Blog

Festive Season Patient Management Plan: Depression and the Festivities

On December 6, 2012 / Pain Medication / Leave a comment

For many elderly folk and those suffering chronic conditions, the festive season is not always an easy time or time of celebration or joy. Sometimes the festive season serves as a reminder of loneliness, financial difficulties, family disputes and an inability to participate in events due to ill health.

Common Symptoms of Depression during the festive seasons

Nursing staff and all health professionals should be cautioned to be alert to signs of holiday depression among seniors, regardless of whether they live on their own, with family members or in a long-term care facility. Depression is more apparent in seniors who have limited options for travel, or whose family members are scattered over long distances. Some of the most common symptoms of elderly depression during these times include:

* Change in sleeping habits

* Difficulty sleeping

* Apathy or lethargy

* Change of appetite

* Loss of interest in activities

* Loss of interest in socializing

Assessment and early intervention is essential in order to help provide seniors with the attention and care needed to prevent serious repercussions and side effects of depression.

Tips for Nursing staff to combat Elderly Depression during the festive season

Arrange and engage in regular phone contact with family members who are distant is important to make the elderly feel cared for
Encouraging regular visits by family to long-term care facilities is also important so that the patient does not feel abandoned or forgotten
Encouraging patients to be involved in activities provided by the facility or provide festive activities that the patient can do in their own room
Providing extra assurance during this time is essential

Above and beyond any pharmacological treatment, the first line treatment and management lies in the human touch. However if you feel your patient is dealing with long-term depression that seems worse at festive season or does not resolve after the festive period, ensure that the patient is reviewed by their doctor as soon as possible.

If medicines are commenced during or just before the festive season, please ensure that the doses are low and increments are slow with close monitoring of adverse effects as doctors may not be as easily accessible over this period. Please ensure you are aware of after hours services available if needed.

Joyce McSwan MedRN Medication Education for Nurses

The Ten Commandments of Pain Management

On October 28, 2012 / Pain Medication / Leave a comment

The TEN Commandments of Chronic Pain Management

Commandment 1:

Listen to the patient with the aim of understanding the pain experience and to provide better medication management.

Commandment 2:
Establish the pain mechanism or working diagnosis and differential diagnosis. Starting with a good pain history is the platform for which treatment can then be planned around. Upskilling with CPD nursing courses may be necessary.

Commandment 3:

Use the a “little bit of everything” treatment approach. Otherwise also known as “multimodal” therapy.

Rational polypharmacy is acceptable. It is important to understand how to use chronic pain medicines in this way.

Commandment 4:
Start LOW and Go SLOW

Chronic pain medicines should be given consistently. Start a trial and titrate analgesic therapy till optimum benefit is reached.
Start with immediate release preparations then change to slow release formulations.
Trial period of 4-6 weeks

Commandment 5:
BUT NOT too SLOW….

In the management of chronic non-cancer pain, it is recommended that short acting opioids are efficiently titrated to a daily sustained or controlled release formulation.
The goal is for patients to take sustained release preparations rather than later so as to avoid the “wait for the next dose” type of behaviour.
So certainly start LOW and go SLOW but NOT TOOOO SLOW and don’t get stuck managing chronic pain with immediate release
Chronic pain that is left untreated efficiently may develop into neuropathic pain which is irreversible.

Commandment 6:
Rotation of Opioids to reduce harms.
An understanding of chronic pain medication management will employ strategies that monitors and switches one opioid to another in an effort to improve clinical outcomes. It just may increase therapeutic benefits, reduce dose of new opioid and reduce harms.

Commandment 7:
Adjuvant analgesics may have a part to play.
Particularly for neuropathic pain adjuvant analgesics may be effective. Tricyclic antidepressants and/or anticonvulsants may reduce pain and improve quality of life. BUT they are not magic bullets!! It is reported that only HALF of the patients get relief. MedRN’s chronic pain training course may help to improve your understanding of these medicines used to treat neuropathic pain.

