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DRUG MANAGEMENT , pharmacy BScM 2016.ppt
- 1. DRUG MANAGEMENT Presented toBScM 2016 By E. Kapito
- 2. LEARNING OUTCOMES • Discussdrug management • Describe the responsibility of a midwife in drug therapy • Describe the basic units of measurement in the metric system
- 3. Introduction • All drugsare poisons – what matters is the dose and giving right medication • Remember - all drugs have beneficial and adverse effects • Drug management covers formulations, supply, routes, administration and storage
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- 5. Drug Supply • Itis the midwife’s role to ensure that there is enough supply of drugs in the ward but avoid wastage
- 6. Wasting of drugs •How can drugs be wasted? • Overstocking – – Ordering more drugs than necessary so that others expire • Poor storage of drugs: – Not maintaining the refrigerator so that drugs vaccines and drugs become ineffective – Exposing drugs to damp, heat or light
- 7. Wasting of drugsCont’d • Stealing drugs • Not checking expiry dates so that drugs can be wasted
- 8. Stocking of Drugs •Stocking of standard drug list - e.g. outpatient, under- fives, labour ward etc. • Know the conditions commonly treated in your unit • The drugs should be relevant with the common conditions • Stock drugs according to management guidelines
- 9. Stocking of Drugs •Order sufficient supply – Too much is wasteful – Too little can make patients suffer because they cannot be treated e.g. pethidine – Life saving drugs must always be in stock e.g. Adrenaline – Make a list of life saving drugs and keep them in one tray
- 10. Stocking of drugs •Orderly stocking of drugs is an essential part of drug management • Most drugs are stored in a cool dry place, away from light • A drug cupboard is good for these conditions • Keep tablets in air tight containers
- 11. Stocking of drugsCont’d • Each container must be clearly labelled • Label with bright colour the drug that will expire first so that they can be used first (First Expiry First Out) • Do not put in same container old stock of drugs with new stock • Dangerous (Controlled) drugs must be stored in a locked cupboard with special issuing register • Record the drugs that have been issued
- 12. Storage of DrugsCont’d • Midwives must know storage conditions of drugs. Storage requirements are important. Read storage for each drug • E.g. insulin and vaccines need to be stored at 0 to 4 degrees centigrade (check for Malawi) • Maintain cold chain for vaccines – that is store drugs at 0 to 4 degrees even when transporting the medication to the point of administering
- 13. Storage of DrugsCont’d • Do not freeze vaccines - may crystalize and lose potency • Dissolved drugs should be used as soon as possible (check insert) • E.g. Dissolved penicillin if it overstays can cause chemical reactions. Must be given within 24 hrs
- 14. Storage of drugsCont’d • Tablets of different generic names should not be put in same container – they can interact • Avoid exposure to sunlight, and dampness/moisture, or too hot or too cold temperatures. It may cause changes in chemical composition. Thus do not store medicines in kitchens or bathrooms to avoid heat and moisture respectively
- 15. Storage of drugsCont’d • Ointments e.g. ophthalmic ointments have a high risk of contamination
- 16. RESPONSIBILITY OF AMIDWIFE IN DRUG MANAGEMENT
- 17. Responsibility of aMidwife in Drug Management • 1. The midwife is expected to understand the pharmacotherapeutic principles for medications given to patients • It is his/her responsibility to know: – What drug is ordered – Name (generic and trade) of drug and drug classification – Intended use – Effects on the body – Contraindication
