NURS90075: Clinical Pharmacology Assignment - QUM Framework Analysis

This report delves into the application of the Quality Use of Medicines (QUM) framework within a clinical pharmacology context, using the case of Mr. Ibun Masoud, a 65-year-old patient with multiple health conditions including angina, diabetes, and renal failure. The report analyzes the four guiding principles of QUM: judiciousness, appropriateness, safety, and efficacy, and how they relate to Mr. Masoud's treatment and lifestyle. It explores the importance of lifestyle modifications, appropriate medication choices, and patient adherence to treatment plans. The report also examines the principles of creating a medicine education strategy, including consumer primacy, collaborative approaches, and system-based support. The analysis considers the risks and benefits of various treatment options, including surgery and lifestyle changes. The report emphasizes the need for a holistic approach to patient care, considering both medical interventions and patient education to achieve optimal health outcomes. The report highlights the importance of patient safety, medication adherence, and the role of clinicians in monitoring treatment outcomes. The report also discusses how the patient's lifestyle choices and non-adherence to treatment impact the effectiveness of medical interventions. The report concludes by discussing the need for appropriate treatment and the importance of patient education and lifestyle modifications to manage Mr. Masoud's conditions effectively.

Running head: CLINICAL PHARMACOLOGY
Clinical Pharmacology
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Institutional affiliation

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Applying the Principles of Qum to a Case Scenario
Introduction
Quality use of Medicine Framework is a central objective of the nursing policy. The
framework has been used successfully in Saudi Arabia and beyond (Sluggett, Ilomäki, Seaman,
Corlis, & Bell, 2017). The purpose of the plan is to help consider the place of medicines in
treating illnesses in an efficient way. It contains particular schedules which help health
practitioners and stakeholders make fundamental decisions about a disease, the drugs and the
treatment plan (Jokanovic et al., 2016). QUM ultimately ensures that the appropriate medicine is
used and with proper monitoring the safety and effectiveness of a treatment plan which ensures
that the best outcome are achieved (Lilly, Hallett, Robinson, & Selvey, 2019). The purpose of
this paper is to discuss the key principles of the use of quality Use of medicine framework. Each
of the outlined principle has been used in analysis of the case study of Mr. Ibun Masoud who has
been accused of many illnesses and from the case scenario he has failed to adhere to treatment
with cases of unhealthy life style and work related stresses also mentioned.
There has been a health concern about patients of the age of 65 years old and above. He
has an acute angina attack. The attack has seen him transferred to the emergency department of
the hospital. It is important to note, that in our case scenario Mr. Ibun Masoud is such a patient
who has been on drugs and suffers from other trigger conditions. Mr. Ibun’s medical history
shows non-insulin dependent diabetes. This has since been subjected to a treatment plan which
involves aspirin. He has also been diagnosed with renal failure. He also takes regular medication
for his hypertension disease. Other health conditions like; hyperlipidemia, blood clotting and
arthritis all have specific treatment and medicinal plans. In terms of lifestyle, Mr. Ibun lives a
rather luxurious life. He focuses a lot on his business and has been diagnosed with business

