By U. Ilja. Azusa Pacific University.

Competence: having the requisite knowledge order 60mg raloxifene with amex, skills and judgement/abilities to perform safely raloxifene 60mg fast delivery, effectively and ethically discount raloxifene 60 mg with mastercard; and applying that knowledge discount raloxifene 60mg without prescription, skills and judgement/abilities to ensure safe, effective and ethical outcomes for the patient/client. Delegation: the transfer of the legal authority to perform a procedure within a controlled act to a person not otherwise authorized to perform the procedure. In this context, labelling does not include the labelling by the manufacturer, packer or distributor of a non-prescription drug or commercially packaged drug or device. Order: An “order” is the authority to undertake an intervention if the circumstances are appropriate and, in your professional judgement, it is appropriate to undertake the intervention. Pharmacy: a premise in or in part of which prescriptions are compounded or dispensed for the public. Prescriber: a person authorized to give a prescription within the scope of his or her practice of a health discipline or profession. Prescription: an authorization from a prescriber permitting the dispensing of any drug or mixture of drugs for a designated person or animal. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. Comments on this guideline are welcome and should be addressed to: Manager, Quality Practice College of Respiratory Therapists of Ontario 180 Dundas Street West, Suite 2103 Toronto, Ontario M5G 1Z8 Tel (416) 591-7800 Toll Free 1-800-261-0528 Fax (416) 591-7890 Email questions@crto. This are not always the optimal error-reduction strategy and may not be may include strategies such as standardizing the ordering, storage, practical for all of the medications on the list. Permission is granted to reproduce material with proper attribution for internal use within healthcare organizations. It’s important to understand the difference between medication adherence and medication compliance. Medication adherence is the act of flling new prescriptions or reflling prescriptions on time. Medication compliance is the act of taking medication on schedule or taking medication as prescribed. According to the National Council on Patient Information and Education, “Lack of medication adherence is America’s other drug problem. In the United States, 12 percent of people don’t take their medication at all after they fll/buy the prescription. There are a number of reasons why people do not adhere or comply with their medication regimen. The chart below lists common factors that interfere with medication adherence and compliance. Social/economic-related factors Age and race Economic status Medication cost Survivor-related factors Forgetfulness Treatment anxiety Misunderstood instructions Fear of becoming dependent on medication Medication-related factors Length of treatment Complexity of treatment Unwanted side effects Condition-related factors Other conditions Level of disability Severity of the condition Improve Medication Adherence and Compliance Help your healthcare professionals help you It is absolutely necessary to help your healthcare professionals create an accurate profle of your medication use. Take an active role and tell your healthcare professional and pharmacist about your experiences with your medications. Share any suggestions and/or changes you have, and be sure to follow up and let them know how you’re feeling after any changes in medication. Reduce cost barriers If you can’t afford to take your medication, it doesn’t matter how good that medication is. Also ask about discount programs and any Patient Assistance Programs that may be available from the drug manufacturer. Make sure that you are informed about your condition(s) as well as why you are taking your medication(s). Talk with your healthcare professionals, and follow up with them with any questions or concerns you may have. Stick with one pharmacy It’s important to remember that medication is not a convenience item— do not hop from pharmacy to pharmacy. Get to know the staff and let the staff get to know you and your family and/or caregivers. If your pharmacist does not answer your questions to your satisfaction, then it is time to look elsewhere for your medications. Also, make sure that your healthcare professional knows where you get your prescriptions flled. Your pharmacist and healthcare professional must work together to ensure safe treatment for you and your condition. Use tools to help remember medications There are many helpful tricks and tools that you can use so that you remember your medications. Make sure that your family and caregivers know and understand your tracking system so they are able to explain it to your healthcare professionals in the event of an emergency. Explaining Stroke- Related Medications With so many stroke-related medications available, remembering each medication and what it does can be confusing. By Hyzaar®) inhibiting the chemical, blood vessels can enlarge and blood pressure is reduced. A stroke is a brain attack that occurs when a blood clot blocks an artery or a