- 18. Responsibility of aNurse in Drug Management • 2. Assessment of clients before giving medications – Family or past medical history – may have allergies – Special consideration – e.g. • Age, weight, Alcohol intake, Lab results • Other medical condition (kidney problems or liver problems) • Other pathophysiological states that can affect pharmacotherapeutic responses • pregnancy or lactating • other drugs that the patient is taking – could be contra- indicated • History of over the counter drugs
- 19. Midwife’s responsibility ctd/ –Side effects – Why the medication has been prescribed for the patient – How the medication is supplied by the pharmacy – How the medication is to be administered and dosages – What midwifery process considerations related to the drug apply to this patient
- 20. 2. The Rightsof Drug Administration • The traditional five rights of drug administration is the basis for safe delivery of drugs • They offer simple and practical guidelines for midwives to use during drug preparation and administration of drugs
- 21. The Rights ofdrug administration 1. Right patient 2. Right medication 3. Right dose 4. Right route of administration 5. Right time of administration 6. Right documentation 7. Right REASON 8. Right of client to refuse
- 22. Documentation • Right documentation –Record medication given – Dosage – Time – Any complaints by the client – Signature
- 23. Additional 3 checksof drug administration • Check the drug against the patient’s case file when removing it from the cupboard • Check the drug when preparing it, pouring it/taking it out of the container or connecting the IV line • Check the drug before giving it to the patient
- 24. Common drug administration errors •the wrong drug is administered • the wrong dose is given e.g. misreading dosage or units • the wrong route, e.g. P.O drug given IV • the drug is given to the wrong patient • at the wrong time or frequency, including omission or double dosing • an infusion is given at the wrong rate
- 25. Avoid Medication Errors •5 Common causes of medication errors: a) Incomplete patient information – e.g. not knowing about patients’ allergies, other medicines they are taking, previous diagnosis or lab results b) Unavailable drug information e.g. warnings about a drug c) Miscommunication of drug orders: illegible hand writing, confusing drugs of similar names, misuse of zeros and decimal points, unclear abbreviations
- 26. Common causes ofmedication errors d. Lack of appropriate labelling of drug containers e. Environmental factors e.g. interruptions that distract a midwife as s/he prepares to administer the medication
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- 28. DRUG FORMULATIONS • TABLETS –May be sugar coated or film coated to disguise bad taste Can be administered as chewable tablets • Capsules – Come in 2 forms – 1. Hard capsules – 2. Soft gelatine – contents are liquid or semi-solid (e.g. Vitamin A) – Capsules come in many colours so identification by colour is not reliable
- 29. DRUG FORMULATIONS Cont’d •Most people prefer capsule • Capsule are better for bad taste drugs than tablets • Oral liquid preparations – Liquids are easier to swallow – Good for children – Flavors have been added to improve on taste
- 30. Types of liquids •Linctus • Syrup formulated for coughs • Elixirs are liquids where alcohol has been added • Tinctures also contain alcohol but are more concentrated e.g tincture of iodine
- 31. Types of liquids •Suspensions – Liquids where the drug is relatively insoluble • Emulsion – Where the drug is soluble • Suspensions and emulsions tend to separate when they stand so should be well shaken before administering
- 32. For liquids andtablets/ capsules • Use proper measuring devices for liquids • Do not crush tablets or open capsules unless directed to by the pharmacist. • Do not crush enteric coated tablets • If a drug is required in another form you may get it from the pharmacy.
