Medicine Management: Salbutamol Nebules - Essay Example

Medicine Management: Salbutamol Nebules Introduction Salbutamol Nebules is a drug used for the treatment of severe bronchospasm associated with chronic bronchitis and bronchial asthma (Newham & Lipworth, 2012). The drug owes its name to the fact that it is administered through a nebulizer where it is used with compressed oxygen. The Salbutamol Nebule is administered at dosage strength of 5 mg salbutamol base/ 2.5 mL (GSK, 2014). The non-medicinal ingredients in the solution include Sodium chloride, dilute sulphuric acid and water. Salbutamol Nebules, commonly referred to simply as salbutamol, is an inhalable medicine that is administered orally. This paper discusses medicine management of Salbutamol. It starts by examining the legal and ethical frameworks in medicine management and administration in the UK and how they impact medicine management practices; it then discusses safe ordering, receiving, storage, administration and disposal of Salbutamol nebules. The paper then discusses drug management and administration in Patient Group Directions (PGD), this is done by explaining the meaning of PGD and the legal framework that establishes it before exploring the possibility of Salbutamol nebules being included as one of the PGD medications. Finally the paper examines self medication and points out some of its advantages to the whole process medicine management and administration. Legal and Ethical Frameworks in Medicines Management and Administration The legislative framework for medicines management and administration in the UK includes a number of legislations relating to the prescription, supply, storage, and administration of drugs (NHS, 2011). All practitioners including nurses and pharmacists have to comply with these pieces of legislation for the safety of patients as well as for general ethical conduct in the practice of medicine (Grifith, 2009). The control of medicines in the UK is carried out mainly through the Medicines Act (1968) and other related legislation in the country and in Europe. According to NMC (2008) administration of medicines is a significantly important aspect of the professional contract of nurses. The Nursing and Midwifery Council takes recognition of the fact that medicines management is a flexible practice as opposed to being performed in strict compliance with the instructions of the medical practitioners prescribing the drugs. The body recognizes the importance of drug administration being practiced through professional judgement and though on the part of practitioners (NMC, 2009). Medicines management and administration is one of the areas that are affected by frequent errors and it is well recognized that practitioners are always likely to make errors (Jamieson, 2009). This is one of the reasons the practice is guided by strict legal and ethical standards that seek to remind practitioners of the potential for error while dealing with patients/customers. Data gathered by the National Patient Safety Agency (NPSA) reveals that the three most frequent types of medicine errors include wrong dosage, omitted medicine, and wrong medicine (DoH, 2010). These errors account for about 57.3% of all the reported incidents involving medicine with wrong dosage being the most significantly reported error (NPSA, 2007). Since 1968 when the Medicines Act first came into being, there has been the production of various statutory instruments serving as secondary legislation which are combined with the primary legislation to provide the legal framework for the management and administration of drugs in the UK (DoH, 2010). With respect particularly to nurses and specialist community public health nurses, the most relevant statutory instrument in place is the ‘The Prescription Only Medicines (Human Use) Order 1997, SI No. 1830’. This instrument brings together all previous secondary laws on the prescription of medicines and details all the medicines under that category (DoH, 2013). Salbutamol is one of the medicines listed under the category as a prescription drug. Prescription only medicines (POMs) are drugs that can only be accessed by patients/ customers after prescription by medical practitioners. Under the regulation, approved practitioners include doctors, dentists, supplementary prescribers, nurses, or pharmacists (Ellis & Mullan, 2009). With regard to POMs, the Royal Pharmaceutical Society of Great Britain (RPSGB) also provides detailed information on the legislations governing them. The Misuse of Drugs Regulations 2001 (MDR) is a regularly amended and revised document that deals with Prescription Only Drugs in its second schedule (Health & Safety Executive, 2011). This schedule has a list of over 100 drugs and indicates that all drugs under the schedule are subject to safe custody and must therefore be stored in a locked place such as locked cabinets or safes that is only accessible to a person in lawful possession of the controlled drug. Safe Ordering, Receiving, Storage, and Disposal of Salbutamol Nebules Medicines management is defined as the clinical, cost-effective and safe application of medicines to ensure that patients derive maximum benefits from the drugs they need, while the potential harm of the drugs is minimized (Eliott & Liu, 2010). Safe management and administration of Salbutamol nebules, like all other medicines is carried out through standards set by the NMC. Medicinal products must only be supplied and administered in accordance with various methods, these include Patient Specific Direction (PSD), Patient Group Direction (PGD), Medicine Administration Record (MAR), and others (NMC, 2008). Ordering and Receiving When ordering, the description of the medicine must be given in full (Salbutamol nebules) by legibly printing in the resident’s medicine chart the name and specification of the drug using indelible ink (Leape et al., 2012). This is important so as to avoid any confusion with regard to the kind and form of the drug. In this case there are two forms of Sabutamol, salbutamol nebules and salbutamol respirator solution, the difference between the two must be well distinguished on the order chart. While writing the order, the drug ordered must be signed and dated by the prescriber appropriately before being sent to the pharmacy. While doing this, the nurse or any other prescriber should avoid transcription, this helps maintain clarity (Williams, 2007). The prescriber’s registration number