NURS 6630 Week 5 Assignment: De-Prescribing

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NURS 6630 Week 5 Assignment: De-Prescribing – Step-by-Step Guide

The first step before starting to write the NURS 6630 Week 5 Assignment: De-Prescribing, it is essential to understand the requirements of the assignment. The first step is to read the assignment prompt carefully to identify the topic, the length and format requirements. You should go through the rubric provided so that you can understand what is needed to score the maximum points for each part of the assignment. 

It is also important to identify the audience of the paper and its purpose so that it can help you determine the tone and style to use throughout. You can then create a timeline to help you complete each stage of the paper, such as conducting research, writing the paper, and revising it to avoid last-minute stress before the deadline. After identifying the formatting style to be applied to the paper, such as APA, you should review its use, such as writing citations and referencing the resources used. You should also review how to format the title page and the headings in the paper.

How to Research and Prepare for NURS 6630 Week 5 Assignment: De-Prescribing

The next step in preparing for your paper is to conduct research and identify the best sources to use to support your arguments. Identify the list of keywords from your topic using different combinations. The first step is to visit the university library and search through its database using the important keywords related to your topic. You can also find books, peer-reviewed articles, and credible sources for your topic from PubMed, JSTOR, ScienceDirect, SpringerLink, and Google Scholar. Ensure that you select the references that have been published in the last words and go through each to check for credibility. Ensure that you obtain the references in the required format, for example, in APA, so that you can save time when creating the final reference list. 

You can also group the references according to their themes that align with the outline of the paper. Go through each reference for its content and summarize the key concepts, arguments and findings for each source. You can write down your reflections on how each reference connects to the topic you are researching about. After the above steps, you can develop a strong thesis that is clear, concise and arguable. Next you should create a detailed outline of the paper so that it can help you to create headings and subheadings to be used in the paper. Ensure that you plan what point will go into each paragraph.

How to Write the Introduction for NURS 6630 Week 5 Assignment: De-Prescribing

The introduction of the paper is the most crucial part as it helps to provide the context of your work, and will determine if the reader will be interested to read through to the end. You should start with a hook, which will help capture the reader’s attention. You should contextualize the topic by offering the reader a concise overview of the topic you are writing about so that they may understand its importance. You should state what you aim to achieve with the paper. The last part of the introduction should be your thesis statement, which provides the main argument of the paper.

How to Write the Body for NURS 6630 Week 5 Assignment: De-Prescribing

The body of the paper helps you to present your arguments and evidence to support your claims. You can use headings and subheadings developed in the paper’s outline to guide you on how to organize the body. Start each paragraph with a topic sentence to help the reader know what point you will be discussing in that paragraph. Support your claims using the evidence conducted from the research, ensure that you cite each source properly using in-text citations. You should analyze the evidence presented and explain its significance and how it connects to the thesis statement. You should maintain a logical flow between each paragraph by using transition words and a flow of ideas.

How to Write the In-text Citations for NURS 6630 Week 5 Assignment: De-Prescribing

In-text citations help the reader to give credit to the authors of the references they have used in their works. All ideas that have been borrowed from references, any statistics and direct quotes must be referenced properly. The name and date of publication of the paper should be included when writing an in-text citation. For example, in APA, after stating the information, you can put an in-text citation after the end of the sentence, such as (Smith, 2021). If you are quoting directly from a source, include the page number in the citation, for example (Smith, 2021, p. 15). Remember to also include a corresponding reference list at the end of your paper that provides full details of each source cited in your text. An example paragraph highlighting the use of in-text citations is as below:

The integration of technology in nursing practice has significantly transformed patient care and improved health outcomes. According to Smith (2021), the use of electronic health records (EHRs) has streamlined communication among healthcare providers, allowing for more coordinated and efficient care delivery. Furthermore, Johnson and Brown (2020) highlight that telehealth services have expanded access to care, particularly for patients in rural areas, thereby reducing barriers to treatment.

How to Write the Conclusion for NURS 6630 Week 5 Assignment: De-Prescribing

When writing the conclusion of the paper, start by restarting your thesis, which helps remind the reader what your paper is about. Summarize the key points of the paper, by restating them. Discuss the implications of your findings and your arguments. End with a call to action that leaves a lasting impact on the reader or recommendations.