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stress. He doesn’t take any physical activities and has not been keen in watching his diet. His
weight is above 80 kilogram. At 98kgs the body is overweight and is exposed to several other
negative health conditions. The latest vital signs just measured from the body have shown very
irregular heartbeat rates. Very high blood pressure, very low breathing rates and very high body
temperatures.
The QUM contains four guiding principles (Meurk, Leung, Hall, Head, & Whiteford,
2016). During creation of the framework the quality use of medicine was meant to ensure that
medicine is used judiciously. By judiciously, it meant that using medicine after considering all
the other treatment options (Alderman, & Lucca, 2017). This marks the first option. The second
one is appropriation (Alderman, & Lucca, 2017). It also involves appropriately choosing a
medicine after appraisal of all the important factors (Alderman, & Lucca, 2017). All the other
factors include; an analysis of risk benefit, the treatment length and the cost of treatment. The
third principle involves ensuring that the medicine is administered safely. Safety involves
minimization of drug misuse and abuse (Petrie, 2018). The last principle is that the treatment
plan should be efficacious (Weekes, Blogg, Jackson, & Hosking, 2018). Efficacious means
having a quantifiable benefit to the target patient health. If not, it should have a benefit to the
quality of life (Weekes, 2015). All these four principles will be adequately discussed in the paper
tailoring each to our case scenario involving Mr. Ibun Masoud.
The QUM contains five principles that guide the creation of a strategy (Ranganathan, &
Gazarian, 2015). Each of these strategies is critical towards applying and creating a medicine
treatment education recommendation for the case scenario (Press, Rajkumar, & Conway, 2016).
The guiding principles of creating a medicine education strategy include; the principles of
primacy of consumers, the principles of collaborative, consultative and multidisciplinary activity.

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The other principles include; the principle of support for existing activities and the principles of
system-based approach (Press, Rajkumar, & Conway, 2016). All the five mentioned principles
are discussed in length and how all of them will influence the decisions and strategy that will be
take in treating Mr. Ibun Masoud as discussed in the latter paragraphs of this paper.
Principles of quality use of medicine and application to the case scenario
As mentioned in the introduction: There are four principles that guide the application of
quality use of medicine (Kimko, & Pinheiro, 2015);
The first principle is the principle of judiciousness. It requires that medicines are used
only after considering that all the other options are null and might not give the expected
effectiveness. It further means that a patient is given access to that form of treatment that will
help the condition at the time it is needed (Simon, McCullough, Snyder, Solheim, & Strauss,
2016). This first principle acknowledges that quality use of medicines is not limited to prescribed
medicines alone, but also to other options. The other options include; non-prescribed medicines
and complementary medicines. This first principle is supposed to ensure that the selection of the
management of the disease is done wisely. It helps recognize that there may be better ways than
medicine to manage any disorders and conditions (Ofori-Asenso, & Agyeman, 2016). From the
case scenario of Mr.. Ibun Masoud, the principle of being judicious in order to achieve quality
use of medicine might apply in avoiding giving Mr. Ibun treatment but adjusting his lifestyle
choices. Mr. Ibun should be subjected to a two to three weeks plan of changing his eating habits
and subjecting him to physical exercise. Recommending a Change in his diets while considering
the first principle will help reduce the body weight from 98kgs to something that is manageable.
Mr. Ibun should also be subjected to physical exercise and physical activities. The neglect of
medicine reported from the patient clearly shows that he isn’t aware of why he should adhere to

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the treatment plan. The action of avoiding taking his drugs and living a care free life demeans the
quality use of medicine. It demeans the rate at which healing is supposed to take place. Mr. Ibun
was likely to be admitted once again for failing to follow his previous treatment plan. Logical
analysis of the case scenario to the first principle of quality use of medicine, recommends that all
medicine plans given to Mr. Ibun should be suspended and that he should be subjected to a
change of lifestyle first. The change of lifestyle should partly include change of diet. He should
be advised to avoid the sugar and wheat as much as possible He should be limited to non-sugary
foods. He also should be introduced to exercise activities. The moment the two plans shall have
failed, it is then can Mr. Ibun be subjected to medicinal plan to deal with his renal failure and the
rising sugar level.
The second principle of quality use of medicine is the principle of appropriateness (Wirtz
et al., 2017). Each of the patients should receive treatment tailored to their clinical conditions,
needs, age, duration, dose and what they can easily afford (Fried, Niehoff, Tjia, Redeker, &
Goldstein, 2016). It involves choosing a treatment or a medicine after a thorough analysis and
appraisal of surrounding factors. Some of these factors that should be appraised include; risk
benefit analysis, the length of the chosen treatment and the cost of the treatment (Khodyakov,
Mikesell, Schraiber, Booth, & Bromley, 2016). For the case study, an analysis of risk benefit
analysis would lead to change of lifestyle for Mr. Ibun as the immediate form of treatment. The
goal of lifestyle change is to help reduce the severity of the attack which includes chest pains,
anxiety and excessive sweating. Mr. Ibun should be subjected to weight loss options, starting a
safe exercise plan that runs for more than two weeks and avoiding strenuous and stressful
activities that might arise from his business. Mr. Ibun is at a positive start since all the conditions
that are likely to accelerate his angina attack are under a proper treatment condition. His

