Patient education self-medication

Educating the patient about medication is an important responsibility for the nurse. The nurse must explain why the medication is given and how the patient can self-medicate. The nurse must also make sure that the patient and the family know the signs and symptoms of adverse side effects from the medication as well as any toxic effects and dietary considerations to follow while taking the medication. 

A major progress in the field is the availability of epinephrine autoinjectors which can be used by the patient him-/herself as a self-medication. Different devices are available which either trigger the injection needle just by pressure on the thigh or which have to be triggered by pressing on a button (like a pencil). The handling of these devices has to be explained and practiced with the patients (see Management, Education) [37-40]. 

Compliance is essential to ensure efficacy of a particular agent. Patients may stop taking their antibiotics once the symptoms subside and save them for a future infection. If the patient does not complete the course of therapy, the infection may not be eradicated, and resistance may emerge. Self-medication of saved antibiotics may be inappropriate and harmful and may select for resistant organisms. Poor patient adherence maybe due to adverse effects, tolerability, cost, and lack of patient education. 

Patient education and the teaching of self-management skills should be the cornerstone of the treatment program. Self-management programs improve adherence to medication regimens, self-management skills, and use of... 

Home blood glucose monitoring is recommended for all patients on antidiabetic medications, particularly insulin, If values are below 4mmol/L or persistently above 15 mmol/L, patients should seek immediate medical advice. Self-monitoring is usually offered to those with type 2 diabetes as an integral part of self-management education,... 

Managed care was initially embraced to counter the escalating costs and distorted incentives in the fee-for-service system. Under the fee-for-service health care, a physician, hospital, or other health practitioner charges separately for each patient encounter or service rendered. Expenditures increase if the fee itself increases, if more units of service are provided, or if more expensive services are substituted for less expensive ones. In the U.S., the fee-for-service system has historically favored institutional care over community-based care, acute care over preventive care, and medical intervention over patient education and self-care. 

The facts that the patient needs to know about the medication Patient education enables the patient to self-administer the medication and report adverse reactions after he or she leaves the healthcare facility. 

Significant deficiencies in the security and control of samples have been well documented. " " In fact, it has been estimated that just over half of samples actually reach patients. Samples may be used by prescribers and staff, or they may be diverted. Personal use of drug samples by physicians and other healthcare providers raises ethical concerns and is not without risk." Limaye and Paauw described three medical residents who self-prescribed antimicrobials and were subsequently diagnosed with Clostridium difficile infection." Tong and Lien reported self-medication with samples and distribution of samples to nonphysicians by almost 60% of pharmaceutical representatives surveyed at a Canadian family practice office. A contributing factor to some of these issues is that institutional or facility sample policy and procedures are often absent, or compliance is poor. One institution found only 10% compliance when the inventory of samples was compared with the required written documentation. Even after an educational program in which the policy was explained to the house staff, a second audit found only 26% compliance. " Poor compliance with policy and procedure may jeopardize patient safety, as well as put the institution at risk for JCAHO recommendations or Board of Pharmacy penalties. 

Gallefoss F, Bakke PS How does patient education and self-management among asthmatics and patients with chronic obstructive pulmonary disease affect medication Am J Respir Crit Care Med 1999 160 2000-2005. 

The nurse is responsible for educating the patient on how to self-medicate at home by providing the do s and don ts of administering the medication. The nurse must explain the following ... 

Osman LM. How do patients views about medication affect their self-management plans in asthma Patient Educ Counsel 1997 32 S43-S49. 

As with hypocalcemia, patient education related to self-care is important. The patient should be instructed to drink plenty of fluids, take only the medications prescribed by the physician, refrain from smoking, and exercise once cleared to do so by the physician. Both strength training and weight-bearing exercises are recommended. The patient should increase the time and duration of exercise sessions gradually,... 

Therefore, self-monitoring by the use of home peak expiratory flow meters is an essential part of the therapeutic program. With proper education, the patient can detect early signs of deterioration and can adjust medication within the framework of a physician-directed therapeutic regimen. 

Various approaches to self-regulation have heen taken hy different physicians organizations. However, a review of these approaches reveals general themes. In most cases, the primary justification for having a direct relationship between the pharmaceutical industry and individual physicians seems to he based on the premise that an advancement of patient healthcare will occur through increased education and research. This assumes that the information provided to the physician is impartial and also disregards the capacity of physicians to keep themselves up to date about advances in drug therapy by way of medical and other academic journals. 

The fear has been expressed that with the increased interest in alternative medicine, we [shall] see a reversion to irrational approaches to medical practice (28). The only way to minimize incompetence is proper education and training, combined with responsible regulatory control. While training and control are self-evident features of mainstream medicine they are often not fully incorporated in complementary medicine. Thus the issue of indirect health risk is particularly pertinent to complementary medicine. Whenever complementary practitioners take full responsibility for a patient, this should be matched with full medical competence if on the other hand, competence is not demonstrably complete, the practitioner in question should not assume full responsibility (29). 

Educate patient upon discharge on the importance of each medication by clearly writing the brand name and generic name of each medication, explaining the purpose of each medication, the time(s) of day each medication should be self-administered, the consequences of missing or doubling doses, and a contact name (preferably the pharmacist) and phone number for use if further questions arise at home. 

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