Integrating nursing research education and practice : safe administration of medications

The integration of the best available evidence into the delivery of safe patient care is a challenging but important task. Southern Health in partnership with Deakin University embarked on a joint initiative to develop a culture of inquiry and evidencebased nursing practice.

Effect of erectile dysfunction medications on coexsisting dysfunctions in couples : Partner's Preference Study

There is sparse information on how treatments for erectile dysfunction (ED) affects couples. This study investigated the effects of ED treatments on 100 heterosexual couples' sexual functioning and whether function achieved using a short-acting versus a long-acting ED medication differed significantly. Couples were randomized to use tadalafil or sildenafil for each of two 12-week study phases; they completed questionnaires (International Index of Sexual Function and Female Sexual Function Index) and kept sexual event diaries. All participants experienced significant improvements over baseline sexual functioning, while the men used short- or long-acting ED medications with no significant differences related to the duration of drug action recorded for either the men or women. Despite this lack of difference in efficacy there was a strong preference by women (79%) and their partners (16%) for the longer-acting medication. The reasons for this warrant further investigation. Understanding the effects on couples of the use of ED medications is a necessary aspect of ensuring ongoing sexual satisfaction in couples treated for ED.

Taking neuroleptic medications as embodied experience : a hermeneutic phenomenological study

This hermeneutic phenomenological study focuses on the question: What is it like to take neuroleptic medications for schizophrenia, and what is the meaning of this experience?

The safety of medications for the treatment of bipolar disorder during pregnancy and the peurperium

Risks associated with pharmacological treatment of bipolar disorder are heightened during reproductive events. Treatments need to be planned with the mutual agreement of both the treating physician and the patient and tailored to the needs of the individual so as to minimise risk while providing adequate treatment. Conventional treatments have all been associated with teratogeny in first trimester exposure, lithium with cardiac malformation and valproate and carbamazepine with neural tube malformations. There have been an insufficient number of first trimester exposures to the newer anticonvulsant mood stabilisers, lamotrigine and oxcarbazepine, to determine whether there is a safety advantage in switching to these agents. Increasingly, atypical antipsychotics are being suggested as useful agents for the treatment of bipolar disorder. While not known to be teratogenic, there are other reproductive safety concerns associated with these agents. Bipolar disorder patients may be prescribed antidepressants, and many of these agents are associated with a low safety risk during reproductive events, however data regarding use of these agents are currently equivocal. Adverse outcomes from inadequate pharmacological prophylaxis have been documented for both the mother and the baby. Risks and benefits need to be carefully balanced based on an accurate review of the evidence.

Construct validity and reliability of the single checking administration of medications scale

Research indicates that single checking of medications is as safe as double checking; however, many nurses are averse to independently checking medications. To assist with the introduction and use of single checking, a measure of nurses' attitudes, the thirteen-item Single Checking Administration of Medications Scale (SCAMS) was developed. We examined the psychometric properties of the SCAMS. Secondary analyses were conducted on data collected from 503 nurses across a large Australian health-care service. Analyses using exploratory and confirmatory factor analyses supported by structural equation modelling resulted in a valid twelve-item SCAMS containing two reliable subscales, the nine-item Attitudes towards single checking and three-item Advantages of single checking subscales. The SCAMS is recommended as a valid and reliable measure for monitoring nurses' attitudes to single checking prior to introducing single checking medications and after its implementation.

Barriers and enablers affecting patient engagement in managing medications within specialty hospital settings

Background : Communication problems contribute enormously to medication errors and adverse events. Encouraging patient engagement can help to facilitate effective medication management.

Objectives : To examine barriers and enablers affecting how patients engage with managing their medications in specialty hospital settings.

Design : An exploratory qualitative design was used involving in-depth interviews with doctors, nurses, pharmacists, patients and family members.

Setting : An Australian public, metropolitan teaching hospital was the study site and five specialty hospital settings were used, including cardiac care, emergency care, intensive care, oncology care and perioperative care.

Results : In all, 21 health professionals, 11 patients and 12 family members participated in the study (n = 44). Barriers and enablers involved intrapersonal, interpersonal and environmental aspects, and differences in perceptions and experiences were found between the various settings. Health professionals had preconceived notions of what was appropriate behaviour in conveying information about medications. Many health professionals stated that they deliberately chose not to provide medication-related knowledge. Different barriers for patient engagement existed in various settings – in emergency care, patients could only stay for 4 h; in intensive care, medication changes regularly happened; in cardiac care, patients were discharged prematurely due to urgent need of beds; in oncology, there was lack of availability of oncology consultants; while in perioperative care, surgeons and anaesthetists were available just before surgery.

Conclusions : Complex barriers and enablers are associated with patient engagement in specialty clinical settings. By developing an understanding of these barriers and enablers, health professionals can help patients to understand and participate in their medication management.

Challenges of managing medications for older people at transition points of care

In clinical practice, pharmacists play a very important role in identifying and correcting medication discrepancies as older patients move across transition points of care. With increasing complexity of health care needs of older people, these discrepancies are likely to increase. The major concern with identifying and correcting medication discrepancies is that medication reconciliation is considered a retrospective problem - that is, dealing with medication discrepancies after they have occurred. It is argued here that a more proactive stance should be taken where doctors, nurses and pharmacists collectively work together to prevent medication discrepancies from happening in the first place. Improved involvement of patients and family members will help to facilitate better management of medications across transition points of care. Efficient use of information technology aids, such as electronic medication reconciliation tools, should also assist with organizational systems problems associated with the working culture, heavy workloads, and staff and skill mix of health professionals.

Legal issues: Disciplinary proceedings for inappropriate prescription of opioid medications by medical practitioners in Australia (2010-2014)

An analysis of 32 cases reported between July 2010 and September 2014 byprofessional disciplinary tribunals in New South Wales and Victoria againstmedical practitioners found guilty of inappropriately prescribing Sch 8 medications(mainly opioids) and Sch 4 drugs (mainly benzodiazepines) demonstrated, among others, a lengthy delay between the occurrence of the miscreant conduct and the conclusion of disciplinary proceedings. The study also raised questions about the appropriateness of utilising common criminal law theories of punishment and deterrence by non-judicial tribunals.

Pharmacists' interprofessional communication about medications in specialty hospital settings

Effective communication between pharmacists, doctors, and nurses about patients' medications is particularly important in specialty hospital settings where high-risk medications are frequently used. This article describes the nature of communication about medications that occurs between pharmacists and other health professionals, including doctors and nurses, in specialty hospital settings. Semistructured interviews with, and participant observations of, pharmacists, nurses, and doctors were conducted in specialty settings of an Australian public, metropolitan teaching hospital. Twenty-one individuals working in the settings of emergency care, oncology care, intensive care, cardiothoracic care, and perioperative care were interviewed. In addition, participant observations of 56 individuals were conducted in emergency care, oncology care, intensive care, and cardiothoracic care. Detailed thematic analysis of the data was performed. Across all of the settings, pharmacy was less visible than medicine and nursing in terms of pharmacists' work performed, pharmacy documentation and resources, and pharmacists' physical visibility. Pharmacists, doctors, and nurses largely worked alongside one another rather than with each other. When collaboration occurred, the professional groups engaged in mostly reactive communication to accomplish specific medication tasks that needed completing. Interprofessional differences in attitudes toward medications and medication management communication behaviors were evident. Pharmacists need to engage in more proactive communication in order to reduce the risk of medication errors occurring.