blood vessel breaks, interrupting blood fow to an area of the brain. All publications are reviewed by National Stroke Association’s Publications Committee. Use the Medication Tracker on the reverse side to write down each medication you take and how you take it. Questions to Ask Your Healthcare Professional/Pharmacist What is the medicine’s name, what is it for, and what does it look like? Besides time of day, is there anything else I should know about taking my meds (e. However, the nature of drug information is that it is constantly changing because of ongoing • Name, age, weight, date of birth research and clinical experience and is often subject • Vital signs including blood pressure, heart rate, respiratory to interpretation. Thus, the reader is advised that rate, temperature, and oxygen saturations the authors, and Children’s Hospital of The King’s • Pertinent history and physical fndings: general Daughters, cannot be held responsible for new appearance (e. If transitioning to times lorazepam to wean off other benzodiazepines, larger doses may be needed - discuss with pharmacists. If transitioning to 96 - 120 0 30 - 10 4h methadone to wean off other opioids, larger doses may be > 120 0 60 - 15 4h needed - discuss with pharmacists. In Adults (≥ 50 kg) an initial infusion of Heparin Dose Adjustments for Patients ≥ 18 years of age 0. Check level 2 hours after loading dose to Initial infusion: 7 - 10 mcg/kg/min assure therapeutic concentration. Midazolam infusion may also be used for refractory status epilepticus - load with May repeat load up to 2 more times if needed. Close monitoring and ongoing adjustment is warranted based upon patient’s clinical status, and changes in nutrition and/or medication therapy. Administration (200/40 mg)/5 mL mg) tabs mg) tabs of antibiotics within 1 hour of presentation with fever is our goal and has been associated < 0. Magnesium Citrate < 6yo: 2 - 4 mL/kg; 6 - 12 yo: 100 - 150 mL Anti-Xa level Hold next dose? Oxide tabs per day (in 2 - 3 divided doses) No dose adjustment nomogram is available.

Tissue samples or fluids from normally based media purchase raloxifene 60 mg free shipping, such as Lo¨wenstein-Jensen agar or agar-based me- sterile sites do not require decontamination purchase 60 mg raloxifene fast delivery. The agar-based ground aseptically in sterile physiological saline or bovine albu- media may also be used for susceptibility testing 60 mg raloxifene with mastercard. A single positive cedure (“double processing”) for specimens from patients respiratory sample with a low colony count (e order raloxifene 60 mg overnight delivery. This approach also helps in the assessment of decontamination methods are described elsewhere (46–48). Most clinically significant slowly growing myco- on microscopic examination of stained smears. Environmental bacteria grow well on primary isolation at 35 to 37 C with the contamination, which usually involves small numbers of organ- exception of the following: the newly described M. Previous which requires temperatures from 22 to 30 C for several weeks studies have indicated that specimens with a high number of and only grows at 37 C in liquid media, M. Recent studies skin, joint fluid, and bone specimens should be cultured at 28 have shown, however, that identification using only conventional to 30 C and at 35 to 37 C. Optimal recovery of all species may biochemical analysis is both time consuming and increases turn- require duplicate sets of media at two incubation temperatures. Rapidly growing mycobacteria usually which form colonies on subculture in 7 days or fewer, are re- grow within 7 days of subculture. Supplemented culture media and special culture condi- molecular methods, must be used. Therefore, currently used in many clinical laboratories (AccuProbe; Gen- identification of most mycobacterial isolates to the species level Probe, Inc. Testing can be performed using isolates from solid cian and the laboratorian and in the event that a specific labora- or liquid culture media and identification of these species can tory does not have the necessary technology for species identifi- be achieved within 2 hours. The size of effort for identification of that isolate as it would not likely be the restriction fragments is generally species specific (56–59). However, some taxa may require additional ing the need for speciation of that isolate. The controversy to all organisms (conserved regions) and also areas where nucle- primarily stems from the observation that, unlike M. In addition, no interstrain nucleotide sequence Susceptibility breakpoints have been defined in the laboratory difference value that unequivocally defines different species has to distinguish populations of mycobacteria that are labeled sus- been established for mycobacteria (48). One of the major and clarified, the clinician should use in vitro susceptibility data limitations of this system, however, is that the MicroSeq database with an appreciation of its limitations and with the awareness has only one entry per species (generally the type strain) (61). Although the caveat that each laboratory must validate each method for not routinely recommended, this