1. Chapter 4 Clinical decision making in drug therapy

2. 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

3. 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

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

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

6. 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

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

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

9. 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

10. Promoting drug therapy
Placebo effect
Managing adverse effect
Lifestyle adjustment

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

12. 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

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

14. 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

15. 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

16. 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.