Welcome to the latest issue of 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.

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In this issue

• New lipid management resources for patients
• Managing pain and over-the-counter analgesics
• New online modules to help Australians be medicinewise
• Online medicines information: deciphering what’s reputable and what’s questionable
• Feed your competency
• NPS publications
• Consumer publications
  

New lipid management resources for patients

Cardiovascular disease (CVD) is the single largest cause of death in Australia. It affects 1 in 6 people and it’s on the rise. By 2050 more than a quarter of Australians are expected to have heart disease.

The latest NPS education program CVD risk: guiding lipid management encourages early assessment of people’s cardiovascular risk to identify those who may need to commence preventative therapies. Overall CVD risk assessment allows treatment to be directed to those at highest risk and who are likely to receive the greatest benefit from therapy.

There are many Australians whose CVD risk has been underestimated or not assessed at all. Using a CVD risk assessment tool has been shown to be more accurate at predicting absolute risk than clinical judgment alone. Encourage patients to ask their GP for their CVD risk score, and if they are found to be at risk of CVD, discuss possible lifestyle modifications that will help them reduce their risk. Encouraging adherence to any prescribed lipid-lowering medicines is also important in achieving overall CVD risk reduction.

Australian guidelines recommend assessing anyone aged over 45, and Aboriginal and Torres Strait Islanders aged over 35. Repeat assessments should be conducted every 2 years for people at low risk (to coincide with their blood pressure check); every 6–12 months for people at moderate risk; and judiciously for people at high risk.

Resources focusing on CVD risk and lipid management for nurses include:

• NPS News 71: Managing lipids, reducing cardiovascular risk
• National case study 67: CVD risk: guiding lipid management
• Prescribing practice review 53: Managing lipids

Practice nurses can also participate in educational visits and facilitated small group discussions by contacting the NPS facilitator at your local division of general practice network.

The following resources can help nurses when discussing lipid management with patients:

	Your heart and stroke risk score A patient information leaflet about CVD risk with space to record people’s risk score.
	Managing my heart health: At a glance A self monitoring record card to help people at high risk of or diagnosed with CVD to track their medical and lifestyle risk factors. It   supports lifestyle changes and medication adherence.

Both resources are available to order for free via the health professionals order page.

A consumer campaign encouraging people to discuss CVD risk assessment with their doctor or pharmacist commences in April 2011.

More CVD risk tools are available online for free.

For more information visit the drugs and therapeutic topics page.

Managing pain and over-the-counter analgesics

The second phase of the NPS Be medicinewise campaign launched in late February and focuses on managing pain. Managing pain continues with the 'Why' theme introduced in the first phase of the campaign. It encourages consumers to ask questions about managing their acute low back pain, using analgesics in chronic conditions and administering medicines to children.

Evidence shows that people taking analgesics don’t always understand how to safely administer their medicines, especially when it comes to dosing. Many people take more than the recommended dose of an analgesic because they believe they will get better pain relief or because they aren’t aware of the potential side effects.

To help people with their pain relief decisions, NPS has developed a new brochure that can be ordered by practices, hospitals and clinics and handed out to patients.

The Managing pain campaign will run on television and in magazines throughout February. For more information visit the Managing pain home page.

Administering medicines to children

In Australia, paracetamol has been shown to be one of the most common over-the-counter medicines associated with unintentional overdose in children under than 5 years.

Nurses can help parents and carers of children to be medicinewise and prevent dosing errors by advising them of the following:

• Read the medicine label and packaging each time you buy a medicine and before giving it to a child. A medicine’s packaging provides important information including the active ingredient, strength and formulation of the medicine, dosing, and storage instructions.
• Use the weight of the child and the dosing instructions on the medicine’s packaging to calculate how much medicine to give. Never guess the amount to give or try to figure it out from adult dosing instructions. Use an oral syringe to measure the correct dose for the child. You may also use the manufacturer’s device that comes with the medicine. Never use a kitchen teaspoon.
• Keep a list of your children’s medicines. Record the active ingredient, brand name and strength of the medicine, why the medicine was given and who gave it, the date, time and amount given (the exact dose and daily total), and the child’s weight.
• Always follow instructions carefully and ask a health professional if you are ever unsure about anything.