must be included on all prescription forms, this is important for the tracing of orders and their originators for accountability purposes (William, 2007). Urgent verbal orders can also be carried out but some due process must also be carried out, the RN records must be filled in with the name of the prescriber, resident, the date, and medicine order. Where an urgent oral order has been made the prescriber must fax a copy of the order to the pharmacy and sign the order on the medicine chart within two working days (Venkatraman & Durai, 2008). Storage of medicine is one of the important elements which should be well taken care of to maintain the integrity and safety of the drugs for human use (Fry & Dacey, 2007). According to Silktone et al. (2010), salbutamol nebules should be stored in a medicines cupboard which is free from light, heat, and moisture as per the recommendations of the manufacturers of the drug. This storage area should normally remain under lock and key and should ideally be below 250 C (GSK, 2014). Usually, salbutamol can be safely stored together with other medicines in one place; this place must always be safeguarded by a designated staff member on duty who ideally should be competent in medicines management. Salbutamol nebules is a medicine with a relatively short life cycle after opening it for use (Benedictis & Selvaggio, 2008). It is important that the date the medicine is opened is recorded so as to avoid confusion as to when the patient should stop using a particular opened medicine bottle in case it has exceeded recommended life after opening. Storage and Transportation Like all other medicines, Salbutamol nebules is usually well labelled and contains the information leaflet detailing its information, including storage, the instructions on this leaflet are supposed to be followed strictly when handling the drug for storage. The patient information leaflet is a summary of product characteristics documents found in all medication licensed and dispensed in the UK (MacConnachie, 2009), this leaflet contains usage and storage information that the patient should follow. When wrapped, Salbutamol nebules should be stored between 2 and 250 C and protected from direct sunlight (GSK, 2014). The medicine must be discarded if not used within one month of opening. On the other hand, Salbutamol nebules that has been removed from the overwrap should also be stored between 2 and 250 C but used within 3 months (GSK, 2014). In a hospital environment or conditions, where this medicine is being applied in this case, the dedication should be taken to the patient to whom the medicine has been prescribed by the nurse. For example the medicine should be taken from the pharmacy to the patient’s ward. This is aimed at maintaining the integrity and safety of the drug during transportation as it is done by a well trained professional in an ethical procedure (Jordan, 2011). Administration and Disposal Medicine administration is regarded in terms of competency and safety (Jordan, 2011). Before administering medicines, the staff doing must be competent enough to administer medicines to patients. In this regard, competence refers to demonstration of knowledge, understanding and practical ability. For nurses, the competence must be assessed by a registered nurse with demonstrated competency and experience. Safe practice in administration of medicine includes ability to follow organizational policy, accurate documentation, carrying out correct checking procedures, making accurate computations when required, educating patients and obtaining their consent before administration, and other qualities (Wright, 2012). Competent registered nurses should be able to check and administer all prescribed medicines correctly and be able to assess and monitor the effects of the medicine to the patient. In general, patients should carry their salbutamol aerosols with them for self administration when they experience asthma episodes. However, in a hospital ward environment it is the duty of the nurse in charge to monitor the patient and administer the medication in case of asthma-related respiratory problems (Benedictis et al., 2008). Present practice for asthma treatment demands that anti-inflammatory therapy should be part of the regimen if Salbutamol nebules should be used by the patient on a daily basis (Newham & Lipworth, 2012) In terms of dosage, Salbutamol nebules is administered to two main age groups, adults and adolescents from 13 years of age, and children from 5 to 12 years of age. In the case of adults and adolescents, the patient may inhale the medicine when faced with an asthma attack; this can be repeated up to 4 times a day. Each spray should contain about 5mg of Salbutamol. For children, about 2.5 mg of Salbutamol is required per intake apart from in severe cases where the child can take up to 5 mg unit dose (Downie, 2010). According to the NMC standards of medicine administration, it is critical for a professional to determine the identity of a patient before administering medicine (Cohen, 2012). Other professional practices include checking that the patient is not allergic to the medicine, knowing the patient’s care plan, checking the prescription or label of the medicine and administering it accurately, and checking the expiry date. Principles of Supply and Administration of drugs via PGD One of the important methods of drug management and administration is Patient Group Directions (PGD). According to Beaney & Black (2012), “PGD refer to specific written instructions for the supply or administration of licensed named medications to specific groups of patients who may not be individually identified before presenting for treatment”. The administration of PGDs is managed in the UK under the Controlled Drugs Legislation, Nurse Prescription and Patient Group Directions provided by the Home Office (Diamond, 2008). According to the Home Office circular 026/2003 Patient Group Directions, a “Patient Group Direction” is defined as “a written instruction for the sale, supply and administration, of named medicines in an identified clinical situation.” (Burgess, 2008). According to Section 9(b)(iv) of the prescription Only Medicines (Human Use) Amendment Order 2003, the final authorization of a PGD should be provided by the relevant Chief Officer or a representative of his/her office once all the requirements for its formation have been met as detailed in Annex A. In 2002, there were proposals