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By Root 2068 0

to ensure patients get the maximum benefit from the medicines they need, while at the same time minimizing potential harm. The professional role of the nurse in medicines management is the safe handling and administration of medicines, including a responsibility for making sure that patients understand what medicines they are taking and why, including the likely side-effects (Luker and Wolfson 1999). Medicinal products are defined, according to the Medicines Act 1968, as, ‘substances sold or supplied for administration to humans (or animals) for medicinal purposes’ (HMSO 1968), and can be used for treating or preventing disease, making a medical diagnosis or restoring, correcting or modifying physiological functions (Council Directive 65/65/EEC).

Related theory

Pharmacology is a wide-ranging subject which looks at the history of drugs, where they are sourced from, what properties they have, how they are made, what effects they have and how they are processed by the body (Hardman et al. 1996).

Pharmacokinetics looks at the absorption, distribution, metabolism and excretion of drugs within the body. When these four factors are considered, with the dose of a drug given, the concentration of drug in the body over a period of time can be determined. Pharmacokinetics is most useful when considered with pharmacodynamics which is the study of the mechanisms of action of drugs and other biochemical and physiological effects (Hardman et al. 1996).

The effects of most drugs arise from the way they interact with receptors in the body. The most important type of receptor is a protein receptor. These proteins can be regulatory proteins involved in the mediating effects of neurotransmitters and hormones, enzymes involved in metabolic or regulatory pathways, transport proteins or structural proteins (Hardman et al. 1996).

Some drugs do not exert their effect through combination with receptors but by interacting with small molecules that can be normally or abnormally present in the body; for example, mesna assists in neutralizing the urotoxic metabolites of ifosfamide and cyclophosphamide to reduce the incidence of haemorrhagic cystitis and haematuria (Brock and Pohl 1983).

Evidence-based approaches

Rationale

Indications

Medicines can be administered for the following purposes.

Diagnostic purposes, for example assessment of liver function.

Prophylaxis, for example heparin to prevent thrombosis or antibiotics to prevent infection.

Therapeutic purposes, for example replacement of fluids and vitamins, supportive purposes (to enable other treatments such as anaesthesia), palliation of pain and cure (as in the case of antibiotics).

Contraindications

Whilst there are no contraindications to the overall administration of medications, there will be contraindications for individual medications or patients such as:

allergic to medication

medication interactions

medication given based on patient’s condition, for example digoxin, chemotherapy

certain preparations can only be administered via certain routes.

Methods for the safe and secure handling of medicines

Administration of medicines is an everyday activity that carries great responsibility and is one of the greatest areas of risk in nursing practice (Hand and Barber 2000). However, although it requires clinical decision making by nurses, it is often associated with routinized behaviour because it is carried out so frequently (Armitage and Knapman 2003). Incidents involving medicines were the third largest group of all incidents reported to the National Patient Safety Agency (NPSA) although the majority of the outcomes are of no or low harm (NPSA/NRLS 2009). It seems that nearly half the reports describe incidents with the administration or supply of a medicine in a clinical area (NPSA/NRLS 2009). The NPSA (2007a) has listed the key areas of risk for medication error (Box 13.1).

Box 13.1 Key areas of risk for medication error

Wrong drug/diluents.

Calculation errors.

Level of knowledge.

Administration to wrong patient.

Administration via wrong route.

Unsafe handling/poor