Adverse drug reactions: treatment burdens and nurse-led medication monitoring

Gabe, Marie; Davies, Gwyneth; Murphy, Fiona; Davies, M.; Johnstone, Linzi; Jordan, Sue

doi:10.1111/j.1365-2834.2011.01204.x

Cited by 30 publications

(51 citation statements)

References 130 publications

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“…Where nurses undertake tasks outside traditional nursing roles, time [114] and educational preparation [115] may be perceived barriers. Any change needs to be seen as beneficial, resourced, and achievable [3]. To allay concerns regarding the necessary investment in time and learning, evidence is needed for the clinical effectiveness of ADR profiles in identifying and ameliorating the burdens of treatment [116].…”

Section: Discussionmentioning

confidence: 99%

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Medication Monitoring for People with Dementia in Care Homes: The Feasibility and Clinical Impact of Nurse-Led Monitoring

Jordan

Gabe

Newson

et al. 2014

The Scientific World Journal

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Objectives. People with dementia are susceptible to adverse effects of medicines. However, they are not always closely monitored. We explored (1) feasibility and (2) clinical impact of nurse-led medication monitoring. Design. Feasibility “before-and-after” intervention study. Setting. Three care homes in Wales. Participants. Eleven service users diagnosed with dementia, taking at least one antipsychotic, antidepressant, or antiepileptic medicine. Intervention. West Wales Adverse Drug Reaction (ADR) Profile for Mental Health Medicines. Outcome Measures. (1) Feasibility: recruitment, retention, and implementation. (2) Clinical impact: previously undocumented problems identified and ameliorated, as recorded in participants' records before and after introduction of the profile, and one month later. Results. Nurses recruited and retained 11 of 29 eligible service users. The profile took 20–25 minutes to implement, caused no harm, and supplemented usual care. Initially, the profile identified previously undocumented problems for all participants (mean 12.7 (SD 4.7)). One month later, some problems had been ameliorated (mean 4.9 (3.6)). Clinical gains included new prescriptions to manage pain (2 participants), psoriasis (1), Parkinsonian symptoms (1), rash (1), dose reduction of benzodiazepines (1), new care plans for oral hygiene, skin problems, and constipation. Conclusions. Participants benefited from structured nurse-led medication monitoring. Clinical trials of our ADR Profile are feasible and necessary.

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Section: Discussionmentioning

confidence: 99%

“…(An adverse drug reaction is defined as any untoward and unintended response in a patient or investigational subject to a medicinal product which is related to any dose administered [7]. ) Failure to monitor for common problems, rather than poor prescribing, is responsible for the majority of ADRs [3, 8–13]. …”

Section: Introductionmentioning

confidence: 99%

Medication Monitoring for People with Dementia in Care Homes: The Feasibility and Clinical Impact of Nurse-Led Monitoring

Jordan

Gabe

Newson

et al. 2014

The Scientific World Journal

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“…The WWADR Profile may also help overcome some perceived barriers to nurse-led medication monitoring such as inter-professional communication or lack of confidence in knowledge of pharmacology and therapeutics [41], [63]–[65], [77]–[80]. With this support, nurses, as the largest group of front-line healthcare professionals working most closely with service users, are well-placed to play a valuable role in medication monitoring [81], [82]. The Profile itself could be easily transferred across healthcare settings and may alleviate under-reporting of drug-related problems [83], [84].…”

Section: Discussionmentioning

confidence: 99%

“…The literature offers no consensus on identifying and addressing medicine-related harm and adverse events [82]. Many ADRs are subtle and ill-defined, and may resemble pre-existing conditions or ageing.…”

Section: Discussionmentioning

confidence: 99%

Medication Monitoring in a Nurse-Led Respiratory Outpatient Clinic: Pragmatic Randomised Trial of the West Wales Adverse Drug Reaction Profile

et al. 2014

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ObjectiveTo assess the clinical effect of medication monitoring using the West Wales Adverse Drug Reaction (ADR) Profile for Respiratory Medicine.DesignSingle-site parallel-arm pragmatic trial using stratified randomisation.SettingNurse-led respiratory outpatient clinic in general hospital in South Wales.Participants54 patients with chronic respiratory disease receiving bronchodilators, corticosteroids or leukotriene receptor antagonists.InterventionFollowing initial observation of usual nursing care, we allocated participants at random to receive at follow up: either the West Wales ADR Profile for Respiratory Medicine in addition to usual care (‘intervention arm’ with 26 participants); or usual care alone (‘control arm’ with 28 participants).Main Outcome MeasuresProblems reported and actions taken.ResultsWe followed up all randomised participants, and analysed data in accordance with treatment allocated. The increase in numbers of problems per participant identified at follow up was significantly higher in the intervention arm, where the median increase was 20.5 [inter-quartile range (IQR) 13–26], while that in the control arm was −1 [−3 to +2] [Mann-Whitney U test: z = 6.28, p<0.001]. The increase in numbers of actions per participant taken at follow up was also significantly higher in the intervention arm, where the median increase was 2.5 [1]–[4] while that in the control arm was 0 [−1.75 to +1] [Mann-Whitney U test: z = 4.40, p<0.001].ConclusionWhen added to usual nursing care, the West Wales ADR Profile identified more problems and prompted more nursing actions. Our ADR Profile warrants further investigation as a strategy to optimise medication management.Trial RegistrationControlled-trials.com ISRCTN10386209

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“…It may be due to the depth and thus the time commitment to complete the workbook suggests it should used as a summative rather than formative assessment. It has been established that knowledge to base safe and competent practice is needed in such a high-risk area of the MHNs' role in MM (Snowden, 2010;Gabe et al, 2011). MHNs also have an important role in preventing medicine error, but to do so they require an adequate knowledge base to fulfil this aspect of their role.…”

Section: Pharmacology Workbookmentioning

confidence: 99%