differentiation may be each species tested, and quality control and proficiency testing important epidemiologically and, in the future, therapeuti- requirements should be enforced. Isolates from patients who previously received macrolide to facilitate identification of M. Communication between the clinician and laboratorian macrolide-containing regimens who relapse or fail after 6 is essential for determining the importance and extent of months of macrolide-containing therapy. Routine susceptibility testing of this species is macrolide-containing regimens for patients with dissemin- not recommended (43). Until further data are available, the isolate is found on subsequent testing to be macrolide resistant. If the isolate proves to be rifampin resistant, suscepti- species that are macrolide resistant (e. Susceptibility testing of these species is difficult even with multiple cultures of the same strain (43). Other methods have been used for ized guidelines for in vitro susceptibility procedures are not avail- strain comparison, including random amplified polymorphic able for testing these species (77–82). There are no current recommendations for one specific clude sputum production, fatigue, malaise, dyspnea, fever, he- method of in vitro susceptibility testing for fastidious moptysis, chest pain, and weight loss. Evaluation is often complicated by symptoms caused by coexisting lung diseases, such as bronchiectasis, chronic obstruc- 7. Physical findings are nonspecific and reflect underlying pul- monary pathology, such as bronchiectasis and chronic obstruc- tive lung disease. Pulsed-field gel electrophore- sis (nodular/bronchiectatic disease) (see the online supplement). These biopsies are performed because of the small size of the tissue findings correspond histopathologically to bronchiectasis, bron- sample) but demonstrates mycobacterial histopathology features chiolar and peribronchiolar inflammation, and granuloma for- (without a history of other granulomatous or mycobacterial dis- mation (94). Unfortunately, A plain chest radiograph may be adequate for evaluating many antigenic epitopes are shared by different mycobacterial patients with fibrocavitary disease. A single positive sputum culture, especially with a small number of organisms, is generally regarded as indetermi- 1. Overly rigorous criteria might delay or tive, subsequently developed new chest radiographic abnormali- prevent the diagnosis, with the subsequent risk for progressive tites. A limitation of all diagnostic criteria developed so mental contamination if the bronchoscopic specimens are far is that, by necessity, they were developed based on experience protected from tap water (see Health Care– and Hygiene- with common and well-described respiratory pathogens such as associated Disease and Disease Prevention). If a tissue times be made on the basis of smear and culture positivity or sample from a transbronchial, percutaneous, or open-lung biopsy negativity without quantitation. Pulmonary symptoms, nodular or cavitary opacities on chest radiograph, or a high-resolution computed tomography scan that shows multifocal bronchiectasis with multiple small nodules (A, I)* and 2. No pathologic studies have been done to demon- be helpful for making this decision. The significance of a single sputum specimen culture posi- absence of radiographic evidence of pulmonary disease, respira- tive for a nontuberculous mycobacterium is more uncertain. Given these considerations, the diagnosis of lung disease apy before species identification of the mycobacterial isolate. There have been with these clinical scenarios must be evaluated carefully, on an numerous reports of clinical deterioration and death temporally individual basis, and may require expert consultation. Smear results were cede any initiation of macrolide monotherapy, and cultures for positive in 26% of culture-positive specimens. Surgical airway disease and altered mucociliary clearance may be predis- resection, lobectomy or pneumonectomy, should be reserved for posing factors. Poor control of the mycobac- of patients on hospital wards for prolonged periods of time terial infection with medical management and, particularly, isola- raise questions about person-to-person transfer or nosocomial tion of M. During tential sources of concern as was noted in a recent study of periods of clinical decline while unresponsive to treatment an M. Occasionally, hypoxemic respiratory failure requires hospitalization or intensive care unit Hypersensitivity-like Disease admission. The water sources, this syndrome has been reported in at least one histopathology is that of nonnecrotizing granulomas although case associated with a household shower (137). Because of the necrotizing granulomas, organizing pneumonia, or interstitial potential for acquiring this disorder from multiple sources, it pneumonia may also be described in some patients (149). Even if nonspecific, identifying characteristic histopathol- bacteria are relatively resistant to disinfectants and may be able ogy on biopsy may be sufficient to raise suspicion for diagnosis. In addition, mycobacteria are also quite resistant to cases (see online supplement).

