5 What does medicine optimisation mean?
Table 1.1 Pharmacokinetics and pharmacodynamics.
Source: Based on Haddad and Nutt, 2020.
| PHARMACOKINETICS | PHARMACODYNAMICS |
|---|---|
| absorption | molecular |
| distribution | biochemical |
| metabolism | physiological effects of drugs on the body |
| excretion of drugs in the body |
Introduction to Pharmacology
Pharmacology is present in daily life, from medicines bought over the counter in shops such as decongestants, nappy rash cream and pain relief, to prescription‐only medicines including antibiotics and inhalers. Lifestyle and what we eat and drink also have an impact on our bodies and our health, which can often be categorised as drugs. This includes drinks containing cafeine, chocolate, alcohol, vitamins and minerals as well as illegal substances. Before going further into this chapter, it is useful to define the terms ‘drug’ and ‘medicine’, which are often used interchangeably in texts. Medicine can be defined as a drug or other preparation for the treatment or prevention of disease, whereas a drug is described as a medicine or other substance that can be natural or artificially made which has a physiological effect when inhaled, ingested or inserted into the body or applied topically to the skin. The definitions link to each other except that the word ‘drug’ can be used for a product not necessarily designed to treat or prevent disease.
Pharmacology can be described in its most simple terms as a science or branch of medicine that looks at all aspects of medicinal drugs, including how they are used, what effect they have on the body and how they are excreted. It is important to understand how medications work and the actions they have on the systems of the body for the safety of the people you offer care and support to. You may read the term ‘drug actions’, which is the commonly used shortened term for this.
Pharmacology has been divided into two overarching categories, pharmacokinetics and pharmacodynamics and it is important to understand the difference (see Table 1.1). The pharmacokinetic aspect of pharmacology examines the absorption, distribution, metabolism and excretion of drugs in the body. Pharmacodynamics is a more detailed scientific aspect of the molecular, biochemical and physiological effects of drugs. As a lifelong learner you will learn about and develop your understanding of the pharmacokinetics of different medications, as well as the side effects, how to manage these and how medications interact with each other. This is an important aspect of healthcare, ensuring that you are providing safe and effective care to CYP, whilst being knowledgeable in detecting side effects or contraindications and seeking further support in managing these for the safety of individual patients.
Professional Framework
The Nursing and Midwifery Council (NMC) set the standards that all nurses must adhere to as outlined in the Code of Conduct (NMC, 2018a). As part of a nurse’s role the NMC highlight that the CYP in your care, and their family, must be able to trust you with their health and well‐being (NMC, 2018a). To be able to justify that trust, nurses must adhere to the following four P’s:
Prioritise people
Practise effectively
Preserve safety
Promote professionalism and trust
Within Preserving Safety, section 18 of the Code specifically focuses on aspects of medicine management and the role of the nurse which includes:
Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations.
NMC, 2018a – see Table 1.2
Table 1.2 Medicine administration, preservation of safety.
| To preserve safety in relation to medicine administration, you must: | |
| 18.1 | Prescribe, advise on, or provide medicines or treatment, including repeat prescriptions (only if you are suitably qualified) if you have enough knowledge of that person’s health and are satisfied that the medicines or treatment serve that person’s health needs |
| 18.2 | Keep to appropriate guidelines when giving advice on using controlled drugs and recording the prescribing, supply, dispensing or administration of controlled drugs |
| 18.3 | Make sure that the care or treatment you advise on, prescribe, supply, dispense or administer for each person is compatible with any other care or treatment they are receiving, including (where possible) over the counter medicines |
| 18.4 | Take all steps to keep medicines stored securely |
| 18.5 | Wherever possible, avoid prescribing for yourself or for anyone with whom you have a close personal relationship |
Source: NMC (2018a). This extract is reproduced and reprinted with permission with thanks to the Nursing and Midwifery Council.
It must be clarified at this point that not all registered nurses are permitted to prescribe, as further qualifications and registration with the NMC as an Independent Prescriber must be achieved first. The NMC’s Future Nurse: Standards of Proficiency for Registered Nurses (2018b) are designed for newly registered nurses to be ‘prescriber‐ready’ on admission to the register, and therefore have more knowledge of pharmacology as detailed within the previous education standards. Although the knowledge level will be in more depth, further training, practice and supervision will be required to be a registered prescriber. This is reinforced in the NMC Code, section 13.5, which states that you must complete the necessary training before carrying out a new role (NMC, 2018a). Table 1.2 outlines the NMC’s (2018a) requirements regarding medicine administration.
The Importance and Value of Medicine Within Healthcare
It has been identified that medicines are the most common intervention in healthcare and are used to prevent, treat and manage conditions and illnesses for people of all ages (National Institute for Health and Care Excellence (NICE), 2015). With the increase in technology and the increase in survival rates of premature births and complex health conditions, the need for medicines has increased. As with adults, more CYP are living with several long‐term conditions that are being managed with an increasing number of medicines. Medicine use can be complex and how patients can take their medicines safely and effectively can be a challenge for the health service (NICE, 2021).
The safety of administering medicines is imperative as healthcare professionals strive to ‘do no harm’. Despite this, it has been estimated that there are 237 million medication errors within England each year across all ages and areas of primary and secondary care (Elliott et al., 2020). It is also estimated from the same systematic review that 72% of errors have little