C H A P T E R 4
Clinical decision making in drug therapy
49
The nurse and midwife’s role
The monumental task of ensuring medication safety
with all of the potential problems that could confront
the person can best be managed by consistently using
the seven “rights” of medication administration. These
“rights” are as follows:
The person’s role
With so many people managing their drug regimens
at home, one other very important check in the system
also exists: the person being treated. Only the person
really knows what is being taken and when, and only
the person can report the actual as opposed to the pre-
scribed drug regimen being followed. Education of the
person and their family plays a vital role in the pre-
vention of medication errors. Encourage people to be
their own advocates and to speak up and ask questions.
Doing so helps to prevent medication errors. The follow-
ing teaching points help to reduce the risk of medication
errors in the home setting:
•
Keep a written list of all medications you are taking,
including prescription, OTC and herbal medications.
Keep this list with you at all times in case you are in
an emergency situation and to keep your healthcare
providers up to date. This list can be essential if you
are travelling and need to refill a prescription while
away from home.
•
Know what each of your drugs is being used to treat
.
If you know why you are taking each drug, you will
have a better understanding of what to report, what
to watch for and when to report to your healthcare
provider if the drug is not working.
•
Read the labels and follow the directions
. It is easy to
make up your own schedule or to just take everything
all at once in the morning. Always check the labels
to see if there are specific times you should be taking
your drugs. Make a calendar if you take drugs on
alternating days. Using a weekly pillbox may also help
to keep things straight.
•
Store drugs in a dry place, away from children and
pets
. Humid and hot storage areas (like the bathroom)
tend to cause drugs to break down faster. Storing
drugs away from children and pets can prevent
possible toxic effects if these drugs are inadvertently
ingested by children or your family pet.
•
Speak up
. You are the most important member of the
healthcare team and you have information to share
that no one else knows.
Children present unique challenges related to
medication errors. Children often cannot speak for
themselves and rely on a caregiver or caregivers to
manage their drug regimen. Because their bodies are
still developing and respond differently from those
of adults to many drugs, the risk of serious adverse
reactions is greater with children. The margin of safety
with many drugs is very small when dealing with a
child. When teaching parents about their children’s
drug regimens, be sure to include the following
instructions:
•
Keep a list of all medications you are giving your
child, including prescription, OTC and herbal
medications.
Share this list with any healthcare
provider who cares for your child. Never assume that
a healthcare provider already knows what your child
is taking.
•
Never use adult medications to treat a child
. The
body organs and systems of children, primarily their
livers and kidneys, are very different from those of
an adult. As a result, children respond differently to
drugs.
•
Read all labels before giving your child a drug
. Many
OTC drugs contain the same ingredients, and you
could accidentally overdose your child if you are not
careful. In addition, some OTC drugs are not to be
used with children younger than a certain age. Doses
may also differ for children.
•
Measure liquid medications using appropriate
measuring devices.
Never use a kitchen teaspoon or
tablespoon to measure your child’s drugs. Always
use a measured dosing device or the spoon from a
measuring set.
•
Call your healthcare provider immediately if your
child seems to get worse or seems to be having
trouble with a drug
. Do not hesitate; many drugs
can cause serious or life-threatening problems with
children and you should act immediately.
•
When in doubt, do not hesitate to ask questions
.
You are your child’s best advocate.
Reporting of medication errors
Medication errors must be reported on a national level
as well as on an institutional level. National reporting
programs in Australia are coordinated by the Thera-
peutic Goods Administration (TGA), and they help to
gather information about errors to prevent their recur-
rence at other healthcare sites and by other healthcare
providers. These reports might prompt the issuing of
healthcare provider warnings, which point out poten-
tial or actual medication errors and suggest ways to
avoid these errors in the future. They may also lead to
public warnings about look-alike or sound-alike drug
names and common dosing errors and transcribing
issues (see Box 4.2 for further information about report-
ing). In New Zealand, the New Zealand Medicines and
Medical Devices Safety Authority (MEDSAFE) is a
business unit of the Ministry of Health and the author-
ity responsible for regulation of therapeutic products
in New Zealand. MEDSAFE is responsible for admini
stering the Medicines Act 1981 and Regulations 1984