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The primary maritime points of entry were Spain in Africa purchase 60mg raloxifene overnight delivery, might have become an alternative method of (due to proximity and cultural links) and the Nether- moving cocaine through West Africa to Europe generic raloxifene 60mg with mastercard. Seizures made in South American countries outside the Andean region order raloxifene 60mg without prescription, in Central America 1998 and the Caribbean in relation to shipments towards North America are estimated at slightly less than 100 mt 12 Canada 63 West and (purity-adjusted) raloxifene 60 mg amex. Thus, out Atlantic and of 380 mt exported to North America, only some 180 Western Caribbean are available for consumption, of which the bulk (88%) Mexico 9 Main cocaine producers is consumed in the United States. Some 220 mt or 26% of total cocaine exports 15 left the Andean countries for West and Central Europe 6 Cocaine consumption in 2009. Of this, close to 60 mt (purity-adjusted) were (in metric tons) seized in other South American countries or in the Car- *main routes ibbean. Thus, close to 160 mt left South America for 2008 West and Central Europe in 2009. The overall amount consumed in Europe is estimated at 129 Southern mt, suggesting that West and Central Europe (123 mt) Africa accounts for 95% of the total European cocaine market. An analysis of individual drug seizures reported in Europe suggests that more than 86% of the drugs were Current trafficking flows to main consumer markets trafficked directly to West and Central Europe, while around 13% were trafficked via West Africa. Trafficking It is estimated that almost 380 mt or 45% of the total via West and Central Africa would have amounted to cocaine exports from the Andean region leave for North 39 some 21 mt. In addition, cocaine is trafficked for local America, a region with a population of some 460 mil- demand to West and Central Africa – a subregion with lion people. The bulk of cocaine shipments are still by a combined population of more than 400 million people, sea across the Pacific to Mexico and on to the United which may consume some 13 mt. In addition, Central American countries have gained prominence in recent years as trans-shipment locations. Production** 1,111 Less seizures in Andean countries -254 Less domestic consumption in Andean region -13 Potential amounts available for export out of the Andean countries 844 Less losses in production and/or losses in global trafficking which cannot be attributed to specific regions -56 Actual exports out of Andean countries 788 Non-Andean South Amer- West and North ica / Caribbean, Central Central Europe America America, Africa, Asia, Oceania Amounts of cocaine leaving the Andean countries 217 378 193 Less amounts seized in non–Andean South America, -59 -98 -64 Caribbean and Central America linked to trafficking flows Less domestic consumption in non-Andean South -83 America / Caribbean / Central America 158 Amounts leaving South America, Caribbean and (incl. Considering purity-adjusted seizures of cocaine (unweighted average of all purities at retail and wholesale level reported by Member States in 2009), some 481 mt would be available for consumption and losses if the lower cocaine production estimate were used. If the higher cocaine production estimate were used, deducting seizures adjusted for wholesale purity (based on 2009 purity data or the latest year available), some 496 mt would be left for consumption and losses. The upper and the lower production estimates could be thus sufficient to cover consumption (440 mt). For the calculation shown above, the higher production estimates and seizures adjusted at wholesale purities were used. This reflects the observation that wholesale seizures account for the bulk of seizures in volume terms and would support the higher production estimates. However, one cannot exclude the possibility that seizures may be over-estimated due to possible double-counting once several law enforcement agencies within or across countries have been involved in cocaine interceptions. North America accounted for 47% and West countries - of which almost two thirds was for subse- and Central Europe 39% of the total. While the North American market shrank over the last Current value and money flows two decades – due to lower volumes and lower prices - The value of the global cocaine market is most certainly the European market expanded. United States 180 120 111 West & Central Europe 160 Cocaine sales 100 140 87 120 80 71 100 62 80 60 5654 5049 60 4344 4544 40 3635 34 363537 32 32 40 34 33 20 31 20 26 26 27 21 0 18 18 141414 1995 2008 2009 0 Fig. West and 40 Reports indicated that up to one third of the shipments Central Europe, is paid in kind to service providers in West Africa, who 33 then traffic most of this cocaine to Europe on their own behalf. Meth- the use of prescription stimulants1 is as common as amphetamine or amphetamine