Commandment 8:
Realistic goal setting.
Education and discussion with cognitively able patients or their representing family members on the goal of drug and non-drug treatment is important. This will promote compliance, set expectations on effectiveness and improve the understanding of potential side effects. Do not assume that those taking chronic pain medicines for many years truly understands how they work or understand their limitations. Talking about medication management and medication administration with specific focus on chronic pain medicines is very important for these patients.

Commandment 9:
Biopsychosocial support
Treating the patient as a WHOLE is important. Chronic pain is more than just a physical burden. Depression is a top risk factor. It is important to acknowledge that patients suffering chronic pain will also be living with other chronic conditions. Chronic disease management is important. The stress of having other chronic diseases together with chronic pain can amplify core symptoms and exacerbate negative emotions which can complicate treatment and interfere with a person’s quality of life.

Commandment 10:
RE-ASSESS and OPTIMISE

Once initial treatment has commenced, it is vital to review how everything is going.

Re-assess the effectiveness of the medicine prescribed or the non-drug strategy employed. Assess and review initial diagnosis, other pathologies and any side effects experienced. Also assess for risks of addictive disorders or tendencies (personal and family history).

Then, optimise treatment with a new plan or new medicine to reach optimal goal.

Optimise your own learning also by updating your knowledge with chronic pain training courses and your patient’s will gain from the knowledge you have gained.

TGA warns about paracetamol use ….even at therapeutic doses!

The TGA has warned in its Medicines Safety Update last week (4th August 2012) to be cautious with the use of paracetamol even at therapeutic doses. Read it here “Accidental Paracetamol Poisoning”

The TGA reports that in a study of 662 patients, it was found that 48% of patients suffered accidental paracetamol poisoning, resulting in paracetamol induced hepatotoxcity.

Patients with increased risk factors may be susceptible to paracetamol toxicity when given the recommended therapeutic dose of 1gram QID.

MedRN discussed this similar issue in our blog on the 15th December 2011 (entitled Maxed out on Paracetamol – Read it here).

Patients at increased risk includes:

High alcohol intake,
Drug interactions – rifampicin or some antiepileptics, other paracetamol-containing products.
Fasting or vomiting resulting in dehydration,
Malnourished,
Underlying liver dysfunction.

This discussion is not suggesting withholding paracetamol unnecessarily unless there are the risks mentioned above. A balanced approach to the Quality Use of Medicines holds true with paracetamol and where required, paracetamol can still be beneficial as a base-line analgesic with benefits seen in osteoarthritis, a chronic pain condition.

MedRN’s Chronic Pain DVD Series, endorsed by the Australian Pain Management Association and Pain Australia, covers this topic in comprehensive detail. It is vital that the competency standards of the Nursing and Midwifery Board of Australia is met with updated medication knowledge in the management of acute and chronic pain.

New Understandings required for Chronic Pain

On July 26, 2012 / Pain Medication / Leave a comment

Have you checked out MedRN’s new page under the Chronic Pain TAB entitled : Chronic Pain- Making Headlines??

Education must not be one-dimensional. And neither is the treatment of chronic pain. It is important to us at MedRN, that effective education is conveyed to you by means of community engagement and patient involvement. It is only when we can see, hear, feel the needs of those suffering chronic pain that we can accurately convey to you what evidence says. You will see from the new page: Chronic Pain – Making Headlines that what we teach is put into action.

Joyce McSwan, managing director of MedRN, leads a dynamic multidisciplinary health care team and has first hand experience creating a consumer support group which has strong partnerships with a diverse range of healthcare professionals across all fields. Lives are transformed rapidly as patients become consumers and are empowered to take control of their pain management through self management.

The following Podcast by Phillip Adams discusses Chronic Pain in a refreshing light. Scroll to 25 minutes into the program which is when it starts. Click on this image to start listening now.

