CLT Conference 2015

6th July 2015

Medication Management Training for Mental Health Student NursesBy Candi, Richard & PaulEdge Hill University

Background

On registration, nurses are expected to have sufficient knowledge and skills in medication management to practice safely and competently.

Do they?

This presentation will analyse this statement and will discuss 2 areas:

1. Student Perspective

2. Evidence.

Strategies to address this issue will also be discussed.

Background – Student Perspective

Evaluations highlight that students are generally unhappy in 2 areas:

Not enough lectures on Medication Management

Not enough time on clinical placements to participate in medication rounds

Changing arena of mental health care – closure of hospitals, reduction in hospital beds, diversity of care in the community.

Background - Evidence Medication Management is described by the Medicines and Healthcare products Regulatory Agency (MHRA) AS…

‘The clinical , cost-effective and safe use of medicines to ensure patients get the maximum benefit they need, while at the same time minimising potential harm.’

Medication administration is not purely a mechanistic task and 'knowing’ is an important part of safety ( Reade-Searle et al 2010).

NMC (2010) Standard 8 Administration of Medication states…

‘you must know the therapeutic uses of the medication to be administered, its normal dosage, side effects, precautions and contra indications’

Nurses are the largest workforce involved in medicine management and in excess of 40% of a nurses time is spent on medicine related activities ( Ndosi & Newell 2009).

Background - Evidence

Study by Hemingway et al ( 2011) identified 4 areas of poor performance:

1. Poor knowledge of pharmacology

2. Poor ability to contextualise medication management to the complex and changing needs of patients.

3. Environmental factors that prevent the nurse from solely concentrating on medication administration.

4. Drug calculation difficulties.

Medication ErrorsSecond most common type of incident reported by NHS staff, after accidents, between

January 2005- June 2006.

In this period, 59,802 medication safety incidents reported.

80% of these in acute, general and community hospitals.

4.9% in primary care settings. (NPSA 2008).

Types of errors:

28.7 % Wrong dose

17.1% Omitted medicines

11.5 % Wrong medication. ( Healthcare Commission 2007)

Solutions?

During discussion, 3 senior lectures in mental health identified the following to be delivered in final year of Pre- Registration Bsc Mental Health Nurse Training:

Facilitation of a Mental Health Workshop.

Formative Medication OSCE for Mental Health Students.

The combination aims to link the theoretical component eg pharmacology (the why) - to nursing interventions (the how) eg administering prescribed medication ( Hemingway et al 2010).

The Workshop A facilitated day the encompasses the following:

Formative testing of knowledge base via a quiz.

Lecture on Medication Groups, Prescribing & Side Effects

Lecture on how medications work

Facilitated Group work identifying interventions and issues from a range of clinical scenarios.

Formative OSCE

Students are expected to simulate a medication round.

The following is expected:

Safe administration procedure – 5Rs

Knowledge of medication, side effects, contra indications, prescribing protocols, MHA specific issues , drug calculations.

Findings The Workshop and OSCE have now been facilitated 4 times, having commenced with September 2011.

Despite there being a difference in course delivery, knowledge base is very similar:

Students are generally safe at administration procedure

5-10% demonstrate good knowledge of medication, side effects etc

30-40% demonstrate average knowledge

50% demonstrate poor knowledge and would fail if this was summative!

Evaluations.

Extremely positive!

100% students state they enjoyed day and felt it had benefitted their knowledge.

85% state they feel they need more on medication management and that it should also be encompassed in earlier modules:

‘fabulous day’ , ‘wish we had more lessons on this’, ‘day perfectly planned and thank you for scenarios…’ ‘ good mixture….quiz was excellent as challenged knowledge…’’ ‘has been invaluable…’

‘

Future……

Medication Management is now facilitated in all 3 Life Sciences Modules.

For revalidation:

? Medication Management Module ( field specific)

? Summative Exam or assignment and OSCE - ? Annual

? Mathematical Skills (Pryce –Miller & Emanuel 2010)

? Blended learning

Thank you for listening.

Any questions?

References. Healthcare Commission. 2007. The Best Medicine. London. Healthcare Commission.

Hemingway, S., Marginnis, R., Baxter, H., Smith, G., Turner. J. & White, J. 2010 Medicines with respect. Phase 1: Implementing a pathway towards competency in mental health nurses. Mental Health Nursing 30(3) 12-16.

Hemingway, S, Stephen, J & Allmark, H. 2011. Student experiences of medicines management training & education. BNJ Vol.20(5) 291-298.

National Patient Safety Agency . 2007. Safety in doses: Medication safety incidents in the NHS. London. npsa.

Ndosi, M.E. & Newell, R.2009. Nurses knowledge of pharmacology behind drugs they commonly administer. Journal of Clinical Nursing. 18(4) 570-80.

NMC 2010. Standards for medicine management. London. NMC

Pryce-Miller, M. & Emanuel, V. 2010. Ongoing education would boost competency in drug calculations. Nursingtimes.net.

Reade-Searle, K. , Moxham, L. ,Walker,s. & Happel, B. 2010. Supervising medication administration by undergraduate nursing students: influencing factors. Journal of Clinical Nursing. 27(16)n16-19.

www.mhra.gov.uk