Mental health nurses’ medicines management role: a qualitative content analysis

Aim: This study explores medicines management role undertaken by mental health nurses (MHN) in a wide variety of clinical specialisms and contexts. Method: Ten MHNs were interviewed and audiotaped. Qualitative content analysis of the transcribed interviews was undertaken. Results: These findings evidenced the wide ranging skills and knowledge the MHN utilizes when psychotropic medication is prescribed, and how they engage with service users and other practitioners. Four themes emerged that illustrated how the participants undertook such interventions: Medicines management in context; Managing time; Knowledge and skill used; Collaboration with other healthcare providers. Medicines management thus needs a greater emphasis in order for the for service users from the drugs they are prescribed achieves the optimum outcome

New Ways of Working – Pharmacy and Medicines Management

Medicines play a key role in the treatment of most mental illnesses. The management of those medicines is of great importance to most mental health service users and also impacts on the daily professional life of many of those involved in caring, be they psychiatrists, nurses, pharmacists or others. The New Ways of Working (NWW) project began with a study of the potential to devolve many of the aspects of the dispensing of medicines within pharmacy departments from pharmacists to pharmacy technicians and then to pharmacy assistants. As this project evolved it became clear that perhaps the greatest impact of pharmacy staff and potential for NWW of medicines management was not just in the dispensary but within teams and wards. As further projects began to identify the potential for pharmacy staff to improve the way medicines are used across the whole spectrum of clinical care, it also became clear that medicines management and pharmacy had for many years been an area of neglect by Mental Health Trusts (MHTs) and for many to achieve safe and effective medicines use, would require significant investment. By the end of the programme a wide range of products associated with medicines management, involving pharmacy, service users, carers and others, had been developed (www.newwaysofworking.org.uk)

Exploring the evidence base for how people with dementia and their informal carers manage their medication in the community:a mixed studies review

BACKGROUND: Little is known about the general medicines management issues for people with dementia living in the community. This review has three aims: firstly to explore and evaluate the international literature on how people with dementia manage medication; assess understanding of medicines management from an informal carers perspective; and lastly to understand the role that healthcare professionals play in assisting this population with medicines management. METHODS: A mixed studies review was conducted. Web of Knowledge, PubMed and Cochrane Library were searched post-1999 for studies that explored medicines management in people with dementia dwelling in the community, and the role healthcare professionals play in supporting medicines management in people with dementia. Following screening, nine articles were included. Data from included studies were synthesised using a convergent synthesis approach and analysed thematically to combine findings from studies using a range of methods (qualitative, quantitative and mixed methods). RESULTS: Four themes were generated from the synthesis: The nature of the disease and the effects this had on medicines management; the additional responsibilities informal carers have; informal caregivers' knowledge of the importance of managing medication and healthcare professionals' understanding of medicines management in people with dementia. Consequently, these were found to affect management of medication, in particular adherence to medication. CONCLUSIONS: This review has identified that managing medication for people with dementia dwelling in the community is a complex task with a frequently associated burden on their informal caregivers. Healthcare professionals can be unaware of this burden. The findings warrant the need for healthcare professionals to undergo further training in supporting medicines management for people with dementia in their own homes

PRN Medicines Optimization and Nurse Education

Medicines management is a high-risk and error prone process in healthcare settings, where nurses play an important role to preserve patient safety. In order to create a safe healthcare environment, nurses should recognize challenges that they face in this process, understand factors leading to medication errors, identify errors and systematically address them to prevent their future occurrence. ‘’Pro re nata’’ (PRN, as needed) medicine administration is a relatively neglected area of medicines management in nursing practice, yet has a high potential for medication errors. Currently, the international literature indicates a lack of knowledge of both the competencies required for PRN medicines management and the optimum educational strategies to prepare students for PRN medicines management. To address this deficiency in the literature, the authors have presented a discussion on nurses’ roles in medication safety and the significance and purpose of PRN medications, and suggest a model for preparing nursing students in safe PRN medicines management. The discussion takes into account patient participation and nurse competencies required to safeguard PRN medication practice, providing a background for further research on how to improve the safety of PRN medicines management in clinical practice

Can student mental health nurses be prepared for medicines management?

Aim This paper reports on an evaluation of the Medicines with Respect project, which implemented a stepped approach to education and training in medicines management (MM) for mental health nurses (MHNs). Method In the retrospective qualitative study, nine MHNs were interviewed to gain their perceptions of the MM training they received at university and to find out if it still had relevance. Results Content analysis of the interview data revealed that overall the participants valued the theoretical and practical learning strategies they experienced, although criticisms relating to all aspects of the education and training were reported. The participants also reported that the approach prepared them for clinical practice as registered nurses. Such an approach may also build the capacity of MHNs to develop as prescribers

Supporting carers to manage pain medication in cancer patients at the end of life: A feasibility trial

