McKenna's Pharmacology, 2e

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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 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 overwhelming. Placebo effect

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. ■■ 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 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.