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P A R T 1
Introduction to nursing pharmacology
Comfort measures
Nurses and midwives are in a unique position to help
people cope with the effects of drug therapy. A person
is more likely to be compliant with a drug regimen if
the effects of the regimen are not too uncomfortable or
overwhelming.
Placebo effect
The anticipation that a drug will be helpful (placebo
effect) has proved to have tremendous impact on the
actual success of drug therapy. Therefore, the healthcare
provider’s attitude and support can be a critical part
of drug therapy. For example, a back rub, a kind word
and a positive approach may be as beneficial as the drug
itself.
Managing adverse effects
Interventions can be directed at promoting safety and
decreasing the impact of the anticipated adverse effects
of a drug. Such interventions include environmental
control (e.g. temperature, light), safety measures (e.g.
avoiding driving, avoiding the sun, using side rails) and
physical comfort measures (e.g. skin care, laxatives,
frequent meals).
Lifestyle adjustment
Some medications and their effects require that a person
make changes in their lifestyle. For example, people
taking diuretics may have to rearrange their day so as
to be near toilet facilities when the drug action peaks.
People taking bisphosphonates will need to plan their
morning so they can take the drug on an empty stomach,
stay upright for at least half an hour and plan their first
food of the day at least half an hour after taking the
drug. Many drugs come with similar guidelines for
assuring effectiveness and decreasing adverse effects.
People taking monoamine oxidase (MAO) inhibitors
must adjust their diet to prevent serious adverse effects
due to potential drug–food interactions. In some cases
the change in lifestyle that is needed can have a tremen-
dous impact on the person and can affect their ability to
cope and comply with any medical regimen.
Education of the person and family
With people becoming increasingly responsible for
their own care, it is essential that they have all of the
information necessary to ensure safe and effective drug
therapy at home. Many healthcare agencies require that
people be given written information. Box 4.1 includes
key elements for any drug education program. Also see
the later section on prevention of medication errors for
teaching tips related to the person’s role in preventing
medication errors.
Evaluation
Evaluation
is part of the continuing process of care that
leads to changes in assessment, diagnosis and interven-
tion. The person is continually evaluated for therapeutic
response, the occurrence of adverse drug effects and the
occurrence of drug–drug, drug–food, drug–alternative
therapy or drug–laboratory test interactions. Some drug
therapy requires evaluation of specific therapeutic drug
levels. In addition, the efficacy of care interventions and
the education program are also evaluated. In some situ-
ations, the nurse or midwife evaluates the person simply
by reapplying the beginning steps of the assessment
process and then analysing for changes, either positive
or negative. The process of evaluation may lead to
changes in the care interventions being used to provide
better and safer care.
KEY POINTS
■■
Nurses and midwives use decision making
frameworks to organise the information that is
needed to provide safe and effective care.
■■
The steps of the decision making process (assessment,
implementation and evaluation) are constantly being
repeated to meet the ever-changing needs of the
person.
■■
The systematic approach provides an effective
method for handling all of the scientific and technical
information, as well as the unique emotional, social
and physical factors that each person brings to a
given situation.
PREVENTION OF MEDICATION ERRORS
With the increase in the older adult population, the
increase in the number of available drugs and OTC and
alternative therapy preparations, and the reduced length
of hospital stays for people, the risk for medication errors
is ever-increasing. In a report conducted for the Austral-
ian Commission on Safety and Quality in Healthcare
(Roughead, 2008), it was estimated that 2–3% of Aus-
tralian hospital incidents are related to medications,
either through the reason for admission or arising during
a hospital stay. In addition, of the incidents reported by
nurses and midwives, medication events rate the second
most common. Hence, they place additional burden on
health services. Ensuring prevention of these errors must
KEY POINTS
Safe medication administration
Special points regarding drug administration and related
comfort measures are noted with each drug class discussed
in this book. Refer to the individual drug monographs in
a drug guide or handbook for more detailed interventions
regarding a specific drug.