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hypertension has been subjected to enalapril. Heart disease can be a trigger to angina attack;
however, this condition has been taken care of. An additional risk condition is diabetes, which
Mr. Ibun has been taking insulin injections for. It is clear that all the conditions that increase the
risk of angina attack have been taken care of using other drugs. From such an analysis of risk and
benefits, principle of appropriateness might require that Mr. Ibun is subjected to a change of
lifestyle treatment.
From the analysis of the case scenario it is clear that Mr. Ibun can afford surgery. It can
also be an option to perform angioplasty or stenting to the patient. The procedure is supposed to
be considered since the kind of attack that Mr. Ibun has is not stable. Having been transferred
from the emergency department, it is quite clear that his attack is quite severe and might need
surgery. In terms of principle appropriateness subjecting Mr. Ibun to a surgical procedure is
beneficial. It is affordable to him and is likely to save his life.
Still considering the principle of appropriateness, it is important to take into consideration
the duration of healing. Both surgery and change of lifestyle will take more than two weeks for
Mr. Ibun’s case. However, since the condition is worse immediate surgery will save the life of
Mr. Ibun. Going forward into the future, Mr. Ibun has to be advised on change of lifestyle to
avoid further future attacks. Both of the treatments likely to be scheduled by the hospital are
costly. However, they are worth it. Deducing from the principle of appropriateness, after risk-
benefit analysis, length analysis and cost analysis Mr. Ibun should be subjected to surgery and
change of lifestyle if quality use of medicine is to be achieved.

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The third principle is the principle of safety (Gotcheva et al., 2017). Safeties involves,
minimizing the misuse and abuse of the medicine and treatment plan given to a patient. The
safety principle involves using medicine safely and effectively to get the best possible results that
one can get from it. From the perspective of a clinician, it involves monitoring outcomes of the
medicine on patients. From the case study; it is at this principle that Mr. Ibun has flouted a lot of
rules. The outcome of the medicine given to Mr. Ibun is likely to be less efficient. The outcome
is likely to be different since Mr. Ibun doesn’t follow his medications like he is supposed to. It
then becomes quite difficult for the clinicians to get the intended outcome. It is even more
difficult to monitor outcome when the patient is doing very little to adapt to a life style that fits
and suits him even better knowing that he has various conditions.
The first aspect of the safety principle requires that the patient and the clinician minimize
misuse of the drug (Pugsley, & Curtis, 2015). By misuse, it means, there should be no cases of
under use or over use of a drug. The drugs, the medicines and the treatment plan should be
adhered to as recommended by the clinician. It is expected that it is only when misuse is avoided
that the expected outcome will be achieved (Pugsley, & Curtis, 2015). From the case scenario,
Mr.. Ibun has committed quality use of medicine offence by neglecting the safety principle. It is
reported that Mr. Ibun, the patient in the study, avoids taking his diabetic medicine. Mr. Ibun has
a clear case of under use. From five years ago Mr. Ibun has been commenced on subcutaneous
(insulin) NovoRapid regularly 2 units twice a day or sliding scale. However, he hasn’t adhered to
his diabetic management, yet diabetes is a trigger condition of an angina attack. From the under
use by Mr. Ibun to his diabetic treatment, a clinician is likely to predict the cause of the attack.
Logically, Mr. Ibun has flouted the principle of safety. Having flouted it, it is unlikely that
quality use of medicine can be achieved.

