MEDICATION MANAGMENT

• What is Medication management

  The Facilitation of the safe and effective use of prescribed and over the counter medications
• Responsibilities of medication management

  • Assessment of the service user
  • Planning of the medication
  • Implementation of the medication plan
  • Evaluation of medication plan
• Main classifications of psychotropic medications

  • Anti-psychotics
  • Anti-depressants
  • Mood stabilisers
  • Anxiolytics
  • Hypnotics
• What is a Long Acting Antipsychotic Injection (LAAI) or Depot

  given as a deep intramuscular injection (IM), which is released slowly over time, Depot intervals vary from weekly to every 3 months
• Clozapine


  An antipsychotic which is used in treatment resistant schizophrenia, When 2 or more antipsychotic drugs have not been effective in treating the service user, Service users must be closely monitored while taking this drug – blood tests and vital signs, Smoking effects blood plasma levels
• Clozapine monitoring

  1. Monitored by Clozapine Patient Monitoring System (CPMS)

  2. Blood tests required throughout treatment

  3. Check for levels of white blood cells (WBC)

  4. Clozapine can alter levels of WBC & potentially cause agranulocytosis

  5. Important to check temperature

  6. Important to ask service user to report any flu like symptoms
• Clozapine 'traffic light' system

  • Green: Safe to give drug/prescription
  • Amber: Continue with drug and recheck bloods every two days until Green/Red
  • Red: STOP. Do not administer, contact CPMS, recheck bloods to confirm
• General side effects of antipsychotics

  • Extrapyramidal side effects (EPSEs): Different types of involuntary movements
  • Central Nervous System: drowsiness, sedation, agitation, anxiety
  • Cardiovascular: Low blood pressure, increased pulse, changes in ECG
  • Gastrointestinal: Constipation, dry mouth, weight gain, heartburn, nausea, polydipsia
  • Genito-urinary: enuresis (involuntary urination), polyuria (increased urine output)
  • Metabolic syndrome: Term for combination of diabetes, high blood pressure and obesity
• use of antidepressants

  • Moderate to severe clinical depression
  • Generalized anxiety disorder
  • Post-traumatic stress disorder
  • Obsessive compulsive disorder
  • Chronic neuropathic pain
• Types of antidepressants


  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Serotonin-nor epinephrine Reuptake Inhibitors (SNRIs)
  • Tricyclic Antidepressants
  • Mono-amine oxidase inhibitors
• General side effects of antidepressants

  • Headache
  • Nausea
  • Indigestion
  • Dry mouth
  • Blurred vision
  • Sedation
  • Arousal / Insomnia
  • Sexual side effects
  • Increased suicidal ideation
  • Increased agitation
  • Weight gain
• Indications for use of mood stabilisers

  • Bipolar Affective Disorder
  • Schizoaffective disorder
  • Acute Mania, Thought to inhibit stimulation in the brain therefore stabilize mood
• Types of mood stabilisers

  • Lithium
  • Anticonvulsants: Carbamazepine, Sodium valproate (Na Val), Lamotrigine
  • Anti-psychotics
• Lithium


  Difficult to determines how it functions, possible inhibitory effects, Therapeutic Range: 0.4-1.2mmol/L, Bloods to be monitored throughout treatment, Be aware of fluid intake and drug interactions
• Anxiolytics


  A medication used to reduce symptoms of anxiety
• Indications for use of benzodiazepines


  Acute stress reactions, Severe episodic anxiety, Fluctuations in generalised anxiety, Initial treatment for severe panic disorders
• Classification of benzodiazepines


  • Long Acting (up to 48hrs): Chlordiazepoxide, Diazepam, Clonazepam, Clobazam
  • Intermediate Acting (up to 36hrs): Nitrazepam, Oxazepam, Bromazepam
  • Short Acting (up to 24hrs): Alprazolam, Lorazepam
  • Ultra Short Acting (1hr): Midazolam
• The role of the nurse in medication management

