McKenna's Pharmacology, 2e

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.

Test your current knowledge of clinical decision making in drug therapy with a PrepU Practice Quiz!

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

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