McKenna's Pharmacology, 2e

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C H A P T E R 4  Clinical decision making in drug therapy

Individual and family teaching

BOX 4.1

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. 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.

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 www.safetyand quality.gov.au/our-work/accreditation/nsqhss. 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.