can be in powder, tablet, methamphetamine. In South America and the Carib- paste or crystalline form while ‘ecstasy’ is usually avail- bean, prescription stimulants are more commonly used. In Africa, especially in West, Central and East Africa and some parts of Southern Africa, the use of amphetamines- 4. This section describes the In 2009, out of the 69 Member States that reported trends in the use of amphetamines-group and ecstasy- expert perception on amphetamines-group use trends group substances in the different regions. In The type of amphetamines-group substances used in developing countries and especially emerging econo- different regions varies considerably. In East and South- East Asia, methamphetamine is the primary substance 1 Prescription stimulants may include substances such as amfepra- consumed within this group, while in the Near and mone, fenetylline, methylphenidate, phenmetrazine, et cetera. The association in developed countries increase in the use of stimulants in developing countries of synthetic drugs, especially stimulants, with moderni- where young people within the growing middle class zation and affluent lifestyles, combined with increasing may want to emulate these lifestyles. This increase in the prevalence of stim- significantly higher than the estimate in 2008 (95,000), ulants use is attributed in part to an increase in the it is still substantially lower than the estimate for 2002 number of methamphetamine users. Among secondary school students in the in the past 30 days (prior to the survey) increased sig- United States, there has been a declining trend in the nificantly from 904,000 (0. In 2009, among school students aged 12-19 in Mexico, the reported lifetime prevalence of 0 amphetamine and methamphetamine use was 1. In previous years, however, the life- Stimulants (all types) Methamphetamine time prevalence among youth aged 12-17 was reported as 0. In 2010, annual prevalence of amphetamines use rose among 10th and 12th graders while it continued to Amphetamines-group substance use in South decline among 8th graders. Use of methamphetamine, America appears to remain stable in contrast, increased among 8th graders, remained stable among 10th graders but declined among 12th There is no updated information on the prevalence of graders in 2010. Despite some increases in ampheta- amphetamines-group substance use in South America. Compared to 2008, most of the countries report- the use of prescription stimulants. Brazil, While most countries in Europe show stabilizing the Bolivarian Republic of Venezuela and Argentina trends in the use of amphetamines-group remain countries with a high prevalence and absolute substances, high levels of injecting amphetamines number of users of amphetamine and methampheta- use are reported by a few mine in South America. The coun- dents in Brazil in 2009, the annual prevalence of tries that reported data show a mixed trend from previ- amphetamines use among the students was reported as ous years. The annual prevalence was higher among female substance use in Europe is estimated between 0. In most parts of Europe, ampheta- of amphetamine and methamphetamine in Central mine is the more commonly used substance within this America, as a region, it has a high prevalence of amphet- group, while the use of methamphetamine remains lim- ited and has historically been highest in the Czech Republic and Slovakia. While in Germany, there was an increase in in a wide range and uncertainty of the estimates. Within West and Central Europe, the Czech Republic, Denmark, the United Kingdom, Norway and Estonia Among the limited number of countries that have remain the countries with the highest annual prevalence reported expert opinion on trends in the use of amphet- rates, while in South-East Europe, Bosnia and Herze- amines-group substances in Africa, nearly half of the govina and Bulgaria have high annual prevalence of countries report that the trend has increased while a amphetamines use. In most parts of Africa, prescription amphetamines In most West and Central European countries, problem amphetamines use represents a small fraction of overall comprise the primary substances used within this group. Those who report there is more consistent and recent information available amphetamine as their primary substance account for less on drug use trends. Such data – based on treatment than 5% of drug users in treatment, on average, in demand - showed a strong increase in the importance of Europe. High levels of injecting use are reported from amphetamines until the second half of 2006, followed the Czech Republic, Estonia, Latvia, Lithuania, Sweden by a stabilization or small downward trend since. The and Finland, ranging from 57% to 82% among amphet- importance of amphetamines increased again temporar- amines users. In which experts perceived the problem to have stabilized other parts of the country, the proportion has remained or decreased over the past year.

