Nurses and midwives know that while medicines make a significant contribution to the treatment of ill health, the prevention of disease, increasing life expectancy and improving health outcomes, they also have the potential to cause harm.
The quality use of medicines requires that the appropriate medicine is prescribed; that it is available at a price the person can afford; and that it is prescribed, dispensed and administered correctly. The goal for the use of any medicines is to promote quality of life.
Quality use of medicines strives to reduce avoidable harm and improve health outcomes.
This year has afforded the ANMF a number of opportunities to provide input to national work to improve the quality use of medicines.
Originally published in 2000, the National Medicines Policy is currently under review. Well due for an update, this high level document has four central objectives – timely access to affordable medicines; appropriate standards of medicines safety, quality and efficacy; quality use of medicines; and a responsible and viable medicines industry.
On behalf of members, the ANMF has participated in consultation for this review through a written submission and focus groups. Our aim is to ensure the critical role of nurses and midwives in the quality use of medicines, particularly medicines administration and increasingly prescribing, is considered and addressed.
Earlier this year, the Australian Commission on Safety and Quality in Health Care (the Commission) was engaged by the Australian Government Department of Health to review and update the Guiding principles for medication management in the community (2006) and the Guiding principles for medication management in residential aged care facilities (2012). In October and November, the ANMF, in consultation with our state and territory Branches, prepared responses to the Commission for these reviews. Members also participated in focus groups established to gather feedback from nurses managing medicines in a variety of contexts of practice.
ANMF responses highlighted the two main areas in need of review. These being the role of nurses in medicines management and administration and the importance of a mandated staffing and skills mix to deliver safe care. We urged the Commission to address these issues in the updated guiding principles. Copies of our responses are available at: anmf.org.au/pages/professional-submissions
This year the Commission has also developed resources to support residential care providers and software vendors to implement and optimise their electronic National Residential Medication Chart (eNRMC) medication management systems. These eNRMC systems will be used to streamline processes for medication management and enable electronic prescribing, removing the need for paper prescriptions. The government engaged the Commission to develop these resources. The ANMF participated on the Expert Advisory Group convened by the Commission to provide oversight of this work. The guide, workbook and information resource are available under new publications at: www.safetyandquality.gov.au/
Work has commenced in recent months on the review of the ANMF Nursing Guidelines for the Management of Medicines in Aged Care, developed to promote the safe delivery of medicines to older people. The aim of these guidelines is to provide support and direction for registered and enrolled nurses for the management and administration of medicines in aged care, as well as clarifying the role of assistants in nursing.
Given the current reviews of the government’s national quality use of medicines publications, this timely review of our guidelines is being undertaken to ensure currency and relevance to best practice aged care, legislative and regulatory requirements, and evidence-based nursing practice.
The ANMF guidelines will be cross-referenced in the revised Australian Government Department of Health national medicines guiding principles publications for residential aged care and community care, detailed above.
Finally, once again, the ANMF was invited by the Society of Hospital Pharmacists to participate on the Editorial Committee for the 4th Edition of the Don’t Rush to Crush (DRTC) publication. The main audience for this resource are nurses, midwives, pharmacists and prescribers, who may, of course, be nurse practitioners or midwives with an endorsement for scheduled medicines.
Before giving an oral medicine, nurses and midwives need these fundamental questions answered quickly, accurately and safely: can I crush it?; can I disperse it?; can I open the capsule?; is there a suitable liquid formulation? can I give the injection orally?
The new edition includes 590 oral medicines, with 50 additions. It also contains the results of extensive testing of over 100 oral liquid medicines against the International Dysphagia Diet Standardisation Initiative (IDDSI) standards for thickness of foods and fluids – vital safety information for people with swallowing difficulties.
Work on this review will be completed shortly and copies of the new DRTC will be available in the new year.