Approaches to managing older people using opiates and their risk of dependence.

There is little doubt that opiates have transformed healthcare, particularly in relation to pain management. However, many patients prescribed this type of drug develop problems such as dependency. Although we do not know how many older people have developed such problems due to opiate use we know that some will.

Considering patient experience and evidence-based choice of medicines in medicines optimisation.

Medicines optimisation can be used by healthcare professionals to support patients to gain maximum benefit from their medicines, with two of the main principles being understanding the patient experience and ensuring medicines choice is evidence-based. Non-adherence is a significant issue in medicines management. Relational aspects of the patient experience, such as empathetic two-way communication between the healthcare professional and patient, the provision of clear information and shared decision-making, can have a positive influence on whether patients take their medicines as intended.

Adverse drug reactions: classification, susceptibility and reporting.

Adverse drug reactions (ADRs) are increasingly common and are a significant cause of morbidity and mortality. Historically, ADRs have been classified as type A or type B. Type A reactions are predictable from the known pharmacology of a drug and are associated with high morbidity and low mortality.

Polypharmacy: the challenge for nurses.

Polypharmacy refers to the prescribing of many medicines for one individual. Polypharmacy is increasingly common as a result of the rise in multimorbidity, use of evidence-based clinical guidelines and care pathways, and a focus on disease prevention. Polypharmacy can be justified and appropriate, but it may also be inappropriate and associated with suboptimal health outcomes and mortality.

Medicines optimisation: priorities and challenges.

Medicines optimisation is promoted in a guideline published in 2015 by the National Institute for Health and Care Excellence. Four guiding principles underpin medicines optimisation: aim to understand the patient's experience; ensure evidence-based choice of medicines; ensure medicines use is as safe as possible; and make medicines optimisation part of routine practice. Understanding the patient experience is important to improve adherence to medication regimens.

Nursing students' reflections on the Francis report.

This article explores nursing students' reflections on the criticisms of nursing highlighted in the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry ( Francis 2013 ). Their reflections on the concerns identified in the report raise awareness of factors that are important in the delivery of compassionate patient-centred care. The media portrayal of nursing in the aftermath of the report and its implications for the nursing profession and nursing practice is considered, and the vital elements required to foster a culture of compassionate care within care environments are examined.

The effect of organisational culture on patient safety.

This article explores the links between organisational culture and patient safety. The key elements associated with a safety culture, most notably effective leadership, good teamwork, a culture of learning and fairness, and fostering patient-centred care, are discussed. The broader aspects of a systems approach to promoting quality and safety, with specific reference to clinical governance, human factors, and ergonomics principles and methods, are also briefly explored, particularly in light of the report of the public inquiry into care failings at Mid Staffordshire NHS Foundation Trust.

Prescribing and medicines management in older people.

The aim of this article is to explore prescribing and medicines management in older people. The author discusses the physiological changes that occur as people age and how these changes affect the use of drugs in this group. Additionally, inappropriate prescribing with specific reference to polypharmacy in older people is explored.

Patient safety: threats and solutions.

The recent landmark report into the care failings at Stafford Hospital has called for sweeping changes to end the NHS's neglect of patient safety (Francis 2013). The report calls for a 'fundamental change' in culture so that patients are always put first, and it makes 290 recommendations covering a broad range of issues relating to patient care and safety in the NHS. This article explores issues surrounding patient safety, including the terminology associated with harm and error.

Asthma: pathophysiology, diagnosis and management.

This article provides an overview of asthma in adults, includin pathophysiology, risk factors and triggers. Assessment, diagn pharmacological therapies are considered. The importance of in partnership with the patient and encouraging supported self-care are highlighted.

Pulmonary tuberculosis: clinical features and patient management.

Pulmonary tuberculosis (TB) is a common infectious disease and a major cause of illness and death throughout the world, particularly in developing countries. This article explores the difference between latent TB infection and active TB disease, and discusses the pharmacological management of TB and issues around adherence to medication. Although TB is usually managed by specialist teams it is essential that all practitioners have an understanding of the signs and symptoms of the disease to ensure early referral and accurate diagnosis.

Antibiotics: mode of action and mechanisms of resistance.

Antibiotic therapy has revolutionised medical care and has many benefits for patients with or at risk of infections. However, the development of antibiotic resistance now limits the effectiveness of these agents, which is a serious public health concern. This article examines these issues and offers guidance on prescribing strategies and resources for nurse prescribers.

Polypharmacy in older adults.

This article explores the issue of polypharmacy in older adults. The physiological changes in organ function in older people and the effect of this on pharmacokinetics and pharmacodynamics are discussed. The risks of adverse drug reactions and adverse drug interactions linked to polypharmacy are explored.

Developing patient group directions for medicines management.

This article explores the development and use of patient group directions in the supply and administration of medicines. It provides an overview of the classification of medicines and differentiates between a patient specific direction and a patient group direction. The use of patient group directions in the NHS and private sector, and the medicines that can be included in such a directive, are discussed.

Basic pharmacology of non-opioid analgesics.

Non-opioid analgesics, such as aspirin, non-steroidal anti-inflammatory drugs and paracetamol, are widely used in the treatment of pain, pyrexia and inflammation. Each has therapeutic advantages and potential disadvantages. This article discusses the indications, cautions and contraindications, adverse effects and interactions of these agents.

Strategies to improve patients' adherence to medication.

This article explores issues surrounding adherence to medication. Terminology associated with the use of medication, most notably the terms compliance, concordance and adherence, are discussed. The article also explores factors that can influence the use of medication and discusses the role of nurses in supporting adherence to treatment.

Patient assessment: effective consultation and history taking.

This article explores patient consultation with specific reference to the Calgary-Cambridge consultation guide. It provides an overview of history taking and explores the patient's perspective during the consultation. The article also discusses the skills required to provide information effectively.

Non-medical prescribing using the British National Formulary.

This article explores how to maximise efficient use of the British National Formulary (BNF) within the context of non-medical prescribing. It provides an overview of the layout of the BNF and identifies how the publication can be used to detect contraindications and potential drug interactions. The detection, recording and reporting of adverse drug reactions are also explored.

Investigating the nursing contribution to commissioning in primary health-care.

Aim: This study set out to investigate nurses', doctors' and managers' perceptions of the nursing contribution to commissioning in primary health-care.

Background: The study was undertaken in the light of the proposal in the government's White Paper The new NHS, Modern, Dependable that community nurses should play a lead role in commissioning health services as members of the new primary care groups.

Method: Semistructured taped interviews were conducted, with seven community nurses, two community midwives, seven managers and four general practitioners, covering three geographical locations in the UK.