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Lastly is the principle that recommends the efficacious use of medicine (Rathbone,
Clarry, & Prescott, 2017). Efficacious use of medicine focuses on the benefits and effects that the
medicine will have on the patient’s health and their quality of life (Rathbone, Clarry, & Prescott,
2017). The said benefits and effects should be measured in quantifiable terms. Effectiveness also
involves improving the ability on the patient to solve the problem with the medication
recommended. It means a patient should be able to identify the negative effects of the medicine
that they are given (Rathbone, Clarry, & Prescott, 2017). They should also be able to manage all
the multiple medications that are administered to help treat the identified condition. From the
case scenario of Mr. Ibu he is on medications of aspirin, clot preventing drugs and blood pressure
lowering medications. Quantifiable effects expected to change after medication inlude; low
blood pressure, reduced chest pains, regular rate of the heart beat and normal blood sugar level.
Additionally, medication related to change in lifestyle will be effective when there is significant
change in factors like weight is realized. The weight of Mr. Ibun should be lower than 98kgs.
Change in the eating habits by maintaining a diet free from sugar i.e. wheat and other sugary
foods that act as trigger agent to the angina attack. Another effective quantifiable change of
medication can be noted in reduction of stress levels of Mr. Ibun. He can be allowed to take a
rest from his business so that the stress levels can drop. With respect to the principle of
effectiveness, one all these factors have dropped down significantly, the clinician can derive that
quality use of medicine has been achieved (Summer Meranius & Engstrom, 2015).
From the above discussion all the four principles have been related and applied to the
case scenario of Mr. Ibun Masoud who is suffering from an angina attack. He has been given
medication, but quality use of medicine is yet to be achieved. Quality use of medicine, in Mr.
Ibun’s case is yet to be achieved since he and the clinician have flouted particular aspects of the

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four principles. The flouting of some aspects of these principles forms the introduction of the
strategy that should be used in ensuring the patients, more than anyone achieves quality use of
medicine.
Strategies for patient medicine education
The principles and the development of the QUM place the patient at the core or reception
(Woods, 2017). All the health outcomes are supposed to help the patient. Even though, they
might be important for the health practitioners too. The importance of a developing a health
patient education strategy are so many. However, the most important one is that as shown by
research educated, patients are likely to manage their own health and medical care throughout
their lives (Woods, 2017). From the case scenario, it is logical to assume that Mr. Ibun lacks
patient education about his condition. His actions of flouting all the QUM principles limit his
health condition. All the patient education strategies should translate to positive patient benefits,
which ultimately leads to QUM.
In order to realize positive patient strategy the following principles have to be adhered to.
The principle of primacy of consumers is the first principle. It requires that consumer, in this
case the patients, are involved in all the aspects of the educational strategy. Secondly, the
principle of partnership, all the partners are involved (Fuzzel et al., 2018). This includes family
and other stakeholders. The third principle is that of consultative, collaborative and multi-
disciplinary activity (Carraccio et al., 2016). In designing the education strategy, the clinician
should think of a method that will enhance interactions of all the stakeholders.
The education strategy should also be one that involves multiple activities to avoid
monotony (Carraccio et al., 2016). The fourth principle is support for existing education activity.
It involves appreciating the already developed methods before trying out a new strategy