Toxicology tests indicated the following drugs: Chlordiazepoxide (1 mg/L) order raloxifene 60mg visa, nordiazepam (0 buy generic raloxifene 60mg on-line. The toxicology report indicates several prescription depressant drugs and narcotic analgesics generic raloxifene 60 mg on-line. The toxicology confirmed the presence of a stimulant buy 60 mg raloxifene visa, methamphetamine and its metabolite, amphetamine. Small doses of stimulant drugs have been shown to improve mental alertness and motor performance in fatigued or sleep-deprived drivers. However, stimulants generally do not improve performance in otherwise normal individuals, particularly when they are used for illicit purposes and are taken in doses significantly high- er than those used therapeutically. No observations of appearance, demeanor or physical appearance were documented in the police report. It is not possible to reliably determine when the man used cocaine based upon the test result and the unknown dose. More impor- tantly, there are no characteristic indicators of a stimulant drug in the police report. Case #4: A 48-year-old man swerved into oncoming traffic, resulting in a near collision. He told the officer he drove onto the wrong side of the road because he dropped a tamale and was leaning over to pick it up. Toxicology tests revealed the following: Morphine (50 ng/mL), meprobamate (20 mg/L), carisoprodol (2 mg/L), oxycodone (130 ng/mL), hydrocodone (80 ng/mL), diazepam (0. The observations and driving behavior are consistent with someone who is under the influence of a central nervous system depressant. Many depressant drugs impair our ability to divide attention, so performing non-essential (dis- tracting) tasks may further compromise our driving. The officer noticed the woman appeared relaxed, her eyes were red, and she appeared dazed or disoriented. The observations and driving behavior are consistent with someone who is under the influence of alcohol and marijuana. He had elevated blood pressure, elevated pulse, dilated pupils, and eyelid and body tremors. Many of these observations are similar to the effects of marijuana, so it can sometimes be difficult to distinguish the two. The observations are consistent with someone who is under the influence of a central nervous system stimulant drug. See, Alcohol Toxicology for Prosecutors;Targeting Hardcore Impaired Drivers, John Bobo, Ed. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (available online at http://www. The Walsh Group and the American Bar Association’s Standing Committee on Substance Abuse. Driving After Drug or Alcohol Use Report, 1996 National Household Survey on Drug Abuse, Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies (available online at http://www. Antagonistic Effects The effect of one drug is lessened due to the presence of another. Ataxia Inability to control voluntary muscular movement causing staggered or unsteady motion. Central Nervous System The part of the nervous system (brain and spinal cord) to which sensory impulses are transmitted and from which motor impuls- es pass out, and which supervises and coor- dinates the activity of the entire nervous system. This includes illicit drugs, prescription medicines, over-the-counter medicines, dietary supplements, herbals and botanicals. First Order Elimination Elimination of a substance in a concentra- tion-dependent (non-linear) fashion. Hallucinogen A substance that alters perceptions, for example, visual images or sounds. Hysteresis The relationship between drug effects and time or the lagging of a physical effect on a body behind its cause. Mellanby Effect A form of acute tolerance whereby the perceived effects are more pronounced when the blood alcohol is rising rather than falling. Opioid Natural or synthetic derivatives of opium in addition to drugs that mimic the effects of morphine. Route of Administration The manner or process by which a sub- stance, or drug, enters the body, i. Synergistic Effect The total effect of multiple drugs that is greater than the sum of the individual effects of those drugs. Volume of Distribution A measure of how widely a drug is distrib- uted throughout the body. The project team would like to thank the following clinicians, reviewers and leaders for their support, enthusiasm and expertise. Guidance is provided for key medicine safety topics relevant to the care of older adults. This guidance is based on current legislation, best available evidence and published guidelines, and is consistent with the New Zealand medicines strategy, Actioning Medicines New Zealand (Associate Minister of Health and Minister of Health 2010). The Medicines Care Guides are designed to support best practice in residential aged care environments and do not replace