Defining medicines management
The Audit Commission report, āA Spoonful of Sugar: Medicines Management in NHS Hospitalsā (2001), was designed to highlight the importance of the effective use of medication as a part of the nurseās role. While nursesā involvement with medicines management varies according to the context of care (e.g. community based, hospital based), the report highlights that up to ā7,000 individual doses are administered daily in a ātypicalā hospital; and up to 40 per cent of nursesā time is spent administering medicinesā (http://www.eprescribingtoolkit.com/wp-content/uploads/2013/11/nrspoonfulsugar1.pdf, point 11, p.9, last accessed 6 August, 2015).
This definition illustrates that managing medicines is not just the responsibility of pharmacists and doctors. It is the collective responsibility of those who work for a healthcare organisation. When working in the NHS, it is easy to find examples of nurses who undertake every facet of medicines management (Figure 1.1). Nurses commonly prescribe, dispense, administer and review patient medication on a day-to-day basis.
The report continues by identifying the main reasons why medicines management needs to continually improve. Medication errors are unacceptably common, the efficacy of medicines is increasing, the costs of medicines are rising and the administration of medicines is becoming more complex. In addition, there is a need to review medicines management across whole health economies as the distinction between primary and secondary care becomes increasingly blurred.
Managing medicines is more than just clinical pharmacology. Clinical pharmacological knowledge is an essential element of safe and efficacious patient care along with the other core skills.
Figure 1.1 is not hierarchical but attempts to illustrate the interconnected nature of the ESCs that make up the medicines management process. Understanding how medicines work (their fundamental pharmacology) is significant knowledge in, for example, medicines administration. Understanding fundamental pharmacokinetics (Chapters 6 and 7) and fundamental pharmacodynamics (Chapters 10 and 11) allow the nurse undertaking medication administration to explain the dose of medication prescribed, its clinical indication, its likely beneficial effects and any potentially important adverse effects such as side effects (Chapter 48) and drug interactions (Chapter 47).
Traditionally, doctors prescribe, pharmacists dispense and nurses administer medication. Modern healthcare practice incorporates increasingly diverse means of supplying medicine: there are growing numbers of prescribers from a range of professional backgrounds (nurses, pharmacists and physiotherapists) and additional ways for patients to access medication ā for example, patient group directions (PGDs), which are written instructions for the supply or administration of medicines to groups of patients according to a set of predetermined criteria. The competent nurse needs to understand their role in supporting these mechanisms of medicine supply and in facilitating patient access to increasingly complex treatments as part of evidence-based interventions.
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