PAIN: NEW UNDERSTANDINGS

with Phillip Adams, Dr Stephan Schug and Prof. Rollin Gallagher


Professor Stephan Schug: Professor and Chair of Anaesthesiology in the School of Medicine and Pharmacology at the University of Western Australia
Director of Pain Medicine at the Royal Perth Hospital

Professor Rollin Gallagher: Editor-in-Chief, PAIN MEDICINE
Deputy National Program Director for Pain Management, Veterans Health System (USA)
Director for Pain Policy Research and Primary Care, Penn Pain Medicine
Clinical Professor of Psychiatry and Anaesthesiology, University of Pennsylvania

Digesic and Doloxene to Stay! TGA overuled by AAT

On June 21, 2012 / dextropropoxyphene, Evidence based medication, Nurse Education, Pain Management, Pain Medication / Leave a comment

In February 2012 we reported that the TGA’s (Therapeutic Goods Administration) decision to remove DiGesic and Doloxene from the Australian market was appealed by Aspen Australia, with the Administrative Appeals Tribunal (AAT) allowing their sale until a final decision was reached.

As reported by Pharmacy News this week, the push for the removal of these medicines, has been overruled by the AAT in favour of DiGesic and Doloxene remaining on the market.

“The decision to allow DiGesic and Doloxene in the Australian market recognised that there was a small group of the population who benefited from dextropropoxyphene and removing this medicine would mean that these people may not find other analgesics as effective or tolerable.” – Pharmacy News.

It is likely that there will be stringent conditions placed on the use and monitoring of those taking DiGesic and Doloxene. Stay tuned for these.

If your patients are taking either DiGesic or Doloxene, it is likely that they can continue with these analgesics, however will require close monitoring and an awareness of their adverse effects.

Monitoring considerations:

Evidence has shown that dextropropoxyphene increases the risk of serious arrhythmias (i.e. the normal rhythm of the heart is disturbed) particularly at higher doses or overdoses. Regular use may lead to accumulation of the parent compound causing dizziness and confusion, with the elderly at high risk for these adverse effects.

Other Options:

Are there other analgesic options for the management of chronic pain? Update your knowledge on chronic pain treatments with MedRN’s Chronic Pain 4 disc DVD series. You can watch the previews here.

Inflammatory Bowel Disorder – Education with a difference!

On May 26, 2012 / Chron's disease, Chronic condition, Continuing Nurse Education, Inflammatory Bowel Disorder / Leave a comment

Our last blog was on constipation and introducing MedRN’s launch of the One Minute Laxative Chart and DVD Presentation.
On the other end of the bowel spectrum is a condition known as Inflammatory Bowel Disorder (quite different from Irritable Bowel Syndrome!)

At MedRN we are always on a look out for ways to transform evidence into everyday practice. How information is delivered is vital to how we can retain, understand and then change practice.

Luke Escombe, a talented Sydney based musician, suffers from a chronic condition – Chron’s Disease. He is not afraid to speak out about it. He is the official ambassador for the Crohns and Colitis Australia and much can be learnt from this feature song - “We Need a Master Key”, as presented at the National Medicines Symposium (24th-25th May 2012).

This is education about Inflammatory Bowel Disorder with an edge!! Raw, 100% honest.

The two major types of Inflammatory Bowel Disorder are Chron’s Disease and Ulcerative Colitis. The main difference between Crohn’s disease and ulcerative Colitis is where the inflammation is located and the nature of the inflammation.

Chron’s disease can affect any where from mouth to anus (the gastrointestinal tract) and Ulcerative colities is isolated to the lower large intestine, i.e. the colon and the rectum.

While they are both very different diseases in terms of their physiology, they may present with similar symptoms such as:

Abdominal pain, vomiting, diarrhoea, rectal bleeding, severe internal cramps and pelvic muscle spasms, weight loss.

Treatment is usually with medicines that have high anti-inflammatory or immunosuppresive benefits. Medicines such as prednisone, azathioprine, methotrexate, mesalazine are some of the more common drugs used that you may have come across. In severe cases, TNF (tumor necrosis factor) inhibitors have been used and surgical interventions may be required.

Let us be reminded of this condition and how we can ensure that our knowledge remains current so that our professional practice and duty of care can make “life more liveable” for patients suffering from IBD. Listening to our patients is vital to bridge the gap between healthcare professionals and consumers/ patients so that what we deliver in our practice achieves outcomes!!

Constipation – Positioning for effect!

