C H A P T E R 4
Clinical decision making in drug therapy
47
be foremost in medication administration by nurses and
midwives.
In 2000, the Australian government established
the National Medicines Policy. This policy sought to
ensure that all parties involved in medications, includ-
ing health professionals, consumers and manufacturers,
worked together to ensure better health outcomes for
the Australian public, through responsible, timely, safe
and appropriate medication production and manage-
ment. The Quality Use of Medicines policy seeks to
promote:
•
judicious use
by ensuring use only when indicated and
once other options have been considered
•
appropriate use
, considering the health issue,
potential effects, dosage and duration of treatment
•
safe use
to avoid underuse, overuse or misuse
•
efficacious use
in ensuring a drug achieves its
intended goals
Within the Quality Use of Medicines framework,
nurses and midwives play a key role through monitoring
and managing medication use, providing education and
advocating for people and their families.
The drug regimen process, which includes prescrib-
ing, dispensing and administering a drug to a person, has
a series of checks along the way to help to catch errors
before they occur. These include the doctor or nurse or
midwife practitioner who prescribes a drug, the phar-
macist who dispenses the drug and the nurse or midwife
who administers the drug. Each serves as a check within
the system to catch errors—the wrong drug, the wrong
person, the wrong dose, the wrong route or the wrong
time. Often the nurse or midwife is the final check in
the process, being the one who administers the drug
and the one responsible for education before the person
is discharged.
In addition, the Australian Commission on Safety
and Quality in Health Care (ACSQHC) has developed
10 Standards to improve the quality of health service
provision across Australia. These Standards provide a
national statement of the level of care consumers should
be able to expect from health services. Awareness and
knowledge of Standard 4 on Medication Safety is an
important part of the nurse’s and midwife’s clinical
repertoire. For more information, see
quality.gov.au/our-work/accreditation/nsqhss.
Include the following key elements in any drug education
program.
1. Name, dose, and action of drug: Ensure that people
know this information. Many people see more than
one healthcare provider; this knowledge is crucial to
ensuring safe and effective drug therapy and avoiding
drug–drug interactions. Urge people to keep a written
list of the drugs that they are taking to show to any
healthcare provider taking care of them, and in case of
an emergency when they are not able to report their
drug history.
2. Timing of administration:Teach people when to take
the drug with respect to frequency, other drugs and
meals.
3. Special storage and preparation instructions: Inform
people about any special handling or storing required.
Some drugs may require refrigeration; others may need
to be mixed with a specific liquid such as water or fruit
juice. Be sure that people know how to carry out these
requirements.
4. Specific OTC drugs or alternative therapies to avoid:
Prevent possible interactions between prescribed drugs
and other drugs or remedies the person may be using
or taking. Many people do not consider OTC drugs or
herbal or alternative therapies to be actual drugs and
may inadvertently take them along with their prescribed
medications, causing unwanted or even dangerous
drug–drug interactions. Prevent these situations by
explaining which drugs or therapies should be avoided.
Encourage people to always report all of the drugs or
therapies that they are using to healthcare providers to
reduce the risk of possible inadvertent adverse effects.
5. Special comfort measures:Teach people how to cope
with anticipated adverse effects to ease anxiety and
avoid non-compliance with drug therapy. If a person
knows that a diuretic is going to lead to increased
urination, the day can be scheduled so that bathrooms
are nearby when they might be needed. Also educate
people about the importance of follow-up tests or
evaluation.
6. Safety measures: Instruct all people to keep drugs out
of the reach of children. Remind all people to inform
any healthcare provider they see about the drugs they
are taking; this can prevent drug–drug interactions and
misdiagnoses based on drug effects. Also alert people
to possible safety issues that could arise as a result
of drug therapy. For example, teach people to avoid
driving or performing hazardous tasks if they are taking
drugs that can make them dizzy or alter their thinking or
response time.
7. Specific points about drug toxicity: Give people a list of
warning signs of drug toxicity. Advise people to notify
their healthcare provider if any of these effects occur.
8. Specific warnings about drug discontinuation:
Remember that some drugs with a small margin
of safety and drugs with particular systemic effects
cannot be stopped abruptly without dangerous effects.
Alert people who are taking these types of drugs
to this problem and encourage them to call their
healthcare provider immediately if they cannot take
their medication for any reason (e.g. illness, financial
constraints).
NOTE: Refer to thePoint for teaching guides that can
be used for people in the actual clinical setting.
Individual and family teaching
BOX 4.1