How to Format the Reference List for NURS 6630 Week 5 Assignment: De-Prescribing

The reference helps provide the reader with the complete details of the sources you cited in the paper. The reference list should start with the title “References” on a new page. It should be aligned center and bolded. The references should be organized in an ascending order alphabetically and each should have a hanging indent. If a source has no author, it should be alphabetized by the title of the work, ignoring any initial articles such as “A,” “An,” or “The.” If you have multiple works by the same author, list them in chronological order, starting with the earliest publication. 

Each reference entry should include specific elements depending on the type of source. For books, include the author’s last name, first initial, publication year in parentheses, the title of the book in italics, the edition (if applicable), and the publisher’s name. For journal articles, include the author’s last name, first initial, publication year in parentheses, the title of the article (not italicized), the title of the journal in italics, the volume number in italics, the issue number in parentheses (if applicable), and the page range of the article. For online sources, include the DOI (Digital Object Identifier) or the URL at the end of the reference. An example reference list is as follows:

References

Johnson, L. M., & Brown, R. T. (2020). The role of telehealth in improving patient outcomes. Journal of Nursing Care Quality, 35(2), 123-130. https://doi.org/10.1097/NCQ.0000000000000456

Smith, J. A. (2021). The impact of technology on nursing practice. Health Press.

NURS 6630 Week 5 Assignment: De-Prescribing Instructions

What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication?

In this Assignment, you will use the following patient examples to write a 5- to 6-page paper on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources in this course. Have a look at NURS 6630 Week 6 Discussion: Patient Case Scenario Debate.

Note: APA style format guidelines will apply.

Patient Examples:

Patient 1: A 36-year-old male presents to your office being prescribed by his primary care physician (PCP) for the past 3 years an opioid analgesic medication for a work accident. He has chronic pain and is attending a pain clinic. It is determined the best course of treatment for pain is to remain on opioid medication. The patient is also being prescribed clonazepam 1mg BID for “relaxation” and panic attacks.

Patient 2: A 42-year-old female on alprazolam 1mg BID for panic attacks. Panic attacks have been in remission and the patient wants to taper off the medication. But, every time she has attempted to do so in the past, she experienced withdrawal effects. She is wondering how to safely taper off the benzodiazepine medication without having withdrawal effects.

Patient 3: A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder. She recently found out she is pregnant (9 weeks gestation). She was referred to you by her OB-GYN to discuss this medication for her current situation. The patient is wondering if she can stay on the lorazepam through her pregnancy and postpartum, as it is an effective medication for anxiety symptoms. She plans to exclusively breastfeed for the first 6 months postpartum. She has not had any other trials of medication to treat anxiety as lorazepam has been effective.

Patient 4: A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia. He is forgetful and seems to be tripping on things or walking into walls, although he has lived in the same home for the past 35 years. The patient does not agree with his daughter but does admit he has had a “few stumbles and falls” lately. Medication reconciliation shows the following medications: metoprolol ER 50mg q day, omeprazole 20mg q day, clonazepam 1mg TID, levothyroxine 75mcg q am. His daughter is wondering if he should be started on a “dementia medication.”

To prepare for this Assignment:
  • Review the assigned Learning Resources for this week.
  • Review the definitions presented in your text and resources for de-prescribing and tapering.
  • Consider the importance of de-prescribing.
  • Based on the example(s) provided, consider how you might de-prescribe a patient.

The Assignment

Answer the following questions using the patient examples described above.

Patient 1

  • What are the concerns of the patient remaining on the opioid medication and clonazepam?
  • How might you educate the patient about these risks and concerns?

The patient agrees that he should not continue both medications in combination. He would like to “get off” the clonazepam but worries about “bad withdrawals” that he’s heard about from stopping clonazepam “cold turkey” and is concerned about re-occurring panic attacks. How might you respond to the following:

  • How would you instruct the patient to taper off clonazepam?
  • What other medication would you recommend for the patient for the treatment of his panic attacks? Keep in mind, he will continue the opioid medication for pain relief.
  • How would you start the new recommended psychotropic medication for the patient?
  • Discuss one legal, ethical, or social consideration with the treatment plan.