On May 17, 2012 / Constipation, Continuing Nurse Education, Laxative, Medication Education, Nurse Education / Leave a comment

Constipation can be a frustrating and debilitating concern for the elderly. It can limit one’s social life, professional life, and affect one’s emotion. Of most concern is the medical complications it can cause, such as faecal impaction, exacerbating urinary tract infections, proctitis, anal fissures and haemorrhoids.

The main stay of constipation has been laxatives. The rational use of laxatives is vital to achieve successful results when used and to minimise cost to the patient. MedRN has launched its ONE MINUTE LAXATIVE chart to support nursing staff in the selection of laxatives so that optimal results can be achieved.

Whilst laxatives are one part of the treatment plan, there are other areas such as diet, lifestyle, medicines, exercise, mobility, chronic conditions which must also be assessed and considered. Non-pharmacological approaches are as equally beneficial.

Constipation in the bedfast patient can become distressing for the patient if they are experiencing difficulty voiding. The following tips are for especially the elderly patient and patients with compromised mobility.

1. An upright position is recommended for the person who is defecating. If patients are not able to sit up, a left-sidelying position is recommended. This puts pressure on the transverse colon and into the descending colon facilitating faeces movement (Sharkey & Hanlon, 1989).

2. Place a footstool in front of the toilet or beside the commode. The rationale for this is that sitting with the legs elevated on a stool in front aids the movement of the faeces into the anal canal. This is commonly seen in patients with Parkinson’s disease who suffer dysfunction of the pelvic floor muscles.

3. Gently manually push the legs toward the abdomen in bed-bound patients to stimulate a squatting position. This facilitates the use of abdominal pelvic floor muscles to help with defecation (Harari et al., 1993; Leslie,1990; Waldrop & Doughty, 2000). In the elderly, a decreased abdominal muscle strength will increase the difficulty of expelling faeces.

Continuing Nurse Education to improve Adverse Drug Reaction Assessment

On April 25, 2012 / Continuing Nurse Education, Evidence based medication, Medication Education, Nurse Education, Transforming evidence into practice / Leave a comment

When a nurse administers a medicine to a patient it is expected that he/she is aware of its actions, potential adverse effects and the management plan in the event of a reaction to the medicine.

All medicines carry risks and thus it is the duty of care of custodians of these medicines to be vigilant to this. In the words of Hippocrates in 500BC :

“PRIMUM NON NOCERE” or “First, do no harm”

A 2009 literature review conducted by the National Prescribing Service on Medication Safety in the Community showed that hospitalisation admissions associated with adverse drug events ranged from 5.6% of admissions in the general population to 30.4% of admissions in the elderly. In 2010 the TGA received approximately 14,200 reports of adverse drug reaction reports.

These studies indicate the importance of continued vigilance.

Nurse continuing education is vital in this area to stay up-to-date so that as medicines change you are current in your knowledge. Nurse education that provides skills in medication management and adminisistration will ensure that competencies are maintained. A nurse has a professional accountability to look up a new medicine with an awareness of the potential effect and side effect of the drug and how to monitor for these. While on the one hand we are concerned about the monitoring of side effects, on the other, we want to also make sure that the medicine is going to be effective. Continuing nurse education is also about meeting treatment targets.

It is a RISK VS. BENEFIT ratio that has be to be constantly reassessed.

The case of Cabikatti vs. Hightower in the Court of Appeal of Louisiana of 1996 is a timely reminder. The laws have not changed. The potency of medicines have remained. Read the case here: Adverse Drug Reaction – Nurse Must Know Possible Side Effects, Monitor Patient Closely and Take Action, Court Rules

In most Residential Age Care Facilities or hospitals, there are incident forms to complete in the event of a medication related error or adverse drug reaction, however does it go beyond the immediate institution to the wider Australia? As part of the protocol of completing an in-house incident form, consideration should be given to completing a TGA Adverse Reaction Reporting Form, which some of you may have previously called a ‘blue card’. By reporting to the TGA (Therapeutics Goods and Administration) it can take regulatory action to ensure that the medicine continues to have acceptable safety, efficacy and quality for its intended use.