to amend medicines legislation to permit the sale, supply or administration of medicines under PGDs in a various specified healthcare providers in the UK through private, charitable sector, and in certain Crown establishments. Basically, these amendments were aimed to reserve the supply and administration of drugs under PGDs for few situations where it would give advantage to patient care without compromising patient safety. The legislation identified the right medical professionals charged with supplying and administration of medicines under PGD. These include nurses, health visitors, midwives, optometrists, pharmacists and a number of other health professionals (Dougherty & Lister, 2008). Salbutamol nebule is a prescription medicine and therefore it is subject to the provision of the Medicines Act of 1968. Under Part III, section 58(2) of the Act, called additional provisions, it is indicated that subject to the provision of the section no one can retail or supply a medicinal product that in description falls under the class specified as a prescription drug except in accordance with prescription from an appropriate practitioner. The section further indicates that no person shall administer any such product unless that person is an appropriate practitioner or acting in accordance with the directions of an appropriate practitioner (NMC, 2008). In this case, Salbutamol can strictly be administered under those conditions by nurses and any other practitioners. It is evident that Salbutamol nebule is a medicine important for severe and sometimes emergency respiratory conditions. The medicine is often self-administered by patients with directions from a health professional after being duly prescribed for treatment of respiratory conditions. In this light it can be argued that Salbutamol can be categorized among drugs dispensed under PGDs. Patients with Salbutamol nebule prescriptions often use the drug for long times unless they heal or their condition improves because asthma is largely a lifetime condition, meaning that they require access to the medication continuously. It would be easy and reasonable for such patients to get the medication under PGD regulations as long as they have written prescriptions from health practitioners. Similarly, nurses working in health facilities can access the drugs under the program for their patients who are either admitted in hospital or who visit the health facility frequently for the medication. Self-Medication Self-medication is common with the usage of Salbutamol nebule because of the nature of the drug and the need for patients to use it regularly and during emergency situations. Various standards guide the practice of self-medication and most of them emphasise responsibility on the part of the medical professionals, in this case nurses, to ensure that the patient can safely self-medicate. In this regard, the professional dispensing the medicine should ensure that the patient understands critical issues concerning the drug including dosage, storage, side effects, use with other drugs and so on (Sharma et al., 2012). Dispensing is generally defined as “labelling from stock and supply a clinically appropriate medicine to a patient, client or carer, usually on the basis of a written prescription, for self-administration or administration by another professional (Beyene et al., 2014). While dispensing medication to be self-administered by patients the professional has to check the validity of prescriptions, appropriateness of the prescription to the patient, labelling, and provision of information leaflets to the patient (Wilson & DeVitoThomas, 2009). This is important for the patient to be able to safely administer the drug successfully. The responsibilities of the patient includes issues like keeping medicines secure at all times, observing the medication schedule and dosage, and notifying the health practitioner when the medicine stock is getting low so as to enable sufficient time for reorder. It is also the duty of the patient to make sure that before receiving the drugs, they are appropriately packaged and labelled by liaising with pharmacists or nurses as necessary. With regard to Salbutamol nebule, the nurse administering the medication in a ward situation is supposed to keep it together with other medications and essentials in the locker next to the patient’s bed. This is because the drug comes in a bottle fitted with a nebulizer which is usually carried around by the patient, meaning that it should be near the patient all the time for emergency situations or for when the patient feels congestion in the respiratory system. The patient should be instructed on how to use the medicine and it should be easily accessible to him or her. The patient should also be instructed on the normal dosage for the drug, its side effects and how to overcome them. The patient also needs to inform the health practitioner of any complementary medicine he or she is taking so that the practitioner can determine whether it is safe to use both and what advice can be given for self-administration (Conrad et al., 2010). It is the duty of the patient to let the nurse know of any changes to regimen, side effects, adverse effects, or whether there are any difficulties in self-medication. Advantages and Disadvantages of Working in Partnership with Patients/ Clients Working in partnership with patients in medicine management and administration is inevitable for nurses and other health practitioners. Working with patients in medication management has more advantages than disadvantages. First, it enables the health practitioner to monitor and understand the patient much better so that any problems with medication can be solved immediately they occur. Secondly working with patients in medicine management is important towards educating clients on important elements of medicine management, particularly where self-medication is concerned like in the case of Salbutamol nebule. After the process the patient gains essential knowledge of how to manage medication, particularly in cases where the patient suffers a long-term condition like asthma. Working partnerships in medicine management provide the medical practitioner with the best opportunity to conveniently collect research information about a particular medication or a particular medication process because of the close proximity with patients and which enhances monitoring. 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