Medicine management can be defined as ‘the clinical, cost-effective and safe use of medicines to ensure patients get the maximum benefit they need, while at the at the same time minimising potential harm.’ (Medicines and Healthcare products Regulatory Agency (MHRA) 2004).
This essay will analyse the role and responsibility of the nurse in medicine management. It will then examine the complexities which arise when applying this clinical skill in the context of learning disability nursing in a medium secure forensic environment, before finally considering implications and recommendations for practice.
It has been argued that medication administration is one of the most time consuming nursing duties, accounting for 40% of a nurse’s workload. (Armitage & Knapman 2003). Safe practice in the management and administration of medication is an essential part of the role of the nurse (NMC 2008). Although drug administration is a multidisciplinary task, the nurse has the final responsibility of checking the medication before it is administered to the patient (Davey et al 2008). Managing and administering medication is the highest risk of nursing duties (Anderson & Webster 2001), with medication error the most frequent cause of illness and preventable death in hospitals (Adams & Koch, 2010). Medication error can be defined as failure in the drug treatment process that leads to or has the potential to lead to harm to the patient (Aronson 2009). It has been estimated that 38% of medication errors are serious or fatal, and 42% of those are preventable (Gurwitz et al 2003).
Lack of competence and safety in the delivery of medicine management can also result in a financial burden to the NHS. The National Patient Safety Agency (2007) estimated that harm by medicines which could have been prevented could cost over £750 million each year.
Medicine management involves more than the administration of drugs to the patient (White 2004). The NMC (2008) states that the duty of the nurse is to act as an advocate and provide relevant information and support to those in their care. The nurse is therefore responsible for informing patients about the medication they are receiving, including its function for their health and any possible side effects. The nurse thus acts to empower the patient by using professional knowledge and skills to provide them with information they are lacking. This is an example of paternalistic empowerment, where the expertise gap is the main characteristic of the nurse-patient relationship (Gomm 1993). It also establishes a person-centred approach, which is necessary in the area of medicines management (Great Britain. Department of Health 2008) and in meeting the health and social care needs of people with learning disabilities (Great Britain. Department of Health 2009). Any information must be provided in a way the patient can understand (NMC 2008). In learning disability nursing, where there may be reduced understanding or communication skills, the nurse must ensure service users receive the relevant information in a way they can understand, this could be by using a range of communication methods such as signs, symbols or makaton.
Collaborative working is essential for good practice in medicine management and has become more important with the development of clinical risk management in healthcare in recent years (Nursing Times 2007). The nurse must understand the drugs which their patients are taking (Hemingway et al 2011). This can be achieved by working with pharmacists and doctors at all stages of prescribing, administration and medication changes. Effective multi-disciplinary work may also result in the development of education and training in medicine-related issues.
The administration of medication in an institutionalised setting involves adherence to relevant local trust policies and procedures in addition to legal frameworks and professional standsards such as the...
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