  • To administer medication
  • To observe and report any side effects, acting if needed
  • To educate and advise service users
  • To promote adherence to medication
  • To provide alternative or supplementary care
  • To adhere to procedures for the control of pharmaceutical products
  • Advocate and empower service users
  • Nurse prescribing – supplementary prescribers
• Key principles within scope of practice in medication management

  • Competence
  • Accountability and Autonomy
  • Continuing professional development
  • Support for professional nursing and midwifery practice
  • Delegation
  • Emergency situations
• Knowledge requirements for nurses in medication management

  • Indication – why is this medication prescribed?
  • Dosage – what are the min/max doses...
  • Possible Side Effects – what should we observe for?
  • Monitoring Precautions – example: do we need to check vitals prior to administering this medication?
  • Contra-indications – when would this drug not be used (i.e., pregnancy)
  • Drug interactions; i.e., Lithium & Ibuprofen, How the interaction occurs: When these two medicines are taken together
• Key Principles within Scope of Practice in Medication Management

  • Competence
  • Accountability and Autonomy
  • Continuing professional development
  • Support for professional nursing and midwifery practice
  • Delegation
  • Emergency situations
• Knowledge Requirements


  • Indication – why is this medication prescribed?
  • Dosage – what are the min/max doses...
  • Possible Side Effects – what should we observe for?
  • Monitoring Precautions – example: do we need to check vitals prior to administering this medication?
  • Contra-indications – when would this drug not be used (i.e., pregnancy)
• Things to Consider in Administration

  • Know exactly why you are administering this drug
  • Prescription written in black ink, dated, signed, generic name, clear instructions
  • If the prescription is illegible or unclear – do not dispense (ask for it to be re-written)
  • Telephone orders accepted in exceptional circumstances
  • Be aware of the service users' current medications, drug allergies or drug interactions
  • Ensure service user is aware of intended purpose of the drug
  • Obtain consent
  • Adhere to 10 rights
• Administration continued

  • Nurse can withhold or omit medication if necessary
  • Medication should never be administered if there is a discrepancy on the prescription
  • If you are unsure of a medication – look it up before giving
  • Do not administer medication prepared by another practitioner
  • Changing the constituency of a drug (crushing) should only be done after consultation with pharmacist
  • Any 'double checking' requires 2 independent checks
  • May double check injections, liquids etc
• '10 Rights'

  • Right Patient: name, photo ID, band, DOB
  • Right Medication: be aware of similar drug names, brand and generic names, check expire date
  • Right Dose: important to be aware of min/max doses
  • Right Form: tablet or liquid
  • Right Time: mane/am, nocte/pm, PRN, clearly stated
  • Right Route: IM, PO, IV, Sublingual, Subcutaneous, Rectal
  • Right Reason: understand the intended purpose of why the medicines is being administered
  • Right Action: inform the service user of the action of the medication
  • Right Response: observe for response and adverse effects
  • Right Documentation: record administration, sign and date
• IM Sites


  • Deltoid
  • Dorsogluteal
  • Ventrogluteal
  • Vastus Lateralis
  • For self administration
• Refusing Medication


  • Discuss the reasons for the refusal
  • Give the rationale for medication & offer support
  • Give service user information
  • Report and communicate
  • Voluntary patient?
  • Involuntary patient?
• Medication times 


  OD - Once a day or 24 hourly

  BD or BID - 2 times a day or 12 hourly

  TDs or TID - 3 times a day or 8 hourly

  QDs or QID - 4 times a day or 6 hourly

  PRN - When needed

  STAT - immediately

  Mane - morning

  Tarde - evening

  Nocte - night time
• Medication Routes

  IV - intravenously (into vein)

  IM - intramuscular

  PO - per oral (oral by mouth)

  PV - per vaginal

  SC - subcutaneously (under skin)

  PR - per rectum (rectally)

  SL - sublingually (under tongue)
• Medication Form


  ml - millilitre

  mg - milligram

  mcg - microgram

  g - gram

  units - not to be abbreviated
• Lengths of prescription 


  1/7 - 1 day

  1/52 - 1 week

  1/12 - 1 month