MEDICINES MANAGEMENT

Medicines Management



Medicines Management

TASK 01

The optimal management of most patients with paracetamol overdose is usually straightforward. However, several differing nomograms and varying recommendations regarding potential risk factors for hepatic injury introduce complexity.

In order to reconcile management advice with current Australasian clinical toxicology practice, revised guidelines have been developed by a panel of clinical toxicologists consulting to the poisons information centres in Australia and New Zealand using a workshop and consultative process. There are currently four major NPSA alerts being launched at the time of writing this article. They include the safer use of injectable medicines, safer administration of liquid medicines via the oral and enteral routes, anticoagulation and preventing hyponatraemia in well children under 16.

Take this product by mouth as directed. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.

For suspensions, shake the medication well before each dose. Measure the liquid medication with the provided dose-measuring spoon/dropper/syringe to make sure you have the correct dose. Do not use a household spoon.

For rapidly-dissolving tablets, chew or allow to dissolve on the tongue, then swallow with or without water. For chewable tablets, chew thoroughly before swallowing.

If you are using sustained-release tablets, swallow the medication whole. Do not crush, chew, or break the tablets. Doing so can destroy the long action of the drug and may increase side effects. For effervescent tablets, dissolve the dose in the recommended amount of water and drink.

Injectable medicines

Between January 2005 and June 2006, the NPSA received over 800 reports per month relating to injectable medications. These figures represented approximately 25% of all medication related reports. During this time, there were 25 incidents of patient death and 28 cases of serious harm.

Research demonstrates that injectable medication have a higher incidence of reporting than other forms of medication. One study showed that errors occur in approximately 2% of cases (Taxis et al., 2003). This is concerning when one recent audit showed that high risk products such as cytotoxic drugs, adult parenteral nutrition and intra-ocular injections were being prepared in the clinical environment. Most errors involve giving bolus doses or preparing drugs which have a multiple step process in preparation.

To overcome some of these problems, the NPSA has recommended that a Pharmacist and a senior practitioner in the relevant area should meet at least yearly to review current practices and identify ways of reducing risk. This should also be completed before any new injectable product or procedure is introduced into the area. The coding of the injectables is based on a traffic light system where red symbolises a high risk product, amber a moderate risk product and green, a lower risk product (Table 1).

Risk factors

Description

Therapeutic risk

Significant risk of patient harm if injectable medicine is not used as intended

Use of a concentrate

Where further dilution is required before use

Complex calculation

Any calculation with more than one step for preparation and/or administration

Complex method

More than five non-touch manipulations involved

Reconstitution of powder in a vial

Where a dry powder has to be reconstituted with a ...