Drugs all round

As I've said before, the pre-registration year is exceptionally busy for everyone but today, I had the opportunity to spend some time away from pharmacists and the dispensary and spend time shadowing a nurse. "What's the use of that?" I hear you cry. The arrangements were made by the pharmacist I am currently shadowing as part of my rotation, as she thought it would be a useful opportunity to see how drugs are used at the end of the line.

Initially, I was a little apprehensive about spending time watching a nurse pop tablets out of containers and into patients hands, however this apprehension was totally misplaced. I observed the nurse giving drugs via multiple routes of administration.

Most interestingly was via a PEG tube, the patient was unable to speak and communicated only with facial expressions and grunts. As the nurse approached him to give him his medicines, the patient eagerly waved his PEG tube in her direction. Then as the nurse lined up his medicines, dissolving each on in sterile water, it appeared to almost look as if she were preparing a line of shots in a night club.

Next on the round was a gentleman with swallowing difficulties, something I'd heard a lot about but never actually seen someone struggling to swallow. This was somewhat of a poignent moment and made me feel quite solemn about the situation the patient was in. Something as easy as taking a sip of water had become almost impossible for this patient. My immediate instinct was to crush and dissolve, but as I said, this patient couldn't even swallow water. The nurse then proceeded to mix the drug solution with Thick and Easy - a neutral compound used to thicken solution to allow the patient to get more of 'a handle' on what is in their mouth. The patient is then spoon fed the thicker-solution. This seemed like a very convenient solution to the problem, however take a moment to consider the volume of liquid normally taken as part of a macrogol sachet?

Several patients all insisted they could handle taking their tablets alone, however I soon realised that this was not always the case. Whilst patients will insist they are capable, more often than not the tablets will end up on the floor, dropped onto knees or end up in a crease in the bedding. I asked the nurse about this, and why she doesn't just feed the patients their medicines to start with, she simply looked at me and then I realised that these patients need to have the dignity of choice (rather than being force fed without consideration.)

I also saw the nurse halving particularly large tablets, such as Co-Amoxiclav. I used this opportunity to explain that by halving the tablet it would be become 'unlicensed' and the medic who prescribed the drug should be informed, to which she replied "It was his idea". I observed sub-cut injections, as well as IV drugs being administered.

The session taught me a lot about how drugs are used in the real world, with an emphasis that pharmacists shouldn't stop thinking about the drug once they've been bagged up and shipped off to the ward. I'd recommend any pre-reg's or students try and get the opportunity to see nurses administering drugs, it is time well spent.