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Patients 'not to blame' for failing to take prescribed medications, says NICE

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NICE will tell nurses not to blame a patient who is failing to take prescribed medications in a bid to improve compliance rates, Nursing Times can reveal.

Adopting a ‘no blame’ approach to medication non-adherence is key to reducing the large quantity of NHS drugs that are wasted every year, according to latest NICE guidance due to be published next week.

Between 30% and 50% of medications that are prescribed for long-term conditions are not taken as recommended, according to the institute, contributing to the estimated £100m the NHS wastes annually in drugs wastage.

The institute suggests that a no blame approach will encourage patients to discuss any doubts or concerns about their medication that may be deterring them from taking it.

According to the guidance, non-compliance often occurs as a result of a failure to fully agree the prescription with the patient in the first place, or to support them once the medication has been dispensed – and should not be ‘considered the patient’s problem’.

To address this, it will recommend that clinicians actively identify any barriers to medication adherence at the time of prescribing, and regularly throughout the course of the patient’s treatment.

It will reinforce the concept of a patient-centred NHS by recommending that clinicians encourage patients to engage in a ‘two-way dialogue’ so that patients are fully informed and involved in all decision-making about their prescribed medications from the start.

The guideline will also recommend that healthcare professionals accept a patient’s decision to refuse medication – even if they do not agree with it – as long as the patient has the capacity and information to make a fully informed decision.

Any practical interventions to support adherence should be discussed with the patient on an individual basis, but it said nurses could suggest that patients keep a record of their medicine taking, simplify the dosing regimen or use alternative packaging if a patient is having problems.

However, the idea that ‘no blame’ should be attached to the patient may rankle with the frontline. RCN mental health advisor Ian Hulat said: ‘We can’t assume that nurses blame patients for non-compliance and then just walk away. But it is very frustrating for them to see patients not taking prescribed medications that are clearly important to their health and welfare.’

Additionally, the guidance is slightly at odds with the new NHS Constitution, published last week, which states that patients have a responsibility to follow the course of treatment they have agreed.

But Molly Courtenay, professor of prescribing and medicines management at Reading University, added that the guidance reinforced opportunities for nurses to encourage medication adherence. ‘Nurses core skills lie in communication, emotional support, health education and shared decision making,’ she said.

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Readers' comments (2)

  • So who is to blame exactly? We cannot force patients to take anything, all we can do is give them out. So if they refuse to take them, why is it not their fault? This is just more liberal politically correct rubbish!!! I mean how long will it be before they start blaming Nurses for patients non compliance?

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  • I think the view you express is the very reason a no-blame approach is needed. All the time you want to lambast patients for not taking their medication their only option is to nod agreement in the midst of your shouting and then not bother away from the surgery. Having a no-blame approach.......if practiced correctly.....allows for a patient to feel able to say when they are concerned about their medication without the fear of being shouted at. I've experienced a GP going off on one when I didn't want to be part of his quota of flu jabs ....when I went to see him about a back complaint....... and a friend of mine decided to stop taking blood pressure pills because she felt so 's*&t' when she was on them but used to literally get shouted at by her GP when she questioned them (how does that help her blood pressure?). She has been off them a year now, has not told her GP....and the patient is doing fine! Taking a no-blame approach is a sign of the NHS finally starting to step down from its pedestal of 'god like' status to allow patients to be included in the decisions made about their own health. It's not political correctness it's an example of treating people as if they have a brain and are not just lumps of meat to be 'treated'.

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