Aged care nurses and care staff can play a vital role in improving older people’s health literacy and ensuring safe and effective use of medicines, write Kay Price and Jo Boylan.
Helping older people make well-informed decisions and to plan ahead for life’s transitions is an important role for aged care staff. To influence how older people make choices that will influence their health and wellbeing outcomes, aged care staff need to know how to accommodate, in their service delivery approach, the understanding that older people want to make their own decisions about their health. However, at the same time, the quality of information they may be using to inform these decisions is likely to be limited and not evidenced based. No doubt it could be different to that information aged care staff may utilise. Of course the challenge here is to ensure that aged care staff are themselves using the best available evidence to inform their decision-making.
Ilona Kickbusch, director of the Global Health Programme at the Graduate Institute of International and Development Studies, Geneva says: “Every choice in daily life potentially becomes a choice for or against health”. A key finding of the National Statement on Health Literacy released 2014 by the Australian Commission for Safety and Quality in Health Care was that low individual health literacy in older people was associated with a poorer health status and with a higher risk of premature death. Indeed it was found that only about 40 per cent of adults can understand and follow health messages in the way in which they are usually presented.
The concept of health literacy is not new. It is much more than being able to read and write. The broadest definition of health literacy was released in 1998 by the World Health Organization (WHO) and emphasises the importance of education to enable people to become health literate, thereby assisting them to choose the healthiest health choices. This definition says:
“Health literacy implies the achievement of a level of knowledge, personal skills and confidence to take action to improve personal and community health by changing personal lifestyles and living conditions. Thus, health literacy means more than being able to read pamphlets and make appointments. By improving people’s access to health information, and their capacity to use it effectively, health literacy is critical to empowerment. Health literacy is itself dependent upon more general levels of literacy. Poor literacy can affect people’s health directly by limiting their personal, social and cultural development, as well as hindering the development of health literacy.”
Any person with low levels of understanding regarding their health, medicines and implications of their lifestyle choices may bring about their own poorer health outcomes. Working with older people to ensure they play an active role in their life and future can improve their quality use of medicines, promote self-care and decision-making and improve their general wellbeing. How to assist older people to decide what choice is best for them in the context of their lives becomes a significant issue.
Quality use of medications (QUM) is one of the four central objectives of the National Medicines Policy (2000) and focuses on ensuring the judicious, appropriate, safe and effective use of medicines. The overall aim of the medicines policy is to meet medicines and related service needs, so that both optimal health outcomes and economic objectives are achieved. Aged care nurses have a responsibility to ensure all people with whom they interact are knowledgeable about QUM and informed about all medicines they take whether prescribed, over the counter, or complimentary. Aged care nurses can influence how and why people may use certain medicines – and whether they make informed decisions; they must consider therapeutic alternatives as well as choosing suitable medicines if a medicine is considered necessary.
Nurses are the lynchpin to achieving QUM as an everyday reality. Nurses working with older people can influence older people and help them understand how and why people may use certain medicines, how they can maximise benefit from their medication regimen, and prevent medication-related problems and ensure therapeutic alternatives are considered. All nurses are responsible to ensure that they, and all people with whom they interact, use medicines safely and effectively.
For QUM to be an everyday reality, nurses must ensure that all aged care staff involved in administering medicines (prescribed or over the counter) know their specific responsibilities for example in relation to:
- monitoring for adverse outcomes
- nurse-initiated medicines
- alteration of oral formulations
- dose administration aids
- storage of medicines
- disposal of medicines
- standing orders
- emergency supplies of medications
- how to avoid misadventures and errors
- when it is best not to use PRN drugs (when required) especially in relation to bowel, pain and sleep management.
Did you know that there is a requirement in the Therapeutic Goods Administration regulation that each prescription medicine must have what is called consumer medicine information (CMI)? CMIs are designed to inform consumers about prescription and pharmacist-only medicines. The CMI gives important facts to know before, during and after taking a medicine. How many staff provide older people with the relevant CMI when a new medicine has been prescribed for them? This is one step in providing consumers access and understanding of the medications, safety and use.
Other imperative elements for fostering effective health literacy and medicines management are outlined by the Lucian Leape Institute for National Patient Safety Foundation in the US. In 2015, this Foundation suggested a vision for consumer safety and quality use of medications that includes:
- a culture that is open, transparent, supportive and committed to learning
- QUM information that is communicated well easily understood and is an essential skill of the health professional
- respectful treatment of consumers: where their interests are paramount
- an integrated platform: multidisciplinary systems that enhance quality and safety
- evidenced-based practice, appropriate and responsive according to consumer needs
- consumer engagement /partnership approach: consumers share in decision making, are guided on how to self-manage and in a way they can understand and are empowered to be in control.
Ultimately, aged care nurses have a responsibility to ensure that older people have the skills, knowledge, motivation and capacity to access, understand, appraise and apply information to make effective decisions about health and health care and take appropriate action. A critical first step is that aged care staff must ensure they themselves have the required level of knowledge, necessary skills motivation and capacity to access, understand, appraise and apply information to make effective decisions about health and health care and take appropriate action. Aged care staff need to also ensure that the infrastructure, policies, processes, materials, people and relationships that make up the environment in which they work impacts in positive ways on the way that older people access, understand, appraise and apply health related information and services.
Kay Price is an Associate Professor in the School of Nursing and Midwifery at the University of South Australia. Jo Boylan is director of operations with Southern Cross Care.
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- Free education about medicines and medical tests is available at NPS: MedicinesWise.
- The National Statement on Health Literacy is available here
- To learn more about CMIs click here
- DSS has advised that the guiding principles for medication management in residential aged care are available here
- Information on the National Residential Medication Chart, which was developed for use in the residential aged care can be found here
- When employing nursing staff, determining their current qualifications and registration can be checked at the AHPRA website
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