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(Carraccio et al., 2016). Lastly, the principle use of system based approach. System based
approach involves developing a strategy that will develop behavior in the patient to support
QUM. It will also create a patient environment that encourages QUM.
Guided by the five afore-mentioned principles the following education strategies for Mr.
Ibun health condition has been developed. The strategies are supposed to ensure total
achievement of QUM for the mentioned patient.
The first strategy is educational assessment on the patient’s knowledge about their
condition and the medicine required for the same condition (Conn, Ruppar, Chase, Enriquez, &
Cooper, 2015). This strategy is implemented through asking patient to complete assessment prior
to the educational appointment. Based on the assessment report the clinician can adapt various
educational clinical needs. Previous research by Alomi, Alghamdi & Alattyh, (2015) has shown
that patient with high literacy levels on their conditions are less likely to adapt to the treatment
plan. When the clinicians know the kind of patient Mr. Ibun is, in terms of health literacy, they
can determine subsequent materials and reviews on the health information that he is required to
know.
A second strategy that doesn’t interfere with ethics and societal concerns is teach-back
(Conn, Ruppar, Chase, Enriquez, & Cooper, 2015). Teach-back as a strategy can be implemented
in the case of Mr. Ibun. However, teach-back as a strategy requires further research on whether it
can change behavior of the patient Conn, Ruppar, Chase, Enriquez, & Cooper, 2015). Teach-
back involves the clinician teaching the patient about a concept before the patient then returning
the favors. The teach-back technique has been successfully used by many technicians. In terms
of involvement teach back is done to ensure that all aspects are carefully explained.

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A final educational strategy is offering educational materials to the patient in the format
they most prefer (Conn, Ruppar, Chase, Enriquez, & Cooper, 2015). This method is widely used
especially with the adoption of technology. However, further research is recommended on
whether busy patients can make time for such. This strategy is likely to be less appropriate in the
case of Mr. Ibun. From the case scenario Mr. Ibun is a business man and might really have little
time reading educational materials concerning health issues and his conditions. However, in case
the clinician decides to use this method, it can be implemented in quite a number of ways.
Firstly, the clinician can use digital formats by sharing handouts, graphics, brochures and even
YouTube videos to the patient. Care should be taken that this should be done in one of the
formats that the patient is most comfortable.
Recommendation
The three strategies: educational assessment, offering educational materials and teach-
back methods are free of social-cultural and ethnic aspects. Teaching patients about medicine
through these strategies can be most appropriate in ensuring the achievement of quality use of
medicine.
Conclusion
In conclusion, this paper analyses the case scenario of Mr. Ibun admitted of an angina
attack. The analysis is done in comparison to the four principles of quality use of medicine. The
four principles include: safety, efficiency, judicious and appropriateness. The paper then
provides strategies that can be applied in educating Mr. Ibun on medicine and his health
condition. The three strategies discussed are expected to meet the five principles of teaching
strategies mentioned just before them. The entire paper is a link on how QUM and its principles
can be applied to a patient scenario.

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References
Alderman, C. P., & Lucca, J. M. (2017). Psychiatry and clinical pharmacy: A logical
partnership. Indian journal of psychiatry, 59(2), 138.
Alomi, Y. A., Alghamdi, S. J., & Alattyh, R. A. (2015). Strategic Plan of General Administration
of Pharmaceutical Care at Ministry of Health in Saudi Arabia 2012–2022. J Pharm
Pharm Scien, 1(3), 1-8.
Carraccio, C., Englander, R., Van Melle, E., Ten Cate, O., Lockyer, J., Chan, M. K., ... &
International Competency-Based Medical Education Collaborators. (2016). Advancing
competency-based medical education: a charter for clinician–educators. Academic
Medicine, 91(5), 645-649.
Conn, V. S., Ruppar, T. M., Chase, J. A. D., Enriquez, M., & Cooper, P. S. (2015). Interventions
to improve medication adherence in hypertensive patients: systematic review and meta-
analysis. Current hypertension reports, 17(12), 94.s
Fried, T. R., Niehoff, K., Tjia, J., Redeker, N., & Goldstein, M. K. (2016). A Delphi process to
address medication appropriateness for older persons with multiple chronic
conditions. BMC geriatrics, 16(1), 67.

