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By F. Tippler. Gardner-Webb University.

The prescription is issued in the usual course of the provision of that health service buy naltrexone 50 mg with visa medicine 2632. In addition, the 2007 Regulations allow a health service provider to determine further conditions in limiting the prescriptive authority of the nurse/midwife. A specific schedule – Schedule 8 - has been devised, composed of four parts, which names the Schedule 2 and 3 drugs that a nurse/midwife is authorised to prescribe and also dictates administration routes and care settings or conditions2. Additional information concerning nurse and midwife prescribing is 2Refer to Appendix C for Schedule 8 details. The Irish Medicines Board (Miscellaneous Provisions) Act, 2006, the Medicinal Products (Prescription and Control of Supply) Regulations, 2003 and 2005 and the Misuse of Drugs Acts, 1977 and 1984, and subsequent regulations authorise the nurse/midwife to possess, supply and administer medicinal products to a patient/service-user. The Pharmacy Act, 2007, makes provision for the regulation of pharmacy, including authority for the sale and supply of medicinal products. The key factors to be considered when determining the scope of practice for nursing and midwifery care also apply to the scope of practice for medication management. These include: • Competence • Accountability and autonomy • Continuing professional development • Support for professional nursing and midwifery practice • Delegation • Emergency situations. Standard Each nurse/midwife is expected to develop and maintain competence with regard to all aspects of medication management, ensuring that her/his knowledge, skills and clinical practice are up to date. The activities of medication management require that the nurse/midwife is accountable to the patient/service-user, the public, the regulatory body, her/his employer and any relevant supervisory authority. Supporting Guidance The nurse/midwife has a responsibility to ensure her/his continued professional development, which is necessary for the maintenance of competence, particularly with regard to medicinal products. She/he should seek assistance and support where necessary from the health service provider concerning continued professional development. It is not acceptable practice for a nurse or midwife to remove or take medication from her/his workplace for personal use or for supplying for use by family, friends or significant others. Supporting Guidance It is not appropriate for a nurse or midwife to ask a work colleague with prescriptive authority to write a prescription for them. In addition, nurses or midwives who remove medications from their place of employment for personal use may be subject to a fitness to practise inquiry by An Bord Altranais for professional misconduct, employment disciplinary procedures and/or criminal charges. Standard The prescription or medication order should be verified that it is correct, prior to administration of the medicinal product. Clarification of any questions regarding the prescription/medication order should be conducted at this time with the appropriate health care professional. The five rights of medication administration should be applied for each patient/service- user encounter: Right medication, patient/service-user, dosage, form, time. The right patient/service-user: • Being certain of the identity of the individual who is receiving the medication • Checking the medical record number and/or identification band • Asking the patient/service user to state her/his name • Confirming that the name and age are means of ensuring the correct identity • Maintaining a photo of the individual on the medication administration record. The right dosage: • Considering if the dosage is appropriate based on age, size, vital signs or other variables • If it is necessary to measure the dose (e. The right form: • Ensuring that the correct form, route and administration method of the medication are as prescribed • If this information is not indicated on the prescription or on the label of the medication, it should be clarified with the prescriber, as many medications can be given by various routes. The right time: • Ensuring the correct timing, frequency and duration of the prescribed order • The timing of doses of medications can be critical for maintaining specific therapeutic blood-drug levels (e. For each patient/service-user encounter, medicinal products may normally be administered by a nurse/midwife on her/his own. As evidenced by best practice, the preparation and administration of a medicinal product should be performed by the same nurse/midwife. Student nurses/midwives may administer medicinal products under the supervision of a nurse/midwife and should follow the principles of supervision. This may involve verification of the medication against the medication prescription order, performing calculations for dosing of the correct volume or quantity of medication and/or other aspects of medication administration as appropriate. Double-checking is a significant nursing/midwifery activity to facilitate good medication management practices and is a means of reducing medication errors. Standard The use of double-checking medications should be implemented purposefully in situations/indications that most require their use – particularly with high-alert medications3. Supporting Guidance Registered nurses/midwives are accountable for their professional decisions and do not need another professional colleague to routinely check their work. There is no legal or professional requirement that a nurse/midwife must double-check the preparation of a medication with a colleague prior to administration.

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But by the time an overdosing person is reached and treated buy 50mg naltrexone amex treatment notes, it is often too late to save them. These programs have been shown to be an effective, as well as cost-effective, way of saving lives. To reverse these trends, it is important to do everything possible to ensure that emergency personnel, as well as at-risk opioid users and their loved ones, have access to lifesaving medications like naloxone. Acute Stabilization and Withdrawal Management Withdrawal management, often called “detoxifcation,” includes interventions aimed at managing the physical and emotional symptoms that occur after a person stops using a substance. Withdrawal symptoms vary in intensity and duration based on the substance(s) used, the duration and amount of use, and the overall health of the individual. Some substances, such as alcohol, opioids, sedatives, and tranquilizers, produce signifcant physical withdrawal effects, while other substances, such as marijuana, stimulants, and caffeine, produce primarily emotional and cognitive withdrawal symptoms. Most periods of withdrawal are relatively short (3 to 5 days) and are managed with medications combined with vitamins, exercise, and sleep. One important exception is withdrawal from alcohol and sedatives/ tranquilizers, especially if the latter are combined with heavy alcohol use. Rapid or unmanaged withdrawal from these substances can be protracted and can produce seizures and other health complications. It is best considered stabilization: The patient is assisted through a period of acute detoxifcation and withdrawal to being medically stable and substance-free. Stabilization is considered a frst step toward recovery, much like acute management of a diabetic coma or a hypertensive stroke is simply the frst step toward managing the underlying illness of diabetes or high blood pressure. Similarly, acute stabilization and withdrawal management are most effective when following evidence- based standards of care. Studies have found that half to three quarters of individuals with substance use disorders who receive withdrawal management services do not enter treatment. For example, 27 percent of people who received detoxifcation services not followed by continuing care were readmitted within 1 year to public detoxifcation services in Delaware, Oklahoma, and Washington. Because withdrawal management reduces much of an individual’s acquired tolerance, those who attempt to re-use their former substance in the same amount or frequency can experience physical problems. Individuals with opioid use disorders may be left particularly vulnerable to overdose and even death. It is critically important for health care providers to be prepared to properly assess the nature and severity of their patients’ clinical problems following withdrawal so that they can facilitate engagement into the appropriate intensity of treatment. For this reason, the majority of research has been performed within these specialty settings. Adolescent substance use needs to be identifed affects brain function and behavior. Adolescents can beneft from a drug abuse intervention even if they are not addicted to a 3. Routine annual medical visits are an opportunity to the individual, not just his or her drug abuse. Behavioral therapies—including individual, family, to enter, stay in, and complete treatment. Treatment should address the needs of the whole treatment for many patients, especially when person, rather than just focusing on his or her drug combined with counseling and other behavioral use. Medically assisted detoxifcation is only the frst stage of addiction treatment and by itself does 10. Sensitive issues such as violence and child abuse or little to change long-term drug abuse. Staying in treatment for an adequate period continuously, as lapses during treatment do occur. However, unlike treatments for most other medical illnesses, substance use disorder treatment has traditionally been provided in programs (both residential and outpatient) outside of the mainstream health care system. The intensity of the treatment regimens offered can vary substantially across program types.

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