Assess ‘blue card’ here: ‘Blue Card’ adverse reaction reporting form

Supporting the nurse : The Adverse Events Medicines line is a useful service for reporting or advice on adverse drug reactions or errors associated with medicine.

MedRN have innovative education package options to help you get up to speed with the “how tos” of adverse drug reactions. Contact Us.

Working collaboratively with Griffith for Mental Health – Needing your help!

On April 10, 2012 / Anxiety, depression, Medication Education, Mental Health, Nurse Education, psychological support / Leave a comment

Working together to improve the health care of Australia is of utmost importance to MedRN.

Whilst we support nursing staff with continuing nurse education in the area of medicines, we are also keen to bring to awareness different projects which nurses can assist in or spread the word to their relevant contacts. Together we can play a part in the changing face of healthcare of which we will all utilise at some point in our lives.

MedRN’s current DVD series focuses extensively on The Management of Chronic Pain and inevitably as a secondary consequence to pain, depression and/or anxiety may result. The mental welfare of someone suffering a chronic condition can be a difficult burden to bear. Strong evidence is gathering and recognising the significance of providing BIOPSYCHOSOCIAL support. Below is in invitation to participate in a worthwhile project that may be of interest to you.

“ Griffith University Mental Health and Community Pharmacy Project”

Can You Help?

We are looking for people who have experienced mental illness or carers/family members to take part in a study of the evolving role of community pharmacy. We would like to hear from you.

What’s it all about?

We want to know about your experiences, needs and expectations of community pharmacies. This information will help develop a new program to train pharmacy staff to work with consumers and carers to manage their medicines.

What will you have to do?

Answer some questions by phone or in a survey after you have visited your pharmacy. This will take about 10-15 minutes. The information will be anonymous and collected by a Griffith researcher. We would like to do this three times over the next 18 months. You will be reimbursed for your time.

Who is behind this project?

The project is funded by the Australian Government Department of Health and Ageing as part of the Fifth Community Pharmacy Agreement Research and Development Program managed by the Pharmacy Guild of Australia. Ethics approval has been obtained from the Griffith University Human Research Ethics Committee (PHM/13/11/HREC).

Will there be reimbursements for my participation?

Yes, ring the hotline: 1800 600 687 for more details.

Want to know more?

Free hotline: 1800 600 687

Email: mentalhealth@griffith.edu.au

www.mentalhealthproject.com.au

Medicine Update – Changes to Movicol and Sinemet CR 200/50mg

On March 13, 2012 / Evidence based medication, Laxative, Medication Education, Nurse Education / Leave a comment

An important announcement has been released by Norgine Pty Ltd (Movicol) and Merck Sharp & Dohme (Sinemet CR) on changes to Movicol and Sinemet CR 200/50mg.

Festive Season Patient Management Plan: Depression and the Festivities

The Ten Commandments of Pain Management

The TEN Commandments of Chronic Pain Management

TGA warns about paracetamol use ….even at therapeutic doses!

New Understandings required for Chronic Pain

Digesic and Doloxene to Stay! TGA overuled by AAT

Inflammatory Bowel Disorder – Education with a difference!

Constipation – Positioning for effect!

Continuing Nurse Education to improve Adverse Drug Reaction Assessment

“PRIMUM NON NOCERE” or “First, do no harm”

Assess ‘blue card’ here: ‘Blue Card’ adverse reaction reporting form

Supporting the nurse : The Adverse Events Medicines line is a useful service for reporting or advice on adverse drug reactions or errors associated with medicine.

Working collaboratively with Griffith for Mental Health – Needing your help!

“ Griffith University Mental Health and Community Pharmacy Project”

Medicine Update – Changes to Movicol and Sinemet CR 200/50mg

An important announcement has been released by Norgine Pty Ltd (Movicol) and Merck Sharp & Dohme (Sinemet CR) on changes to Movicol and Sinemet CR 200/50mg.

View discussions on these changes:

To print this for nursing staff:

Serving you with up to date, evidence based medication education.

Subscribe to our Newsletter

MedRN Courses

Join MedRN on Facebook

MedRN is endorsed by

Testimonial

Recents Articles on MedRN