1. MEDICINE USE CHALLENGES- NURSING PERSPECTIVE. PRESENTED ON 16 TH MAY, 2014 BY; ELIZABETH MUTEMI. MSc. NURSING (PEADS). OPTIMIZING MEDICINE USE TO IMPROVE PATIENT OUTCOMES.

2. OUTLINE. Guiding principles. Expected outcomes in medicine use. Elements of medication administration. Nursing roles in medicine use Challenges related to the roles. Way forward.

3. GUIDING PRINCIPLES Nursing role in medicine use is 24 hrs Nursing service form the crucial link of all the other medical care services. TEAM WORK… Must be embraced 24 /7. Effective Communication is key. Ethical practice.. Patient safety and accountability Beneficence…. DO NO HARM Quality assurance and corporate issues(vision, mission, core values, objectives)

4. EXPECTED OUTCOMES Patient satisfaction. Patient safety Symptoms resolution and reduction. Compliance/ Adherence/ cooperation Trust in provider. Collaboration among providers. Perception of being cared for. Reduction in pt length of stay. Quality of life.

5. THE ELEMENTS OF MEDICATION ADMINISTRATION. Procuring…. Pharmacy Prescribing… order by licensed providers. Transcribing..to medication administration record. Dispensing.. Pharmacy Administering…to the patient. Monitoring, assessment and evaluation. Documentation of the assessment finding.

6. NURSING ROLES IN MEDICINE USE Acquisition of drugs. Storage and accountability. Administration of drugs. Monitoring patients on drugs. Documentation. Evaluation. Communication.

7. SEVEN RIGHTS OF MEDICINE USE Right medication. Right patient. Right dose. Right time. Right route. Right indication. Right documentation.

8. Prescription of drugs challenges Investigations delay time between arrival and prescription. Prescription change quite often- after investigations and consultants/ specialists reviews. Teaching hospitals – wide range of clinicians prescribing ( from C.O in turns to Consultants/ specialists) ; drug prescription errors…

9. Medication administration safety Medication errors are a great threat to patient safety. Patient safety is a global priority Mediation errors that result to patient harm occur in est. 1- 2 % of hospital inpatients. 7000 Americans die annually of mediation errors Medication errors contribute to increase length of hospital stay. Research suggests that prescribing and administration stages of medication use process account for the largest percentage of 39% and 38% respectively. MAE r/t prescribing are often intercepted at dispensing stage.

10. Prescription and acquisition continued Reported delays in KEMSA deliveries of medicine orders to level 1-5 hospitals. Use of prescription drugs without prescription through OTC Patients system Identification numbers… errors / delays. Use of S11 Acquisition vouchers. Shortage ; Out of stock feedbacks- delay and increase length of stay The availability of the drugs in the supply chain. Patient dose supply challenges… Delays Emergency drugs challenges r/t patient dose drug supply / record management.

11. Acquisition challenges continued First 24 hours of inpatient care related challenges … system numbers, change in prescription Drug packaging and reconstitution issues. …. Pediatric doses.. Potency and efficacy of the drugs administered ??? Drug wastage. Returning of unused patient dose drugs…surplus supply..patients rights and accountability.

12. Storage and accountability challenges Lockable sub sterile drug cupboards... Storage Space commensurate to the need…. Inadequacies. Correct storage requirements for medication!!! “borrowing” of old patients drug to curb the first 24 hour challenges…related issues. Emergency drugs….deaths and weekend related challenges..accountability????

13. Drug administration challenges Adherence counseling and effects counseling!! Intra venous access challenges… missed doses. I/M Option versus effects to patient. Neonate and peads dosages versus drug packaging Drug prescription and administration errors. Reconstitution challenges r/t busy drug round. Patient nurse ratio.. Understaffed. Testing of drug reaction / adverse effects Vigilance on concurrent use of patient “own medicines” and ward prescribed drugs. …chronic cases

14. Monitoring challenges Working in busy units… understaffed Dislodged i.v canulas… efficacy of the reconstituted drugs. Medication give longer periods...infusion regulation… Lack of infusion pumbs.

15. Documentation challenges Administered drugs on the treatment sheets… Missed drugs… Borrowed drugs!!!!!!!! Returned drugs… Newly prescribed drugs… Any adverse reactions…. Availability of dugs… Not issued drugs…. Out of stock drugs…

16. Evaluation /monitoring challenges… Facility institutional policy!!!! check points...reduce risk s and errors Documentation on clinical evaluation of patients on medication…improvements etc. Patients response documented on daily basis documented!!!! Drug error documentation.!!!!

17. Communication challenges Pharmacy to Pharmacy.. Pharmacy to nursing services and opposite. Nursing services to clinicians and opposite. ISSUES; Drug availability, dose adjustments, updates related to drug use..evidence based practice and findings..drug prescription errors. Disconnect / breakdown.

18. WAY FORWARD. Facility/institutional policy on medicine use. Regulation in licensure and management of private pharmacies KEMSA. Review of the supply chain protocols. TEAMWORK– Commitment.. Work towards medication competence. RESEARCH– Facts on medicine administration errors. Building and sustaining interdisciplinary research teams. ONLINE ORDERING – improve time management AUTOMATION CHALLE NGES R/ T PATIENT ID or system number addressed at entry points before arrival to wards. Patients to have 24 hr drug supply at the entry points as above is being addressed. List of the medicine available /out of stock to all units.

19. ASANTENI SANA