most of this criticism seems to be fuelled because of the early promises offered by the guiding principle so widely publicised when the NHS was first established: that everyone would receive all of their medical, dental and nursing care, free of charge, at the point of delivery. This seems to have encouraged the assumption that healthcare would be both comprehensive and universal, with unlimited healthcare free at the point of delivery. Unfortunately, for a variety of reasons, including lack of comprehension of what the true cost of such a service would be, increasing public demands and little recognition that medicine would advance in the way that it has, these founding principles have long been quietly abandoned by all of the UK governments since the establishing of the NHS (Klein, 2006; Ranade, 1997). From the 1940s to the 1960s most of the advances in the health of the population were not a direct result of the NHS but were due to a raft of social measures, such as improved housing and sanitation, clean running water, improved diet, better dental hygiene and immunisation and vaccination programmes. The years since the inception of the NHS have seen improving health. During this time, there have been many changes both in the NHS and in adult nursing: nowhere is this more evident than in what we think of today as medicines management. Certainly, even before the advent of the NHS, the administration of medicines was an important part of the adult nurse’s role, particularly for nurses working in hospital wards and certain hospital departments such as accident and emergency (A&E). For nurses working in the community and attached to schools and workplaces, medicines management was a less important role, although these nurses did need a sound understanding of the medicines prescribed for their patients so that they could educate their patients. Although administration is a key part of the role of many adult nurses today, this role, along with many others, has changed and is still changing, and it can no longer be identified as the only role and responsibility that nurses have in relation to medicines management.

Factors Influencing the Development of Adult Nursing

There is no doubt that the underlying knowledge and skill of adult nurses in the UK has changed considerably over the previous three centuries, and their values, beliefs, attitudes and images have changed too (Hallett, 2007). Hallett argues that nurses are now in what she calls the ‘technocratic era’. This is because over the years nurses have taken on more procedural skills, such as venous cannulation, that were once perceived to be the skills that lay firmly within the discipline of medicine. Nursing cannot be separated from the society within which it operates, and UK society has altered markedly over recent decades. Today, some of the expectations that patients and healthcare professionals have about healthcare are very different from those of even just 25 years ago. There has been considerable social and cultural change during this time; there have also been a variety of political drivers that have influenced not only the way the NHS operates but also the development of nursing. These political changes appear to have been attempts to address the agendas of each of the more recent governments, challenging the power of the medical profession and attempting to contain the ever-rising cost of health services while at the same time attempting to increase the health of the population as a whole (Klein, 2006, 2007; Pollock, 2005; Ranade, 1997). These drivers have had a major influence on how adult nursing has developed, because in order to deliver these various agendas nurses and nursing have been key targets for many of these changes (DH, 2006a). The Department of Health (DH) has set up a strategy group whose sole purpose and remit is that of modernising nursing careers (DH, 2006b). This group recognises the changes that have happened to date and claims that it will propose further opportunities for change, which perhaps will be linked to the Knowledge and Skills Framework and the Agenda for Change. However, as discussed later in this chapter, both the Agenda for Change, which introduced new contracts for nurses and non-clinical staff in the NHS, and the other contractual changes brought in for medical consultants and GPs have come in for criticism (Buchan and Evans, 2007; Wanless et al., 2007). Many of the developments and changes in the NHS that have happened over the past decade have been a result of a major political strategy taken when the Labour government was first elected to power in 1997 (DH, 1997). This strategy has been ongoing since then, and it has been announced that an internationally renowned, London-based surgeon, Lord Dazi, will lead another major review of the NHS, entitled ‘Our NHS, Our Future’. This new vision for a twenty-first-century NHS will be ‘a once-in-a-generation opportunity to ensure that a properly resourced NHS is clinically led, patient-centred and locally accountable’ (Alan Johnson, Secretary of State, www.ournhs.nhs.uk.

This desire by the Labour Party to have a health service fit for the twenty-first-century was on its agenda from 1996, before they were elected to government in 1997, and has resulted in the NHS seeing regular major investment by...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Contents
• Acknowledgements
• 1 Setting the scene
• 2 Important concepts and principles
• 3 Starting to apply the information
• 4 Patient scenarios
• 5 Where next?
• Appendix 1 Using medicines to relieve pain
• Appendix 2 Infection
• Answers
• Glossary
• Index