Patient 2

  • The patient reports withdrawal symptoms when previously tapering off the alprazolam. What symptoms are common withdrawal symptoms from this medication?
  • Provide the patient education of withdrawal symptoms that range from common and less serious to withdrawal symptoms that are a cause for concern and that should prompt patient should seek medical attention.
  • Given the patient’s history of having withdrawal effects from attempting to taper off alprazolam, what longer-acting benzodiazepine would you choose to convert the patient to?
  • What is the dose you would prescribe and how would you taper off the medication?

Patient 3

  • Review the potential risks, benefits, and side effects of continuing lorazepam throughout the pregnancy and postpartum for both the patient and fetus.
  • Review other alternative medications to treat generalized anxiety disorder. Include risks, benefits, and potential side effects to both the patient and the developing fetus. Keep in mind, the patient is looking to breast feed for 6 months postpartum.
  • The patient agrees that it would be safest for her pregnancy and fetus to discontinue the lorazepam. How would you recommend she discontinue lorazepam? Provide education on potential side effects from tapering off the medication, including common side effects to more serious side effects and when to seek medical attention.
  • The patient would like to forgo medications at this time, given she is early in her pregnancy and is concerned about “damage” to the fetus if she were to continue medications. Provide education to the patient about the risks of untreated anxiety symptoms during pregnancy for both the patient and the fetus.

Patient 4

  • Review potential side effects for elderly on benzodiazepines providing education to both the patient and the patient’s daughter. What are the risks of continuing the benzodiazepine for this patient?
  • How would you evaluate the patient for these side effects?
  • The patient and daughter agree he will need to taper off the clonazepam given the risks of continuing this medication. How would you recommend tapering off this medication?
  • Review with the patient and daughter potential side effects of tapering off the medication. Review with them common side effects to more serious side effects and when to seek medical attention.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Walden Writing Center Sample PaperLinks to an external site. provides an example of those required elements.

By Day 7

Submit your Assignment by Day 7 of Week 5. 

NURS 6630 Week 5 Assignment: De-Prescribing Example

De-Prescribing

De-prescribing, the systematic approach overseen by healthcare professionals to discontinue medications that are inappropriate or unnecessary, emerges as an essential strategy to optimize medication regimens, especially in complex clinical situations. With the rise of polypharmacy and medication-related adverse events, de-prescribing greatly contributes to improving patient safety, enhancing medication adherence, and lowering healthcare costs (Elbeddini et al., 2021).

This paper seeks to provide a comprehensive analysis of de-prescribing practices by reviewing four different case studies involving complex medication management scenarios. Through an in-depth exploration of these case studies, including discussions on potential drawbacks, advantages, and difficulties linked with de-prescribing, this paper aims to clarify fundamental principles and factors that influence the de-prescribing process.

Patient #1

Patient 1 is a 36-year-old male with chronic pain resulting from a work accident. He has been prescribed opioid analgesic medication for the past three years and is attending a pain clinic. Additionally, he is being treated with clonazepam 1mg twice daily for relaxation and panic attacks. The decision has been made to discontinue the combination of opioid medication and clonazepam due to concerns about their risks and potential interactions.

Concerns of Remaining on Opioid Medication and Clonazepam

The continued use of opioid medication raises concerns about the potential for developing tolerance, dependence, addiction, and overdose. Studies suggest that prolonged use of opioids for managing chronic pain may result in decreased effectiveness, heightened risk of adverse reactions, and potential development of opioid use disorder (Kotlińska-Lemieszek & Zylicz, 2022).

Additionally, using opioids and benzodiazepines such as clonazepam concurrently is linked to an increased risk of sedation, respiratory depression, and overdose due to both drug classes causing central nervous system depression (Liu et al., 2021). Upon mutual agreement between the patient and his primary care physician to maintain the opioid prescription, a practical course of action would be to replace the benzodiazepine with a group of medications that do not carry potential risks of drug interactions with opioids.