Encourage parents and carers to find the active ingredient(s) in a medicine before they buy it or give it to a child. That way there is less chance of doubling up with another medicine that contains the same active ingredient(s). Some medical conditions, allergies and other medicines may affect which medicine is most suitable to give a child.

Advise parents and carers that if they think a child has had a higher dose than recommended, to immediately phone a doctor or the Poisons Information Centre (13 11 26) for advice. Do this even if there are no signs of discomfort or poisoning.

Chronic Conditions

Chronic conditions are common as people get older. One report found that more than 20% of Australians aged over 65 have persistent pain and half of those said it has a moderate or more severe impact on daily life.

No matter what the cause of pain, people with chronic conditions need to take care with analgesics. It’s good to remind them that all medicines have both benefits and risks, including the ones used to treat their condition and others they can buy over-the-counter without a prescription.
Encourage people with stomach, heart, liver or kidney conditions, or those who are taking other medicines, to ask their doctor or pharmacist which pain reliever medicines are safest for them.

When taking prescription medicines for pain, it’s important to check before using over-the-counter pain relievers as they may contain the same or similar active ingredients. If taken together this may cause an accidental overdose or side effects. People should also have their medicines and pain management plan reviewed regularly if they often need to use over-the-counter pain relievers.

Read more about analgesic use in specific chronic conditions.

New online modules to help Australians be medicinewise

To help people make the best decisions about their medicines — from what to consider before starting a new medicine to understanding clinical trials — NPS has developed a series of free online learning modules for consumers.

Anyone starting a new medicine or who has been taking medicines for a while and wants to know about other options will benefit from the Medicinewise choices series.

Medicinewise choices is about giving people the skills they need to play an active role in their own health care and make informed decisions about their medicines.

The interactive modules cover a range of medicines issues with fictional case studies guiding you through the types of medicines decisions you may encounter. Topics are designed to help people weigh up their medicines choices, considering both benefits and risks. Issues range from why some medicines don’t mix well together, to clinical trials and how medicines are approved for use.

A key component these modules is how to find and assess reliable information sources, particularly on the internet where advice may be driven by commercial interests, out-dated or not supported by evidence.

The modules are available for free on the Medicinewise choices home page.

Online medicines information: deciphering what’s reputable and what’s questionable

Following a recent survey that found around 80% of Australians search online for health information, NPS has developed 5 questions people should ask to help decide if the medical or health information they find on the internet is accurate, unbiased and up-to-date.

Quality of information from sources other than a health professional can be difficult to judge. NPS encourages Australians to play an active role in their medicines decisions, but with the wide variety of information available on the internet, it can be difficult to distinguish between reputable and questionable sources.

You can assist patients with deciphering what a reputable health information website is by providing them with the following questions to ask:

1. Who is providing the information?
   Is it clear who is providing the information? Also, who funds the website? If it is not clear, beware. If the website is run by a government authority, an independent body, a professional organisation or support body, the information is more likely to be reliable and of good quality.
   Check to see if the website and the organisation linked with it is Australian. If not, some of the information provided might not be relevant.
2. Is the information biased?
   Websites exist for a purpose — for example, to provide information, to sell a product or to tell the world about the theories of their contributors. Knowing the purpose of a website helps you judge the information it provides. Sites that provide information without selling a product will probably give you more balanced advice.
3. Does the information promise too much?
   The best information is based on evidence, not belief. The best information also acknowledges that health and healthcare is uncertain, that all treatments have both positives and negatives, and that nothing can be guaranteed. Warning signs to watch out for include things such as promises that the medicine will be effective for everyone, instant cures or miracle recoveries.
4. Is the information up to date?
   Look for dates on web pages. This is more important for some information than for others. General information about an illness and its causes may not change much in 2 or 3 years, but information about its treatment may well change within that time. Links are another clue: a lot of broken links suggest a website is out of date.
5. Are the links of good quality?
   Most websites link to other sites. Have a look at some of these links. If a website you’re interested in links to sites you assess to be good quality, then it reflects well. If its links are to websites that don’t meet your quality standards, then this reflects badly.

Read more important questions to ask about your medicines.

Feed your competency