Chapter 4 Clinical decision making in drug therapy

Nursing and midwifery: art and science Assuming increasing responsibilities Holistic Nurses and midwives are key healthcare providers Integrate knowledge of the Basic sciences Social sciences Education Other disciplines

Clinical decision making Assessment Data gathering: history, physical assessment Identifying issues or problems Drawing a conclusion from the assessment data that was gathered Intervention Formulation of a plan of care that includes actions to improve or maintain the person’s health Evaluation Determining if the plan of care was effective at either maintaining or improving the person’s health

Assessment History Chronic conditions Drug use Allergies Level of education and understanding Social supports Financial supports Pattern of healthcare

Physical examination Weight Age Physical parameters related to disease or drug effects

Implementation Synthesising information into plan for care Setting goals Desired outcomes Effective response to drug therapy Minimisation of adverse effects Understanding of the drug regimen

Interventions Three types of care interventions Drug administration Provision of comfort measures Individual/family education

Proper drug administration (the seven rights) Storage Route Dosage Preparation Timing Recording

Comfort measures Help the person cope with the effects of drug therapy Nurses and midwives are in a unique position for this Person more likely to be compliant

Promoting drug therapy Placebo effect Managing adverse effect Lifestyle adjustment

Individual and family education Cornerstone of drug therapy Nurses and midwives are the primary educators about medications

Elements of teaching Name, dose and action of drug Timing of administration Special storage and preparation instructions Specific OTC drugs or alternative therapies to avoid Special comfort or safety measures Specific points about drug toxicity Specific warnings about drug discontinuation

Evaluation Part of the continuing process of care Leads to changes in assessment, problem/issue identification and intervention

Prevention of medication errors “To err is human” Drug regimen process Series of checks Nurse’s or midwife’s role Person’s role Reporting of medication errors

Question What information needs to be included in a doctor’s order for a person so the care provider can use the “seven rights” when administering medication? a. Person’s weight b. Person’s drug history c. Person’s name d. Person’s address

Answer Person’s name Rationale: The doctor’s order for a drug needs to include information that allows the care provider to administer the medication according to the seven “rights” to ensure safe and effective drug administration. These are correct drug and person, correct storage of drug, correct and most effective route, correct dosage, correct preparation, correct timing, and correct recording of administration.