Patient Education on Risks and Concerns

To educate the patient about the risks and concerns related to using opioids and benzodiazepines, it is crucial to present evidence-based information in a clear and compassionate manner. Utilizing resources such as patient education materials (for example, infographics), trustworthy websites, and educational sessions can help elucidate potential negative effects, risks of dependence, and methods for minimizing harm. Moreover, fostering open communication and addressing any inquiries or misunderstandings the patient may have about their medications and treatment plan will play a significant role in fostering a strong therapeutic relationship between the patient and clinician.

Tapering off Clonazepam

To reduce the risk of experiencing withdrawal symptoms and repeated occurrence of panic attacks, I would advise the patient to taper off Clonazepam gradually. This would involve creating a customized tapering plan based on the individual’s dosage, duration of use, and response to treatment. Guidelines recommend that tapering off the dosage of benzodiazepines gradually by 25% every one to two weeks over several weeks to months is successful in minimizing withdrawal symptoms (Finlayson et al., 2022).

Although it may be clinically advisable to taper off benzodiazepines, it is important for clinicians to recognize the unpredictable course experienced by individuals who undergo this process. Many patients continue to suffer from a variety of severe and prolonged symptoms even years after completely discontinuing benzodiazepines. Consequently, careful consideration is necessary when addressing this issue.

Alternative Medication for Panic Attacks

While tapering down benzodiazepines, it would be prudent to consider prescribing an alternative medication for managing panic attacks while maintaining opioid therapy for pain management. Selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly recommended as the first choice of pharmacological treatment for panic disorder, with options such as sertraline, paroxetine, venlafaxine, and duloxetine showing effectiveness in alleviating panic symptoms and preventing attacks (Garakani et al., 2020).

When introducing a new psychotropic medication, I would begin with the lowest possible dose and titrate upwards to achieve the desired therapeutic outcome while reducing potential side effects. For instance, when prescribing Escitalopram, I would initiate treatment with a daily oral dose of 10 mg, then increase to 20 mg after one week, and progressively evaluate the necessity for therapy. Close monitoring of the patient’s response and any adverse effects is essential, along with continuous support and education on adhering to the medication regimen and management of potential side effects.

Legal, Ethical, or Social Consideration

One legal aspect to consider in the treatment plan is to guarantee adherence to the regulations and recommendations for prescribing controlled substances like opioids and benzodiazepines. It is crucial to follow prescription limits, documentation criteria, and monitoring procedures to avoid misuse, diversion, and legal consequences.

Moreover, ethical considerations involve finding a balance between the patient’s autonomy and their right to pain management while fulfilling the duty of minimizing harm and supporting safe and effective treatment options (Vaismoradi et al., 2021). Access to healthcare resources, socioeconomic disparities, and the negative perception of mental health and addiction are social factors that can impact the execution of the treatment plan. These elements should be taken into account in a patient-centric approach to care.

Patient #2

The second patient, a 42-year-old woman, is seeking guidance on tapering off alprazolam due to remission of her panic attacks. However, she is worried as she has previously experienced withdrawal symptoms from the medication. Common withdrawal effects of alprazolam include agitation, rebound anxiety, tremors, insomnia, and digestive problems (Finlayson et al., 2022). Patient education should address these symptoms, which can range from mild and transient to severe and potentially life-threatening manifestations such as seizures or delirium. Patients should be advised to seek medical assistance if they encounter severe withdrawal symptoms or if their condition worsens over time.

The patient’s previous experience of withdrawal symptoms suggests that switching to a longer-acting benzodiazepine such as diazepam is prudent due to its more favorable pharmacokinetic profile and lower likelihood of withdrawal effects. According to Finlayson et al. (2022), an appropriate starting dose would be 10mg of diazepam taken orally twice daily, with a gradual reduction of 25% every 1-2 weeks. Evidence-based guidelines recommend this approach as it aims to minimize withdrawal symptoms and optimize successful discontinuation of benzodiazepines while ensuring patient safety.

