How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 52

This book is in B&W, not color - Print page in Grayscale for Correct view! Administering medication: general issues The main issue in administering medication in a prison setting is how to make sure that the right medication goes to, and is taken by, the right patient at the right time. All psychotropic medications and many medicines used for physical conditions (eg analgesics) also may be used as currency on the wing. Patients may sell or give them to other prisoners or be pressured/bullied into doing so. There is also the possibility that patients may save medication and then use it to overdose. Other issues, common to administering psychotropic medication in any setting, include the following: • How to provide information about the medication and its side-effects to all patients, and also those with communication difficulties who may not understand the instructions. Information tends to increase compliance. • What to do about those patients who are not capable of managing their own medication, eg those with learning di sability. • How to encourage ‘compliance’ or concordance without infringing the rights of patients to refuse medication they do not want. This is a particular issue with antipsychotic medication especially depot injections. Possible solutions A major response to the problem of reducing trading and the hoarding of medication is to supervise consumption of medication — giving it only ‘in sight’ and not ‘in possession’. This solution may, however, bring its own problems. For example, giving medication in sight rather than in possession may: • mean that the dose is given at the wrong time. For example, a sedative could be given at 4.00 or 5.00 pm and so be ineffective in helping the individual sleep at night • turn medication into a battle ground between patients and healthcare staff and • make it difficult or impossible to give medication twice or three times per day. The decision about whether any particular medication should be given in possession or not is an individual one. It will depend upon the timing of the dose, the number of doses needed per day, the patient’s ability to understand his/her medication, the risk of abuse, etc. Whether medication is to be given in possession or not and the reasons for the decision should be documented in the notes. Systems and policies about medication Effective programmes for administering medication include the following: • Tracking and monitoring system that records whether patients are turning up for and taking their medication. Actively seeking out those patients who are considered to be at risk without their medication (including those on antipsychotics, mood stabilisers and some on antidepressants) who do not take it. • Regular reviews of medication. Reviews will ideally take place in a clinic, be multidisciplinary, and include the prescribing doctor and administering nurse/HCO who together review compliance, the behaviour of the patient with regard to medication and the patient’s own report of his/her progress. • Regularly scheduled patient educational groups related to the use of psychoactive medications. These are important and can reduce the need for in sight administration of medications, with all its attendant problems. They also increase compliance. • Policy on ‘in possession’ medication including flexibility within the policy. • Awareness by all who are involved in administering medication of the need to obtain patient consent and of what to do if a patient refuses to take the medication. For [email protected] Property of Bookemon, do NOT distribute 54