1 Batt, A. Enhancing patient safety education for paramedics with the IHI Open School. http://prehospitalresearch.eu/?p=6171 2 Elliott, R.A., Camacho, E., Campbell, F. et al. (2018). Prevalence and Economic Burden of Medication Errors in the NHS in England. Sheffield: Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU). 3 Hobgood, C., Bowen, J.B., Brice, J.H., Overby, B. and Tamayo‐Sarver, J.H. (2006). Do EMS personnel identify, report and disclose medical errors? Prehospital Emergency Care 10(1): 21–27. 4 Institute for Safe Medication Practices Canada. (2020). Multi‐incident analysis of incidents involving paramedicine. ISMP Canada Safety Bulletin 20(1): 1–4. 5 Lammers, R., Willoughby‐Byrwa, M. and Fales, W. (2014). Medication errors in prehospital management of simulated pediatric anaphylaxis. Prehospital Emergency Care 18(2): 295–304. 6 McGovern, K. (1992). 10 Golden rules for administering drugs safely. Nursing 22(3): 49–56. 7 Nguyen, A. (2008). Bad medicine: preventing drug errors in the prehospital setting. Journal of Emergency Medical Services 33(10): 94–100. 8 Roughead, L., Semple, S. and Rosenfeld, E. (2013). Literature Review: Medication Safety in Australia. Canberra: Australian Commission on Safety and Quality in Health Care. 9 WHO Collaborating Centre for Patient Safety Solutions. (2007). Look‐Alike Sound‐Alike Medication Names. Patient Safety Solutions: Solution 1. https://cdn.who.int/media/docs/default‐source/integrated‐health‐services‐(ihs)/psf/patient‐safety‐solutions/ps‐solution1‐look‐alike‐sound‐alike‐medication‐names.pdf?sfvrsn=d4fb860b_6&ua=1
Further reading
1 Australian Medicines Handbook (AMH). 2020 print edition or online: https://amhonline.amh.net.au
2 British National Formulary (BNF). 2020 print edition or online: www.bnf.org
Multiple‐choice questions
1 A medication error occurs when:The wrong dose is administeredA drug that would benefit a patient is not givenA drug that it not necessary is givenAll of the above.
2 The purposes for which a medication can be used are the:Mechanism of actionContraindicationsIndicationsNone of these.
3 The conditions in which a drug cannot be used are the:Mechanism of actionIndicationsNone of these.
4 When drugs such as alprazolam are referred to as benzodiazepines, they are being classified according to their:Mechanism of actionIndicationsChemical classOriginal trade name.
5 When drugs such as reboxetine are referred to as antidepressants, they are being classified according to their:Mechanism of actionIndicationsChemical classOriginal trade name.
6 A medication which is prescribed for an indication other than its listed indications is being used:IllegallyOff‐labelEven though it is contraindicatedNone of the above.
7 The drugs known as specific serotonin reuptake inhibitors, which include fluoxetine (Prozac®), would act by binding to:A receptor for a neurotransmitterAn ion channelAn enzymeA transport molecule.
8 In general, the more selective a drug is in its binding sites:The fewer side effects it will haveThe more easily it will reach its site of actionThe more potent it will beThe more it will interact with other drugs.
9 When administering adrenaline intravenously, which dilution is most appropriate?1:1001:10001:10 0001:100 000
10 A drug that is an antagonist or blocker of a receptor is likely to ‘fit’ the receptor chemically better than a drug that is an agonist.TrueFalse
11 A drug, such as a general anaesthetic, that can penetrate the blood–brain barrier very rapidly after intravenous administration is likely to be:Highly water solubleA proteinHighly lipid solubleNo drugs can penetrate an intact blood–brain barrier.
12 A medication dose may need to be adjusted down in which of these situations?Renal failureHigh first‐pass metabolismDiarrhoeaVomiting
13 The NSAID aspirin has its effects due to action at:An ion channelA neurotransmitter receptorA transport moleculeAn enzyme.
14 You are attending a patient who has suffered trauma and lost a lot of blood. The patient’s heart rate is normal, even though their blood pressure is low. Which of the following medications being taken is most likely to be responsible for this?IbuprofenMetforminAtenololTetracycline
15 If a drug undergoes extensive first‐pass metabolism, which of these routes should be avoided as administration routes for this drug?IntramuscularIntravenousOralIntranasal
Chapter 2 How to use pharmaceutical and prescribing reference guides
Nigel Conway and Jennifer Dod
Aim
This chapter aims to introduce you to commonly used pharmaceutical and prescribing reference guides and their use in paramedic practice. Specific focus is placed on the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) Clinical Practice Guidelines (2019).
For clarification:
The JRCALC Clinical Guidelines (2019) full reference book will be referred to throughout this chapter as JRCALC Guidelines
The JRCALC Clinical Guidelines (2019) Pocket Book will be referred to in this chapter as JRCALC Pocket Book
The JRCALC Clinical Guidelines digital application (app) will be referred to in this chapter as JRCALC app.
Learning outcomes
After reading this chapter, the reader will:
1 Be aware of the different pharmaceutical and reference guides that may be used in paramedic practice
2 Understand how to navigate the:JRCALC Guidelines (full reference book)JRCALC Pocket BookJRCALC app
3 Be aware of other common pharmaceutical resources available to the paramedic.
Test your knowledge
How frequently are the hard‐copy JRCALC Guidelines reviewed and republished?
How many HCPC standards of proficiency are there?
How many different forms of the JRCALC Guidelines are available?
What is the unique feature of the ‘JRCALC plus’ feature?
What are the core paramedic care approaches to the fundamentals of medicine management?
Introduction
The world of medications is vast and learning about them can be daunting for all allied healthcare and nursing profession students, as well as registered professionals. The people you care for may have extensive past medical history and lists of medications specific to treatment interventions. You need to be able to assess, review, administer, consider interactions, monitor and evaluate the effects of these medications.
Regulatory and professional bodies