Patient #3

Review of Continuing Lorazepam Throughout Pregnancy and Postpartum

Continuing the use of lorazepam throughout pregnancy and postpartum presents significant dangers for both the mother and the fetus. A study by Noh et al. (2022) established that exposure to benzodiazepines during pregnancy is linked to poor pregnancy outcomes, including preterm deliveries, low birth weight, and neonatal withdrawal syndrome. Furthermore, lorazepam use during lactation can result in adverse effects on the infant, including sedation and poor feeding (Nishimura et al., 2021). Despite the risks associated with untreated anxiety during pregnancy, it is essential to carefully assess the potential harms of using lorazepam against its benefits.

Review of Alternative Medications for Generalized Anxiety Disorder

Alternative treatments for generalized anxiety disorder comprise SSRIs and SNRIs, which have exhibited effectiveness and safety during pregnancy and breastfeeding. SSRIs such as sertraline and fluoxetine are the preferred initial options for managing anxiety disorders in pregnant women due to their favorable safety profile. Despite having a low risk of adverse effects on the fetus and newborn, these medications may potentially lead to side effects such as nausea, sexual dysfunction, and insomnia.

Recommendations for Discontinuing Lorazepam

Discontinuing lorazepam should be done gradually to minimize withdrawal symptoms and risks to the patient and fetus. A tapering schedule should be tailored to the individual patient’s dosage and duration of use, with close monitoring for withdrawal symptoms such as rebound anxiety, agitation, insomnia, and tremors (Finlayson et al., 2022). Patients should receive information about the possible side effects associated with tapering off lorazepam, including both common and short-lived symptoms, as well as more severe outcomes like seizures or delirium. Moreover, it is important to instruct them to seek medical assistance if they encounter severe or worsening symptoms during tapering.

Education on Risks of Untreated Anxiety Symptoms

Educating the patient about the consequences of untreated anxiety symptoms during pregnancy is crucial. When left untreated, anxiety disorders can have adverse impacts on both maternal and fetal health, leading to increased risks of premature birth, low birth weight, and postpartum depression (Ossola et al., 2021). Emphasizing the significance of addressing anxiety symptoms through non-pharmacological approaches like cognitive-behavioral therapy and relaxation methods can help reduce risks while promoting the well-being of both mother and baby. Additionally, it is important for healthcare providers to offer continuous support and monitoring to ensure effective management of anxiety throughout pregnancy.

Patient 4

Recognizing Cognitive Decline in Older Adults

Patient 4, a 71-year-old male, presents with symptoms suggestive of cognitive decline, prompting concern from his daughter about the possibility of dementia. This case warrants a thorough evaluation to assess cognitive function, consider potential medication-related factors, and develop an appropriate management plan. Due to his advanced age, it is essential to handle this case with utmost compassion and take into account the specific requirements of older individuals.

Potential Side Effects of Benzodiazepines in Elderly Patients

Benzodiazepines such as clonazepam, which are prescribed for anxiety management, can present significant dangers for elderly patients. According to Liu et al. (2020), these drugs cause cognitive impairment, sedation, and a higher risk of falls. Moreover, prolonged use of benzodiazepines could worsen existing cognitive decline, ultimately leading to decreased functionality and decreased quality of life (Liu et al., 2020). Educating both the patient and their family about these potential negative effects is crucial to facilitate informed decision-making concerning medication management.

Evaluation of Side Effects of Benzodiazepines

Assessing the patient for side effects associated with benzodiazepines requires a comprehensive evaluation, which includes assessing symptoms, conducting cognitive screening using tools like the Mini-Mental State Examination, and evaluating functional status. It is also crucial to monitor signs of benzodiazepine toxicity, such as confusion, ataxia and falls in elderly patients (Liu et al., 2020). Collaborating with other healthcare professionals, such as neurologists or geriatricians, may be required for a comprehensive assessment.

Tapering off Clonazepam

To minimize withdrawal symptoms and the risks of rebound anxiety, it is recommended to taper off Clonazepam gradually. The tapering plan should be customized according to the patient’s current dosage, duration of use, and treatment response. As Finlayson et al. (2022) note, a common strategy involves reducing the dose by 25% every 1-2 weeks until complete discontinuation while closely monitoring for any signs of withdrawal. This approach aims to ensure a smooth transition while mitigating the potential adverse effects of discontinuing Clonazepam.