- 33. Drug Formulations Cont’d •Creams and ointments Mostly used for treatment of skin conditions • Creams have an aqueous base • Ointments have a lipid base and are greasy. • Eye ointment are specially made to dissolve quickly not to disturb vision
- 34. DRUG FORMULATIONS Cont’d •Topical preparations – Eye and nose drops – must be isotonic in order to avoid pain or discomfort – Eye drops are aqueous or oily or suspensions Nose Drops – avoid putting oily drops in the nose. – Oil hinders the ciliary action of nasal mucosa – The oil can cause more problems if it enters the trachea – It can cause aspiration pneumonia
- 35. DRUG FORMULATIONS Cont’d •Pastes • Has powder • They are also used topically • Gels • Lotions – are topical liquid
- 36. Routes of drugadministration 1. Enteral drug administration – Tablets and Capsules – Swallow or through NG – Sublingual and Buccal 2. Topical drug administration i) creams, lotions, gels, powders and sprays ii) Irrigations iii) Inhalations including Nebuliser – They are used administer medications to lower respiratory passages
- 37. Routes of drugadministration iv. Transdermal (patches) V. Ophthalmic Administration vi.Optic Administration vii. Nasal Administration
- 38. Routes of drugadministration Cont’d • Vaginal – Insert them high up in the vagina(Posterior fornix)) • Rectal – push them up so that they do not fall out • For each topical route of administration read on what factors to consider
- 39. Routes of DrugAdministration • Parenteral Drug administration – Intra dermal (into the dermis layer of the skin) – Subcutaneous tissue (into the deepest layer of the skin - insulin, heparin – Intra muscular – Intravenous
- 40. Other forms ofinjections • Intrathecal – injection made in CSF – usually at level of 3rd or 4th lumbar vertabrae inoder to avoid the spinal cord • Epidural injections – same location as the intrathecal but drug is deposited above the dura matter not in CSF. – Local anesthesias are sometimes given in this way during surgical procedures involving the pelvic region e.g. Ceasarian section
- 41. Other forms ofinjections • Intra-articular injections – They are made into joints to obtain high concentrations e.g. of anti-inflamatory steroids in the treatment of inflammatory conditions of the joints
- 42. Process of Administering Medication •Identify the client • Inform the client • Check expiry dates carefully before administering • Prepare the drug
- 43. Process of Administering Medication •Administer the drug • Provide support where necessary (before and after administering the drug • Record the drug administered • Evaluate the client’s response to the drug – after minutes, hours or days –depending on drug
- 44. Allergic reactions • Noteany Allergic reactions – skin rash, runny nose, redness of eyes, nausea, vomiting, wheezing, diarhoea • Anaphylaxis – involves massive systemic release of histamine and other chemicals that lead to shock and is life-threatening
- 45. Allergic reactions • Steven-JohnsonSyndrome – Starts as non specific upper respiratory tract infection with chills, fever and malaise – Followed by generalised blister-like lesions within a few days – Skin sloughing
- 46. Educating patients aboutdrugs • There is need to teach patients on how to take drugs properly: – Assess patient’s level of understanding – Establish if there is need for a significant other – Proper dosage – little is weak to cure, large dose can poison patient – Proper time/s to take the drugs
- 47. Educating patients aboutdrug Cont’d – Duration of the drug and importance of complying to duration – the whole course must be completed to avoid relapse or resistance – Whether to take before food, with food or after food – Length of time to take the drug – Drug compliance - more critical for clients with chronic conditions such as TB, hypertension, diabetes
- 48. Educating patients aboutdrugs Cont’d • Antibiotics should be taken even if they feel better. Some drugs have serious adverse effects if stopped suddenly • Action of drugs – in simple terms • A drug used for one condition will not help another • Doses for children are smaller and at times are specifically calculated for each child (mg/kg of body • Treatment must be regular to ensure maintenance of desired level of the drug in the blood.
- 49. Educating patients aboutdrugs Cont’d • Drugs must be kept out of reach of children • Drugs must be stored properly to avoid destroying their potency
- 50. Points to remember •Client assessment is important. • It should include- history of past illness, physical examination – to provide baseline information to ensure safe administration of a drug and evaluate effectiveness and adverse effects
- 51. Points to remember •Proper administration of drugs • Include comfort measures to patients to cope with drug effects • Patient and family education regarding drug effects, ways to avoid adverse effects, what warning signs they should report and any other specific information about the drug
- 52. Points to remember •Evaluate effectiveness of the drug
- 53. Drug calculation • Calculationof medications e.g. : – Mega units or Milligrams to milliliters – Milliliters to Mega units or Milligrams • Calculation of medications e.g. – Calculation of Intravenous fluid drops per minute
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- 55. • Questions andAnswers • Assignment – Calculation of drugs • References