Background: Carers of people with advanced cancer play a significant role in managing pain medication, yet they report insufficient information and support to do so confidently and competently. There is limited research evidence on the best ways for clinicians to help carers with medication management. Aims: To develop a pain medicines management intervention (Cancer Carers Medicines Management) for cancer patients’ carers near the end of life and evaluate feasibility and acceptability to nurses and carers. To test the feasibility of trial research procedures and to inform decisions concerning a full-scale randomised controlled trial. Design: Phase I-II clinical trial. A systematic, evidence-informed participatory method was used to develop CCMM: a nurse-delivered structured conversational process. A two-arm, cluster randomised controlled feasibility trial of Cancer Carers Medicines Management was conducted, with an embedded qualitative study to evaluate participants’ experiences of Cancer Carers Medicines Management and trial procedures. Setting: Community settings in two study sites. Participants: Phase I comprises 57 carers, patients and healthcare professionals and Phase II comprises 12 nurses and 15 carers. Results: A novel intervention was developed. Nurses were recruited and randomised. Carer recruitment to the trial was problematic with fewer than predicted eligible participants, and nurses judged a high proportion unsuitable to recruit into the study. Attrition rates following recruitment were typical for the study population. Cancer Carers Medicines Management was acceptable to carers and nurses who took part, and some benefits were identified. Conclusion: Cancer Carers Medicines Management is a robustly developed medicines management intervention which merits further research to test its effectiveness to improve carers’ management of pain medicines with patients at the end of life. The study highlighted aspects of trial design that need to be considered in future research

Facilitating Interprofessional Collaboration on Electronic Medicines Management

Medicines are important for well-being. Thus, medication errors can have severe consequences, even death. Transfers between professionals and levels of care are a challenge in terms of medicines management. Norwegian governmental strategies encourage communication and collaboration between levels of care, and several initiatives are invested in to improve digital medicine management. In the project Electronic Medicines Management (eMM), we established an arena for interprofessional discussions about medicines management. This paper provides an example of how the eMM arena contributed to knowledge sharing and development in current medicines management practices at a nursing home. Building on communities of practice as a method we carried out the first of several sessions, with nine interprofessional participants. The results illustrate how discussion and agreement were reached on a common practice across different levels of care, and how the knowledge required bringing this knowledge back to the local practices

A modified Delphi study of structures and processes related to medicines management for elderly hospitalised patients in the United Arab Emirates.

Rationale and aim: The structures and processes around the management of medicines for elderly, hospitalized patients are ill defined. This study aimed to determine consensus related to strategic and operational approaches in the United Arab Emirates. Methods: A modified Delphi technique, consensus study with first round statements developed from systematic reviews related to medicines management. Normalization process theory and the theoretical domains framework were applied in the construction of statements, organized into key elements of medicines management: guidelines for medicines management, medicines reconciliation, medicines selection, prescribing and review, medicines adherence, medicines counselling, health professional training and evaluation research. Seventy per cent (summative agree and strongly agree) was set as the target for consensus. Thirty panellists were recruited, representing senior physicians working within geriatrics, hospital pharmacy and nursing directors, chief health professionals (including social workers) and policy makers within the Health Authority of Abu Dhabi and academics. Results: A high level of consensus was obtained for most statements relating to the structures and processes of medicines management. While consensus was not achieved for targeting only those patients with medicines related issues, it was achieved for focusing on all elderly admissions. Similarly, consensus was not achieved for which professions were most suited to roles but was achieved for trained and competent staff. Conclusions: High levels of consensus were obtained for structures and processes of medicines management relating to elderly hospitalized patients. Trained and competent health professionals were preferred to specific professions for any tasks and that all elderly patients and not targeted patients should be the focus for medicines management

The Establishment of Communities of Practice for Electronic Medicines Management

Digital medicines management is a high priority in Norwegian e-health strategies. A key challenge is the existence of multiple electronic information sources and systems, which require multi-professional cooperation. Lack of communication, understanding and collaboration between pharmacies, hospitals and community caregivers is also a challenge. Communities of practices (CoPs) have been used to establish arenas for discussing issues challenging the workflow to reach a common agreement on successful work practices for electronic medicines management. The purpose of this paper is to explore: How can we establish communities of practice (CoPs) to gather new knowledge on the facilitators and challenges for electronic medicines management practices in Norway? The results show engagement in establishing the CoPs and a willingness for joint enterprise. The establishment of the CoPs was performed simply based on established forms of collaboration. For CoPs to be effective, established alliances need to be expanded and renewed to form new group dynamics and thus a basis for new knowledge about electronic medicines management

The Role of the Nurse in the Management of Medicines During Transitional Care: A Systematic Review

Purpose: To synthesise knowledge and to explore the role of the nurse in medicines management during transitional care. Methods: An integrative systematic review was conducted. Electronic databases such as PubMed [including Medline], Web of Knowledge, Scopus, and Cinahl from January 2010 to April 2020 were searched. Original qualitative and quantitative studies written in English that focused on the role of the nurse in medicines management during transitional care, which included movement between short-term, long-term, and community healthcare settings were included. Results: The search process led to the retrieval of 10 studies, which were published in English from 2014 to 2020. They focused on the role of the nurse in patients’ medicines management during transitional care in various healthcare settings. Given variations in the aims and methods of selected studies, the review findings were presented narratively utilizing three categories developed by the authors. In the first category as ‘medication reconciliation process’ the nurse participated in obtaining medication history, performing medication review, identifying medication discrepancies, joint medication reconciliation and adjustment. The second category as ‘collaboration with other healthcare providers’ highlighted the nurses’ role in clarifying medicines’ concerns, interdisciplinary communication and consultation, discharge planning and monitoring. In the third category as ‘provision of support to healthcare recipients’, the nurse was responsible for interpersonal communication with patients, education about medicines, and simplification of medication regimens, and symptoms management during transitional care. Conclusion: Nurses play a crucial role in the safety of medicines management during transitional care. Therefore, they should be empowered and more involved in medicines management initiatives in the healthcare system. Patient safety and avoidance of medication errors during transitional care require that medicines management becomes a multidisciplinary collaboration with effective communication between healthcare providers.publishedVersio