Potential Side Effects of Tapering off Medication

It is vital to educate the patient and his daughter about the potential side effects of tapering off clonazepam, ensuring their understanding and preparedness. Typical withdrawal symptoms may involve rebound anxiety, insomnia, agitation, tremors and gastrointestinal problems (Finlayson et al., 2022). In severe cases, more severe symptoms like seizures or confusion can arise. Patients should be counseled to seek medical help if they experience intense or worsening symptoms while tapering off.

Conclusion

De-prescribing is a complex process, especially when dealing with multiple medication regimens or vulnerable groups like older adults and pregnant women. It requires a comprehensive approach that focuses on patient safety and well-being. This involves educating patients and their families about potential risks and benefits, personalizing tapering plans based on individual patient factors, and carefully monitoring for withdrawal symptoms or side effects.

By promoting open communication, offering evidence-based advice, and considering legal, ethical, and social aspects, healthcare providers can address the difficulties of de-prescribing in a compassionate yet effective manner. Focusing on non-drug treatments and providing consistent assistance while reducing medication can reduce risks and improve patient results. Ultimately, de-prescribing is an important part of patient-focused care, supporting the optimization of medications, decreasing harms related to taking multiple drugs, and improving overall well-being.

References

Elbeddini, A., Sawhney, M., Tayefehchamani, Y., Yilmaz, Z., Elshahawi, A., Josh Villegas, J., & Dela Cruz, J. (2021). Deprescribing for all: A narrative review identifying inappropriate polypharmacy for all ages in hospital settings. BMJ Open Quality, 10(3), e001509. https://doi.org/10.1136/bmjoq-2021-001509

Finlayson, A. J. R., Macoubrie, J., Huff, C., Foster, D. E., & Martin, P. R. (2022). Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey. Therapeutic Advances in Psychopharmacology, 12, 204512532210823. https://doi.org/10.1177/20451253221082386

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: Current and emerging treatment options. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.595584

Kotlińska-Lemieszek, A., & Zylicz, Z. (2022). Less well-known consequences of the long-term use of opioid analgesics: A comprehensive literature review. Drug Design, Development and Therapy, 16, 251–264. https://doi.org/10.2147/dddt.s342409

Liu, E. Y., Tamblyn, R., Filion, K. B., & Buckeridge, D. L. (2021). Concurrent prescriptions for opioids and benzodiazepines and risk of opioid overdose: protocol for a retrospective cohort study using linked administrative data. BMJ Open, 11(2), e042299. https://doi.org/10.1136/bmjopen-2020-042299

Liu, L., Jia, L., Jian, P., Zhou, Y., Zhou, J., Wu, F., & Tang, Y. (2020). The effects of benzodiazepine use and abuse on cognition in the elders: A systematic review and meta-analysis of comparative studies. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00755

Nishimura, A., Furugen, A., Umazume, T., Kitamura, S., Soma, M., Noshiro, K., Takekuma, Y., Sugawara, M., Iseki, K., & Kobayashi, M. (2021). Benzodiazepine concentrations in the breast milk and plasma of nursing mothers: Estimation of relative infant dose. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 16(5), 424–431. https://doi.org/10.1089/bfm.2020.0259

Noh, Y., Lee, H., Choi, A., Kwon, J. S., Choe, S.-A., Chae, J., Kim, D.-S., & Shin, J.-Y. (2022). First-trimester exposure to benzodiazepines and risk of congenital malformations in offspring: A population-based cohort study in South Korea. PLoS Medicine, 19(3), e1003945. https://doi.org/10.1371/journal.pmed.1003945

Ossola, P., Ampollini, P., Gerra, M. L., Tonna, M., Viviani, D., & Marchesi, C. (2021). Anxiety, depression, and birth outcomes in a cohort of unmedicated women. The Journal of Maternal-Fetal & Neonatal Medicine: The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 34(10), 1606–1612. https://doi.org/10.1080/14767058.2019.1641483

Vaismoradi, M., Jordan, S., Logan, P. A., Amaniyan, S., & Glarcher, M. (2021). A systematic review of the legal considerations surrounding medicines management. Medicina (Kaunas, Lithuania), 57(1), 65. https://doi.org/10.3390/medicina57010065