What is an effective educational plan for non-RN (Registered Nurse)/non-DO (Doctor of Osteopathic Medicine) staff who administer medications, specifically those affecting respiration, blood pressure (BP), and anticoagulation, to understand their mechanisms and side effects?

From the Guidelines

A strong educational teaching plan for non-RN/doctor staff who administer medications should prioritize a patient-centered approach, focusing on the benefits and safety of medications, as well as alleviating fears of side effects and harm, as recommended by the 2024 ESC guidelines for the management of elevated blood pressure and hypertension 1. To develop this plan, consider the following key elements:

• Establish basic pharmacology concepts, including drug absorption, distribution, metabolism, and excretion
• Focus specifically on respiratory medications (bronchodilators, corticosteroids, anticholinergics), blood pressure medications (ACE inhibitors, beta-blockers, calcium channel blockers), and anticoagulants (warfarin, heparin, DOACs)
• Cover mechanism of action, common side effects, monitoring parameters, and warning signs requiring immediate attention for each medication class
• Include practical sessions on medication administration techniques, vital sign monitoring, and documentation
• Implement competency assessments through written tests and skills demonstrations
• Provide pocket reference cards with key information for each medication class This approach ensures staff understand the importance of effective communication with patients about their medication regimen, as emphasized in the study on medication reconciliation 1, and provide patients with education and information about their condition and management options, as recommended in the review of best practice care for musculoskeletal pain 1. By prioritizing patient-centered education and competency-based training, non-RN/doctor staff can provide high-quality care and improve patient safety, ultimately reducing morbidity, mortality, and enhancing quality of life.

From the FDA Drug Label

DRUG INTERACTIONS 7. 1 Diuretics Initiation of lisinopril in patients on diuretics may result in excessive reduction of blood pressure. The possibility of hypotensive effects with lisinopril can be minimized by either decreasing or discontinuing the diuretic or increasing the salt intake prior to initiation of treatment with lisinopril. 7. 2 Antidiabetics Concomitant administration of lisinopril and antidiabetic medicines (insulins, oral hypoglycemic agents) may cause an increased blood-glucose-lowering effect with risk of hypoglycemia. 7. 3 Non-Steroidal Anti-Inflammatory Agents Including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors) In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including lisinopril, may result in deterioration of renal function, including possible acute renal failure.

A strong educational teaching plan for staff that are not RN/DOCTORS who give medications, specifically respiratory affecting, BP affecting and anticoagulant meds should include:

• Mechanism of action: Understanding how the medication works, such as the effect of lisinopril on blood pressure and potassium levels 2.
• Side effects: Recognizing potential side effects, such as hypotension, hyperkalemia, and hypoglycemia, and knowing how to manage them.
• Drug interactions: Being aware of potential interactions with other medications, such as diuretics, antidiabetics, and NSAIDs, and taking steps to minimize risks.
• Monitoring: Knowing what to monitor, such as blood pressure, renal function, and electrolytes, and how to respond to abnormal results.
• Patient education: Educating patients on the importance of adherence, potential side effects, and when to seek medical attention. The FDA drug label does not provide a comprehensive educational plan, but it highlights key points to consider when administering medications like lisinopril 2.

From the Research

Educational Teaching Plan for Staff

To develop a strong educational teaching plan for staff who are not RN/doctors and give medications, specifically respiratory affecting, BP affecting, and anticoagulant meds, the following components should be considered:

• Lesson Plan Basics: A clear "road map" is essential to guide the lesson and document what is taught 3.
• Clinical Teaching Strategies: Staff nurses should be educated on clinical teaching strategies to effectively instruct on medication administration 4.
• Medication Mechanism and Side Effects: The teaching plan should include information on the mechanism of action, clinical efficacy, and safety of medications such as albuterol, ipratropium, and combination therapies 5, 6, 7.
• Respiratory Affecting Medications: The plan should cover medications used to treat chronic obstructive pulmonary disease (COPD), such as albuterol and ipratropium, and their combination therapies 5, 6, 7.
• BP Affecting and Anticoagulant Medications: The plan should also include information on medications that affect blood pressure and anticoagulant medications, although specific studies on these topics are not provided in the available evidence.

Implementation and Evaluation

The teaching plan should be implemented in a way that promotes compliance and understanding among staff, such as using a two-in-one inhaler versus separate inhalers 7.

• Compliance and Effectiveness: The plan should be evaluated to determine its effectiveness in increasing compliance and decreasing respiratory morbidity and charges 7.
• Staff Education and Development: The plan should be part of a comprehensive staff development program that prepares staff nurses for the teaching role and educates them about clinical teaching strategies 4.