Royal College of Nursing;
the four UK Health and Social Care Departments;
specialist associations, such as the British Association of Sexual Health and HIV, UK Oncology Forum;
the World Health Organization.
Clinical considerations
Managing oxygen in care homes
Oxygen is a medical gas and as such should be treated as a medicine.
Home oxygen therapy is commonly used in care homes. It involves breathing oxygen mixed with air from a cylinder or machine. It is often prescribed for those people who have respiratory conditions, such as chronic obstructive pulmonary disease that can result in low oxygen levels in the blood. Home oxygen therapy can be given via:
nasal cannulae
face mask
tracheostomy mask.
The oxygen is delivered via tubing or mask from an oxygen cylinder, an oxygen concentrator or a ventilator.
Oxygen is prescribed on a home oxygen order form. The form contains details of how the oxygen is to be used. The prescriber sends the home oxygen order form to the oxygen supplier who then arranges delivery.
Staff at the care home should tell the person prescribing the oxygen about any changes in a person's clinical condition; this then allows the prescriber to amend and organise for a new home oxygen order form, if required.
The person's care plan should include information about home oxygen therapy. This should include who it is who will be monitoring the person who is using the oxygen.
The care plan (documentation) should also address the administration of oxygen. This has to include flow rate, frequency and duration of use; the prescriber's details should also be included. Each time staff administer oxygen, these details should be checked to ensure that the oxygen is being administered correctly.
If the person is self‐administering the oxygen, a risk assessment has to be carried out (individual risk assessments should include information about the potential dangers of having and using oxygen in the care home). A copy of the risk assessment should be kept in the person's care plan.
Local policy and procedure must be adhered to at all times. The tubing and masks must be clean and in good condition and replaced when needed. Tubing and masks must only be used for the person the oxygen was prescribed for.
Staff have to be trained and deemed competent to manage home oxygen therapy.
As with all medications, oxygen cylinders have an expiry date. The expiry date has to be checked to ensure that out‐of‐date cylinders are not used.
If equipment is no longer in use or it is out of date, it should be returned to the oxygen supplier.
Medicines optimisation
The term medicines optimisation is generally used to encompass a more people‐centred approach to the use of medicine as part of a person's care (NICE, 2015). It is essential that patients get the best quality outcomes from medicines: medicines play an important role in maintaining health, preventing illness, managing chronic conditions and curing disease – all against a backdrop of significant economic, demographic and technological change. There is evidence to suggest that there is an urgent need to get the essentials of medicines use right. Medicines use is too often sub‐optimal and a step change is needed in the way that all healthcare professionals offer support to patients in order to get the best possible outcomes from their medicines (Royal Pharmaceutical Society, 2013).
Medicines optimisation is concerned with ensuring that the right patients get the right choice of medicine, at the right time. When healthcare providers focus on patients and their experiences, there is much potential to help patients improve their outcomes, take their medicines correctly, avoid taking unnecessary medicines, reduce wastage of medicines and improve medicines safety. Medicines optimisation can help to encourage patients to take ownership of their treatment. In order to ensure medicines optimisation reaches its full potential, this requires a multidisciplinary team working approach. Healthcare professionals work together to individualise care, monitor outcomes, review medicines and support patients when needed.
Medicines management is different to medicines optimisation in a number of ways; most importantly it focuses on outcomes and patients as opposed to process and systems. Focusing on improved outcomes can help to ensure that patients and the NHS get better value from their investment in medicines. Medicines optimisation considers how it is that patients use medicines over time. This can involve stopping some medicines as well as starting others and utilising opportunities that may arise for lifestyle changes and nonmedical therapies to reduce the need for medicines.
Patient beliefs and medicines
Patients' beliefs and preferences about medication prescribing may affect medication adherence. Clyne et al. (2017) point out that patients' beliefs about treatment are a critical influence on prescription medication use. Patients may influence prescribing decisions on the basis of their expectations or, in some cases, their unwillingness to take medicines. Patients' strong beliefs in medicines, their expectations and resistance to change are cited as important barriers to prescribing.
Bearing in mind the important role that beliefs can play in medication use, it is important for the nurse to acknowledge this and to explore the beliefs of patients. Non‐adherence can result in morbidity and mortality, unnecessary health costs, unnecessary investigations and changes in treatment regimens. Neame and Hammond (2005) conclude that people with strong beliefs in the necessity of taking medication to maintain their health were found to be more adherent to treatment, and those with higher levels of concern about medication, commonly about the dangers of dependence and long‐term side effects, were more likely to be non‐adherent.
A Scandinavian study (Mårdby et al., 2009) considered beliefs, not of patients but of doctors and nurses in an outpatient setting; their aim was to explore general beliefs about medicines among doctors and nurses. They concluded that nurses saw medicines as more harmful and less beneficial than did doctors. The profession's different beliefs about medicines are important factors for adherence to medicines, just as patients' beliefs are.
There are many reasons for non‐adherence and one reason may lie between the expectations of health professionals and the behaviour of patients where there is a failure to recognise that the views and expectations of patients are key factors associated with medicine taking. Patients' beliefs and goals must be at the centre of decision‐making about their medicines, so the process of selecting and providing care has to be one of partnership and negotiation between the patient and health professionals.
Patients are invited to make informed decisions about all aspects of their care, and this comes with support from health professionals. In order to make an informed decision, then, these decisions have to be well informed. Health professionals are required to provide information that is appropriate and that fits with the patient's health beliefs, they are also required to offer that information in such a way that it is understandable to each individual. The RPS (2016) provides a framework for reaching a shared decision (see Box 1.1.)
It
