4
Clinical decision making
in drug therapy
Learning objectives
Upon completion of this chapter, you should be able to:
1.
List the responsibilities of the nurse and midwife in relation to drug therapy.
2.
Explain what is involved in clinical decision making as it relates to drug therapy.
3.
Describe key points that must be incorporated into the assessment of a person receiving drug therapy.
4.
Describe the essential elements of a medication order.
5.
Outline the important points that must be assessed and considered before administering a drug, combining
knowledge about the drug with knowledge of the person and the environment.
6.
Describe the role of the nurse or midwife and the individual in preventing medication errors.
7.
Identify what is meant by pharmacovigilance.
Glossary of key terms
assessment:
information gathering regarding the current status of a particular person, including evaluation of past history and
physical examination; provides a baseline of information and clues to effectiveness of therapy
clinical decision making:
problem solving process that underpins formulation and evaluation of care
evaluation:
determining the effects of the interventions that were instituted for the person and leading to further assessment
and intervention
implementation:
actions undertaken to meet a person’s needs, such as administration of drugs, comfort measures or teaching
midwifery:
art and science of working with women and their families throughout the childbearing process, combining scientific
application of chemistry, anatomy, physiology, biology, nutrition, psychology and pharmacology to the individual woman’s situation
nursing:
the art of nurturing and administering to the sick, combined with the scientific application of chemistry, anatomy, physiology,
biology, nutrition, psychology and pharmacology to the particular clinical situation
pharmacovigilance:
monitoring and prevention of adverse effects of medication to promote safe use
Test your current knowledge of clinical decision making in drug therapy with a PrepU Practice Quiz!
T
he delivery of healthcare today is in a constant state of
change, at times reaching crisis levels. The population
is ageing, resulting in an increased incidence and preva-
lence of chronic disease and more complex care issues.
The population is also more transient, with individuals
and families more mobile, often resulting in unstable
support systems and fewer at-home care providers and
helpers. At the same time, healthcare is undergoing
a technological boom, including greater use of more
sophisticated diagnostic methods and treatments, new
specialised drugs, including experimental drugs, and
so on. Moreover, people are being discharged earlier
from acute care facilities or are not being admitted at
all for procedures that once were treated in hospital
with follow-up support and monitoring. People are
also becoming more responsible for their care and for
adhering to complicated medical regimens at home. The
wide use of the Internet and an emphasis in the media
on the need to question all aspects of healthcare has led
to more knowledgeable and challenging care provision.
People may no longer accept a drug regimen or therapy
without question and often feel confident in adjusting
it on their own because of information that they have
found on the Internet. Such information might not be
accurate or even relevant to their particular situation.
Nurses and midwives are often central to clarifying
