McKenna's Pharmacology, 2e

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

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