Welcome to Nurse Update, a digest of evidence-based information to help you improve your knowledge of medicines use and prescribing practices.

NPS actively engages with nurses to encourage a greater understanding of medicines by providing information and activities on various therapeutic programs.

In this issue

• Testing for vitamin D deficiency
• Managing pain in patients taking other medicines
• Understanding medicine brand choices
• New hospital DUE toolkit available May
• Feed your competency
• Clinical resources and publications
• Consumer resources and publications

Testing for vitamin D deficiency

Rates of vitamin D testing in Australia have increased almost tenfold in the last 5 years. This coincides with increased interest in vitamin D deficiency, media reports of its high prevalence in Australia and its suggested role in a range of health conditions.

NPS’s latest education program for health professionals provides guidance around common questions being asked about vitamin D deficiency including who is at risk, when is testing of value and appropriate supplementation for those who are deficient. It encourages careful consideration using a targeted rather than screening approach before testing patients for vitamin D deficiency as the benefit of routine testing in low-risk populations is unclear. 

However, there are some at risk groups for which vitamin D testing and supplementation is advisable. These include people:

• who are housebound, particularly those over 65 years or living in aged care facilities
• with naturally dark skin
• who cover themselves for religious or cultural reasons.

There are a number of different tests used in Australia to determine vitamin D levels and there has been a considerable degree of variability between the tests and between laboratories. In some studies, a substantial minority of blood samples have been classified as adequate by one assay or laboratory but deficient by another assay or laboratory.

Awareness of these limitations of vitamin D testing appears to be low among health professionals. While new international standards and quality assessment programs should amend this, doctors should be aware of these current limitations.

The association between vitamin D deficiency and non-bone diseases such as type 2 diabetes, hypertension and others is also yet to be proven.

The following resources and activities about vitamin D are available for health professionals:

• NPS News 72: Testing and treating vitamin D deficiency
• National case study 68: Vitamin D
• MBS feedback data

Read more about vitamin D and vitamin D deficiency. 

Managing pain in patients taking other medicines

As part of the latest phase of the Be Medicinewise campaign, people with chronic conditions are being encouraged to consult a health professional before taking over-the-counter pain relievers to avoid adverse interactions.

People with chronic conditions such as diabetes, heart disease, asthma or arthritis are likely to be taking medicines to treat or manage their condition, but many use analgesics to manage break-through pain without consulting their doctor or pharmacist.

Sometimes people double up on pain medicines, believing it will give them greater relief. However the side effects of this can result in conditions like stomach bleeding, kidney toxicity, or liver damage.

Nurses have a role to play in educating people with chronic diseases that medicines can interact with other medicines bought over-the-counter as well as natural remedies. It’s important they always check with a doctor or pharmacist before taking any new medicines.

Also remind people to watch out for disease interactions or contraindications. If a person’s condition affects their stomach, heart, liver or kidney, or is related to their blood pressure, some pain medicines could make their symptoms worse or cause harmful side effects.

NPS research shows many Australians don’t know the active ingredient in the analgesics they take. Nurses can help people identify the active ingredient in their pain relievers and remind them if their current pain management plan isn’t working effectively to seek advice from a doctor or pharmacist.

Medicines List is an easy way for people to keep track of important information about their medicines, including the active ingredient and brand names, what the medicine is for, what strength they need to take, how much they need to use and when they need to take it. It also makes it easier for them to discuss their medicines with their doctor or pharmacist. Medicines List is also available in Arabic, Chinese, Croatian, Greek, Italian, Spanish and Vietnamese.

Understanding medicine brand choices

The next phase of the Be Medicinewise campaign focuses on safety in the context of medicine brand choices.

Medicine choices can be confusing for people, especially when they are offered different brands to those prescribed by the doctor or those dispensed in a hospital. By assisting people to identify the active ingredient in their medicines, health professionals can help people prevent medicine mix ups, accidental double dosing, and may also help them detect if an error has been made by the doctor or pharmacist.

Most medicines have an active ingredient and a brand name but many people don’t understand that the same medicines can be sold under several different brand names. For example, the brands Panadol, Panamax and Herron all contain the same active ingredient — paracetamol.

Not all pharmacies stock all the available brands of a medicine, and hospitals often use different brands to the ones available in pharmacies. This can make it hard if someone doesn’t go to the same pharmacy each time or if they have been in hospital and don’t know their medicines by the active ingredient.

Nurses can help explain that different brands of medicines may look different because of the inactive ingredients, or ‘fillers’. The active ingredient is the important one, however, because it’s what makes the medicine work. It will always be the same in medicines that are interchangeable.

Changing between different brands can have benefits but it can also have risks, mainly if someone is likely to get confused about what their medicines look like. If you think a person is at risk of becoming confused, talk them through their medicine choices and suggest they discuss things further with their pharmacist or doctor.

New hospital DUE toolkit available May

Drug Use Evaluation (DUE) is a quality improvement activity used to review medicines use and improve patient care. The latest hospital DUE from NPS looks at improving the discharge management of patients with acute coronary syndromes (DMACS).

The DMACS toolkit contains the e-DUE audit tool as well as a number of educational resources such as PowerPoint presentations, reminders, checklists and information summaries.

Benefits of using the online toolkit and e-DUE tool include:

• easy data entry and generation of clear summary reports
• access to educational resources based on current Australian guidelines
• flexibility to conduct the audit on selected quality measures — as few or a many as you require
• real-time feedback that informs quality improvement interventions
• lead quality improvement at your hospital to improve patient care
• an opportunity to earn CPD points.

The DMACS e-DUE toolkit will be available in May 2011 for download from www.nps.org.au/due_dmacs.

You can also take part in the nationwide snapshot audit in May 2011 and compare your audit results with a national aggregated result. To register your interest contact Lisa Pulver.

Feed your competency