CLINICAL PHARMACOLOGY 13
Fuzzell, L. N., LaJoie, A. S., Smith, K. T., Philpott, S. E., Jones, K. M., & Politi, M. C. (2018).
Parents’ adherence to pediatric health and safety guidelines: Importance of patient-
provider relationships. Patient education and counseling, 101(9), 1570-1576.
Gotcheva, N., Viitanen, K., Ylönen, M., Lahdenperä, P., Tuovinen, J., Ruutu, S., ... & Artto, K.
(2017). Management principles and safety culture in complex projects (MAPS).
In SAFIR2018-The Finnish Research Programme on Nuclear Power Plant Safety 2015-
2018: Interim Report (pp. 29-39). VTT Technical Research Centre of Finland.\
Jokanovic, N., Tan, E. C., van den Bosch, D., Kirkpatrick, C. M., Dooley, M. J., & Bell, J. S.
(2016). Clinical medication review in Australia: a systematic review. Research in Social
and Administrative Pharmacy, 12(3), 384-418.
Khodyakov, D., Mikesell, L., Schraiber, R., Booth, M., & Bromley, E. (2016). On using ethical
principles of community-engaged research in translational science. Translational
Research, 171, 52-62.
Kimko, H., & Pinheiro, J. (2015). Model‐based clinical drug development in the past, present
and future: a commentary. British journal of clinical pharmacology, 79(1), 108-116.
Lilly, K., Hallett, J., Robinson, S., & Selvey, L. A. (2019). Insights into local health and
wellbeing policy process in Australia. Health promotion international. (112-115)
Meurk, C., Leung, J., Hall, W., Head, B. W., & Whiteford, H. (2016). Establishing and
governing e-mental health care in Australia: a systematic review of challenges and a call
for policy-focussed research. Journal of Medical Internet Research, 18(1), e10.
Ofori-Asenso, R., & Agyeman, A. (2016). Irrational use of medicines—a summary of key
concepts. Pharmacy, 4(4), 35.

CLINICAL PHARMACOLOGY 14
Petrie, N. (2018). Education extra: Efficacy and safety of diclofenac for the management of
pain. Australian Pharmacist, 37(4), 44.
Press, M. J., Rajkumar, R., & Conway, P. H. (2016). Medicare’s new bundled payments: design,
strategy, and evolution. Jama, 315(2), 131-132.
Pugsley, M. K., & Curtis, M. J. (Eds.). (2015). Principles of safety pharmacology (Vol. 229).
Springer.
Ranganathan, S. S., & Gazarian, M. (2015). Rational use of medicines (RUM) for children in the
developing world: Current status, key challenges and potential solutions. In Optimizing
Treatment for Children in the Developing World (pp. 225-238). Adis, Cham.\
Rathbone, A. L., Clarry, L., & Prescott, J. (2017). Assessing the efficacy of mobile health apps
using the basic principles of cognitive behavioral therapy: systematic review. Journal of
medical Internet research, 19(11), e399.
Simon, T. L., McCullough, J., Snyder, E. L., Solheim, B. G., & Strauss, R. G. (Eds.).
(2016). Rossi's principles of transfusion medicine. John Wiley & Sons Incorporated.
Sluggett, J. K., Ilomäki, J., Seaman, K. L., Corlis, M., & Bell, J. S. (2017). Medication
management policy, practice and research in Australian residential aged care: current and
future directions. Pharmacological research, 116, 20-28.
Summer Meranius, M., & Engstrom, G. (2015). Experience of self‐management of medications
among older people with multimorbidity. Journal of clinical nursing, 24(19-20), 2757-
2764.
Weekes, L. (2015). QUALITY USE OF MEDICINES: CONSIDERATIONS IN
PHYTOTHERAPY. Phytotherapies: Efficacy, Safety, and Regulation, 554-572.

CLINICAL PHARMACOLOGY 15
Weekes, L. M., Blogg, S., Jackson, S., & Hosking, K. (2018). NPS MedicineWise: 20 years of
change. Journal of pharmaceutical policy and practice, 11(1), 19.
Wirtz, V. J., Hogerzeil, H. V., Gray, A. L., Bigdeli, M., de Joncheere, C. P., Ewen, M. A., ... &
Möller, H. (2017). Essential medicines for universal health coverage. The
Lancet, 389(10067), 403-476.
Woods, N. (2017). Understanding the Importance of Patient Engagement through Case Study
Learning.34-35