Medication management in acute mental health settings: A comparison of the views of staff and patien

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Medication management in acute mental
health settings A comparison of the views of
staff and patients

• Joy Duxbury
• Karen Wright

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Aims

• to describe current practice in the
  administration of medication during rounds on an
  acute psychiatric unit
• to identify factors that influence nurses when
  making decisions regarding the administration of
  psychotropic medication.

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Background

• Psychotropic medication is a key component
  of many inpatient
• mental treatment plans (Haglund et al
  2004, Higgins 2007)
• Clinical effectiveness of medication within
  acute psychiatry is yet to
• be established (Geffen et al 2002,
  Whicher et al 2003).
• Research examining the quality of acute
  psychiatric inpatient care
• has identified medication management
  as a focus for much
• needed improvement (SNMAC 1999). ward
  routine.
• Concerns have been raised about the poor
  assessment of
• patients before and after its
  administration.
• Research has identified that nursing staff
  have a poor knowledge
• and skill base in this area (Usher et
  al 2001, DH 2002, Richards
• et al 2007).

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Further research needed in

• decision making
• rationales for choosing to dispense medication,
• factors pertaining to consent
• therapeutic actions enabling the service user to
  take part in treatment decisions,
• information giving
• the use of effective communication.
• Usher et al 2003

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Method

• Observation of nurses carrying out medication
  rounds (30) - WAMS
• Semi-structured face-to-face interviews
• In total 57 service users and 24 qualified nurses
  were recruited from three acute admission wards
  in an inner city hospital in Northern England.
• The interview data was analysed using thematic
  analysis

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Research questions

• What information do nurses use when making
  decisions about the administration of medication
  to service users?
• What styles of interaction are used in making
  decisions between nursing staff and service
  users?
• How much influence do service users have in the
  making of this decision?
• How do nurses determine the effectiveness of the
  decision made?

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Nurses views

• Four themes emerged
• ward environment,
• communication with service users,
• communication with colleagues
• information giving.

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Ward Environment

• We just dont have the time
• It takes a long time. Staff get called out of
  the drug round to attend to other things. We get
  distracted all the time.
• Hectic, demanding, chaotic- especially on ward
  round days
• Acute wards are very busy and we will not
  compromise on medication
• It is stressful trying to manage the queue of
  impatient patients and checking the cards
  properly.

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Communication withservice users

• Have to be careful not to ask private things
  when others are there. Being aware of their
  vulnerability they may disclose information
  whilst others are present. Try to protect them by
  saying that you will talk with them after the
  round.
• The need for teamwork, collaboration and support
  was also recognised as imperative in maintaining
  safe practice

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Information Giving

• The patients question us. We lose
  professionalism and integrity if unable to
  respond
• Getting doctors to talk to patients about
  changes in meds as well as nurses.
• I wish the doctors would inform the patients
  more about when they make changes to the
  patients medication. Often the first they know
  is when they come for their meds

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Service users views

• 4 themes emerged
• therapeutic effects,
• time,
• therapeutic relationships and
• information giving.

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Therapeutic Effects (of
medication)

• I think the medication does take the edge off it
  (the stress)
• The medication is doing me the world of good
• Calms you down a bit
• It helps me to settle down-gives me more
  confidence. It helps me to control my thoughts
  and slows down my aggression.

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Side effects

• Meds make me sleep more and put weight on
• It doesnt do anything but give me side-effects
• Nothing useful just side effects
• The medication makes it so I dont hear the
  voices any more, but I am getting bad side
  effects as well in that it stops me getting an
  orgasm.

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Time

• It takes a long time, you end up queuing, you
  could wait here until 10.20pm to get your tablets
  at night, especially if Im waiting for pain
  killers, youre standing up in pain. Its
  degrading.
• Sometimes its a long time waiting (queuing). It
  takes a long time to get medicines especially
  when you are feeling desperate.

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Therapeutic Relationship

• The staff are absolutely brilliant and very
  sincere
• I was able to relieve grief, resentment, fear
  and anger from my mind by talking to the nurse
  giving out medication.
• Its important he listens to me and finds out my
  personality

• Patients are not good or well at explaining
  themselves and are fearful of medication time. We
  just cooperate because of past experiences.

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Information giving

• The biggest difference between a good experience
  and a bad is them including me asking my
  opinion explaining things to me.
• I dont get any information about my tablets. If
  I ask they tell me about side-effects

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Findings

• Nurses felt under pressure to deliver a service
  for which some felt unprepared
• Environment is chaotic and stressful
• Confidentiality is an issue
• Nurses are aware of need to monitor effects and
  side effects but are frequently hard-pressed to
  meet these within the acute environment.
• In the main, most service users were happy with
  the way their medication was administered by the
  nursing staff. BUT TIME A FACTOR
• Some patients felt that improvements could be
  made around the interactions that occurred in
  relation to information giving and side effect
  management.

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Implications

• Relationship building is good
• Therapeutic alliance with regards to the
  provision of information may need more attention
• Procedural issues to do with the medication
  round! Take into consideration confidentiality.
• Training may be best aimed at collaboration
  practices and information giving strategies.
• Side effect management and consultation
• PRN and post round not explored here
• Use of audit tools like WAMS

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Contact

• Dr Joy Duxbury
• University of Central Lancashire
• Preston
• Lancashire
• PR1 2HE
• JDuxbury_at_uclan.ac.uk
• 01772 895110