sound clinical judgement, facility-specifc policies and procedures, or current legislation. It is envisaged that the Medicines Care Guides will be utilised by managers, registered nurses, enrolled nurses, health care assistants, and other contracted health professionals who work in residential aged care facilities. Care environments include rest homes, dementia units, private hospitals, and psychogeriatric hospitals. In utilising these guides, it is important to be aware of the context and scope for which they were developed and consider other documents that guide the provision of services in New Zealand, such as the Health and Disability Service Standards 2008. Medicines Care Guides for Residential Aged Care 1 Medicines Management A comprehensive medicines management system is required in residential aged care facilities to manage the safe and appropriate prescribing, dispensing, supply, administration, review, storage, disposal and reconciliation of medicines. Policies and procedures should be clearly documented and available to all staff at all times. Staff involved in medicines management are required to work within their scope of practice and demonstrate their competence to provide this service. Access to specialist medicines education and advice for residents and staff must be made available The clinical fle should include documentation that records all relevant details to support safe medicines management and should comply with legislation, regulations, standards and guidelines. The safety of residents, visitors, staff and contractors must be maintained through appropriate storage and access to medicines. Multidisciplinary team involvement The multidisciplinary team can include but is not limited to the following: Resident/Representative • The resident or their representative is included in the multidisciplinary team and agrees to and is kept informed of medicine-related aspects of their care. Manager • Contracts services of health professionals (eg, pharmacists; general practitioners, nurse practitioners, registered nurses; dieticians, etc) to support safe, resident focused medicines management • Ensures there are suffcient appropriately qualifed staff to meet the needs of the residents • Ensures there are appropriate quality and risk management activities to support safe medicines management. Prescribing – Medical or nurse practitioner • Maintains current evidence-based knowledge of medicines relevant to the care of older adults • Provides timely, legible, accurate and legal medicine prescriptions that meet the individual needs of the residents • Considers non-pharmaceutical alternatives • Liaises with the pharmacist and facility staff regarding medicine prescriptions as necessary • Liaises with the multidisciplinary team to ensure appropriate ongoing care to residents • Provides advice and direction to staff regarding medicines’ administration, monitoring and management • Documents, diagnoses and treatment rationale in the clinical fle • Participates in medicines reconciliation for residents • Participates in multidisciplinary medicine reviews • Is actively involved in quality and risk management activities related to safe medicines management, including review of policy and procedures • Provides learning opportunities for staff related to resident diagnoses and medicines management. Administration – Registered nurse • Maintains current evidence-based knowledge relevant to the care of older adults • Assesses and identifes possible individual risk factors related to medicines • Monitors changes in health status and responds accordingly • Identifes signs and symptoms indicating adverse medicine reactions • Liaises with the manager and the multidisciplinary team to provide services that meet the needs of the resident • Participates in multidisciplinary medicine reviews • Provides direction and/or supervision for unregulated staff as required • Documents information regarding medicines and their effects on the resident in the clinical fle • Contacts the prescriber regarding changes in health status where necessary • Participates in medicines reconciliation for residents • Participates in multidisciplinary medicine reviews • Is actively involved in quality and risk management activities related to safe medicines management, including review of policy and procedures • Provides learning opportunities for staff. Medicines Care Guides for Residential Aged Care 3 Medicines Administration Competency Before giving medicines, all staff must demonstrate that they have knowledge, understanding and practical abilities to be considered as competent. Skill and knowledge will be assessed by a registered nurse who has demonstrated competency.

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