Item 16

Promoting understanding of illness and medication, and addressing concerns around medication

Target

a) CRT staff have access to and awareness of materials to give to service users regarding diagnosis and the nature of their mental health problems.

b) Side effects are monitored with evidence of review or response to identified side effects with  at least 80% of service users on psychotropic medication. 

c) Service users and involved carers are provided with written details of the current medication regime.

d) Service users and involved carers are provided with written and oral information about the rationale, desired effect and possible side effects of prescribed medication.

e) Service users' current adherence to prescribed medication is documented for at least 80% of service users.

f) Strategies to aid medication adherence are implemented when non-adherence is identified. 

Why this is important

Our survey of CRT service users and carers indicated that understanding the nature of their diagnosis and medication was valued by this group. To meet this need staff should have access to written information and materials which can be provided to service users and carers. Monitoring and addressing side-effects from medication is particularly important during a crisis, when medications may be changed, and to address reasons for non-adherence.

Ways of doing this well

Monitoring and management of side-effects

The following side effects assessment is a useful tool for clinical practice.

• LUNSERS side effects self-assessment tool (.pdf)
• LUNSERS website http://www.reach4resource.co.uk/node/104

The Chichester team have a useful form that they use to keep track of medication, side effects, and whether service users and carers have received relevant information about these things:

• Chichester medication review form (.doc)

The following presentation provides an overview of various side effect rating scales, and also explains the biological basis of certain specific side effects. The author suggests that a crucial part of working with side effects is working closely with the patient to assess what they were suffering from, making a specific plan for how to manage those side effects, and setting a particular time to review the efficacy of that plan.

• Assessment and Management of Side-Effects (.ppt)

Encouraging adherence to medication

In the audio clip below Dr David Osborn, consultant psychiatrist, discusses the importance of finding acceptable medication solutions for service users, in order to encourage adherence.

An experienced nursing academic has made the following recommendations about encouraging adherence to medication:

• The patient's beliefs about medication should be elicited and explored. This will allow a full discussion of concerns they may have about their medication, and may also identify any beliefs which could be targeted for change as a means of encouraging adherence.
• Problem-solving on the part of the patient should be encouraged. Barriers such as difficulties obtaining medication and prescriptions may be identified, and helping the patient resolve these may enhance their ability to problem solve and thus the likelihood that they will in the future be able to maintain taking their medication as prescribed.
• Talking about what the patient's goals are for the future is a good way to encourage hope, and may allow them to identify ways in which medication can fit in with their future plans.

Full details of these recommendations and much more information about medication adherence can be found in the following presentation:

• Adherence Therapy Workshop (.ppt)

Providing information on medication 

An easy way to provide materials for service users and carers regarding their diagnosis and medication is via the Choice and Medication website.  Nearly all NHS Trusts in the country subscribe to this website, which has been created by Prof. Stephen Bazire (Consultant Pharmacist for Norfolk and Suffolk NHS FT) and Dawn Price (Chief Pharmacist for Addaction).  If your Trust subscribes to the website you can download information sheets to give to service users and carers.

• Choice and Medication Website (www.choiceandmedication.org) 

Examples of good practice

In our fidelity review survey of 75 crisis teams in 2014, the following teams achieved good model fidelity, and can be contacted for advice about how they achieved this:

• Redbridge HTT, North East London NHS Foundation Trust
• Adur, Arundle & Worthing CRHTT, Sussex Partnership NHS Foundation Trust
• Manchester North, Manchester Mental Health and Social Care Trust
• Brighton & Hove CRHTT, Sussex Partnership NHS Foundation Trust
• North West Sussex (Crawley) CRT, Sussex Partnership NHS Foundation Trust
• Sandwell CRHTT, Black Country Partnership NHS Foundation Trust

Relevant reading