The Roles of Nurses and Physicians in Medication Prescribing Guidelines

Many of the malpractice suites against doctors and nurses have to do with medication errors. Prescribing is the first point in the drug administration process at which drug error can arise. Hospitals invest millions of dollars in training nurses and doctors to help prevent sentinel events from occurring.

In looking at how medication errors arise, it is first necessary to look at the steps that are followed to prescribe a medication. If these steps are not followed, then an error in prescribing can occur which can translate to a combination of medication errors and possible drug interactions. It is always good to follow an algorithm that works.

First doctors should determine the appropriate drug therapy for their patients based on the current state of knowledge through literature review, continuing education programs, consultation with pharmacists and other physicians and other means.

Secondly, prescribers should evaluate the patient's total status and review all existing drug therapy before prescribing new or additional drugs to ascertain possible antagonistic or complementary drug interactions.

Appropriate monitoring of clinical signs and relevant laboratory data is necessary. Prescribers should be familiar with the drug ordering system, including Formulary processes, allowable delegation of authority, procedures to alert Nursing and others to new drug orders that need to be processed, standard drug administration times and approved abbreviations.

Physicians should always print drug orders if their handwriting is eligible. Patient specific information should always be accessible.

The patient information available to safely order, prepare, dispense, administer, and monitor drugs, as appropriate includes: age, sex, current drugs, inactive drugs, patient diagnoses, co morbidities and concurrently occurring conditions: relevant laboratory values; allergies and past sensitivities; patient weight and height, when applicable; pregnancy and lactation status, when applicable.

Most of the time hospitals require that those prescribing medications write clearly using a ballpoint pen. This is because felt tips do not penetrate carbon copies. Look alike drugs should be legibly printed such as Inderal vs. Isordil, Humulin vs. Humalog etc. Avoiding the use of abbreviations also helps to reduce the risk of medication errors.

An order should be documented on the doctors order sheet in the correct area. Always verify that the name of the patient is on the doctor's order sheet and it is the correct patient. Always double check the room number and their name and medical record number.

Frequently patients are transferred during a shift or moved to another room. Sometimes the doctors are not always aware of the transfer and can pull the chart not realizing that there is a different patient within the same room.

The following items should be included in a complete drug order: name of the medication, dosage in correct units, correct route and frequency. Physicians should follow up within a twenty four hour period to ascertain if there are any significant side effects and monitor the client's vital signs.

Ordering blood work is also necessary for some medications that can deplete electrolytes such as Lasix or cause an increase such as potassium sparing diuretics. Blood work is also necessary for certain medications that can build up in the body causing destruction to the liver or kidneys such as Phenobarbital, Digoxin, and Lithium. Obtaining initial blood work prior to administering any medications is necessary so that the client's baseline can be determined.

If these guidelines are followed, the physician can feel confident that the medication regime will benefit the client and prevent untoward events from occurring that could harm the client.

Nurses should work closely with physicians to report any changes in the client's vital signs or level of consciousness. Excessive lethargy, diarrhea, an increase or decrease in the client's blood pressure are signs that should not be ignored and be reported to the physician immediately.

It is recommended that a physician order to have their client's vital signs taken every shift when beginning a new medication. Working as a team benefits the health of the client and carefully listening to clients when they say that they are not feeling, "just right", or "something feels wrong" are signs that the medication may be causing adverse side effects.

The client's health will benefit by all medical personnel following the specified protocol. In addition to this, sentinel events will be eliminated or greatly reduced and the client's experience will be a positive one.

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