title: Managing adverse drug reactions: an orphan task.
abstract: BACKGROUND
  Nurse prescribing initiatives have potential to impact on medication management for long-term conditions. Over time, the adverse effects of medications become increasingly onerous. This 'side-effect burden' is particularly heavy for users of antipsychotic medication. Although consensus exists that strategies are needed to alleviate these problems, currently, they are not clearly the responsibility of any one professional group.
  
  
  OBJECTIVE
  This paper explores the introduction of nurse-administered evaluation checklists, in relation to nurse prescribing initiatives and division of professional responsibilities for medication management.
  
  
  METHODS
  This was an observation study, with a quasi-experimental comparator group design, undertaken with clients receiving long-term antipsychotic medication. In both intervention and comparator groups, before and after introduction of evaluation checklists in the intervention group, 20 nurse-client interactions were observed. Problems actioned by the nurses, with and without the checklists, were compared. Stakeholders' views were sought concurrently.
  
  
  RESULTS
  Implementation of evaluation checklists increased the numbers of adverse effects detected and actioned by nurses. They also served to apportion aspects of medication management between nurses and medical prescribers. Most actions taken by nurses to alleviate adverse effects concerned clients' physical health and advice on health-promotion. However, the nurses' interventions would have been more effective had they been able to supply clients with certain medicines either by prescribing from the Nurse Prescribers' Formulary or issuing under Patient Group Directions. For some clients, ameliorating the adverse effects of medication would have involved changes to prescribed antipsychotic medication; here decisions were more equivocal.
  
  
  CONCLUSIONS
  The identification of previously unattended problems, together with the views of service users, suggests that empowering nurses to address the 'care gaps' in medication management may benefit service users. The 'checklist evaluation' approach warrants further investigation, ideally in conjunction with nurse prescribing initiatives.
authors.affiliation: School of Health Science, University of Wales, Swansea, UK. s.e.jordan@swansea.ac.uk
authors.forename: Sue
authors.initials: S
authors.lastname: Jordan
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D016903:Drug Monitoring / Q000379:methods / Q000451:nursing*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000451:nursing*; D008875:Middle Aged; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009730:Nursing Assessment
chemical_list: D014150:Antipsychotic Agents