Patient education and consumer medicine information: a study of provision by Queensland rural and remote area Registered Nurses

Abstract

Aims and objectives. The aim of the larger study was to ascertain the medication practices of registered and enrolled nurses in rural and remote areas of Queensland after the introduction of the Health (Drugs and Poisons) Regulation. This paper reports on the findings of the role of registered nurses and their confidence in the ability to provide information on medications in a way that the client understands; the frequency of the provision of information to clients prior to discharge; and the frequency of Indigenous Health Workers or interpreters for people without English as a first language. Background. Queensland employs approximately 17% of the Australian registered nurse workforce. In 1996 Queensland changed the Health (Drugs and Poisons) Regulation to allow specific registered nurses, who had undertaken approved postgraduate education and training programmes, to become endorsed for an expanded medication practice role. In particular, it allowed endorsed nurses to administer and supply (but not prescribe) drugs listed in a drug formulary to certain clients using protocols. It was not clear, however, whether the changes to the Regulation reflected the scope of practice, thereby providing adequate legal protection for the nurse. Design. During 2001–02 an exploration of the medication practices of rural and remote area nurses was conducted by the use of a cross‐sectional postal survey. Phase 1 of the study used a facility audit to ascertain facility medication practices and phase 2 of the study used a postal survey to ascertain nurses’ medication practices. Method. All nurses employed in rural and remote health facilities in Queensland were eligible to participate in the study. The nurse registering authority's (the Queensland Nursing Council) register was used to generate a non‐proportional stratified random sample. Of the 1999 questionnaires sent, there were 668 respondents. Of these, 520 were registered nurses. Results. The data indicated that there was a difference between endorsed and unendorsed registered nurses’ medication practice. In particular, it was apparent that endorsed registered nurses were more likely to believe they could explain the side‐effects of medication to clients in a way the patient understood; provided medication education to clients on discharge; and used Indigenous Health Workers or interpreters to explain medications to those clients for whom English was not a first language. However, it was apparent that <50% of all Registered Nurses were providing client medication education or using Indigenous Health Workers or interpreters. Conclusion. It is apparent that the changes to the Regulation have ensured that Registered Nurses who have undergone postgraduate education to enhance their medication practice are more likely to provide client education and consumer medication information. However, the results suggest that the majority of registered nurses in Queensland, whilst believing they have sufficient knowledge of pharmacology to provide client education, often do not provide...

A review of the medication pathway in rural Queensland, Australia

“…The previous step generally leads to the dispensing and/or extemporaneous compounding by a pharmacist [2] . In rural areas, where pharmacists are not available, other healthcare providers (Figure 1) are endorsed to ‘supply’ medications [5,6,31] . Rural‐specific provisions are summarised in Table 2 [27–29] .…”

“…These healthcare providers do not need to conform to the quality standards under which pharmacists practise, although they are bound by the requirements in the Regulation for labelling and recording of medications issued [5,32] . Research has highlighted that these healthcare providers require support systems amidst the scarcity of pharmacists and lack of technological support in rural areas, particularly in terms of complying with legislative requirements, clinical drug knowledge and provision of medication information [4,31,33–36] . While medical doctors are endorsed to dispense or supply medications under the Regulation , they may only provide PBS medications as ‘a convenient and efficient pharmaceutical service’ in a rural location where there is no pharmacist‐approved location under the National Health Act 1953 (Cth) [32]…”

“…Numerous reports [7,23,26,41,42] have demonstrated that the involvement of a pharmacist in providing medication consultation can influence patients' self‐management of their medications. Reports have also shown that nurses were able to provide basic medication information, including the action of medications and common side effects, although the information provided was not as comprehensive as that provided by pharmacists [30,31] . This is because nursing staff, with specific reference to rural nursing staff, often supply and/or administer medications, raising the need for them to have pharmaco‐therapeutic knowledge when monitoring patients' response to medications to ensure patients' safety [30,31] …”

“…Reports have shown that rural sole pharmacists experience high workloads from dispensing and pharmacy management, impeding their involvement in medication consultations [4,7,28,43,44] . In addition, non‐pharmacists involved in medication supply have limited scope of practice in the provision of medication information and medication management [4,31,36] . Training packages developed to up‐skill non‐pharmacists in their medication knowledge have been limited due to the costs of time and travel, high turnover of rural staff and scarcity of rural pharmacists to train these healthcare providers [4,33,36] .…”

“…While legislation and workplace protocols set boundaries to promote safe practice, it can also inhibit the provision of the required services in rural areas, where healthcare workforce is limited [6,35] . Some reports have drawn attention to the blurring of nursing roles, often out of necessity in practice, and raised concerns about medication administration, clinical monitoring of patients' responses and medication safety [31,35,45,47] …”