EVOLUTION OF NURSING RESPONSIBILITIES REGARDING DRUGS
In  the  past,  a  nurse's  responsibility  regarding  medications focused  on  the  Five Rights of Drug Administration  (the Rights)--namely,  give  the  right drug to the right patient in the right dose by the right route at the right time.Consequently, in addition to the limited information  needed  to  administer  drugs  in  accordance  with the  Rights,  you  must  acquire  a  broad  base  of  pharmacologic knowledge so as to contribute fully to achieving the therapeutic objective.However, although these basics are vital, much more is required to achieve the therapeutic objective.Put another way, although both the nurse and the pitcher  have  a  clear  obligation  to  deliver  their  objects  in  the most  appropriate  fashion,  proper  delivery  is  only  the  begin-
ning of their responsibilities: Important events will take place after the object is delivered, and these must be responded to. Like the pitcher, the nurse can respond rapidly and effectively only  by  anticipating  what  the  possible  reactions  to  the  drug might be.
To  anticipate  possible  reactions,  both  the  nurse  and  the pitcher require certain kinds of knowledge.For example, the prescriber may overlook potential drug interactions, or  may  be  unaware  of  alterations  in  the  patient's  status  that would  prohibit  use  of  a  particular  drug,  or  may  select  the correct  drug  but  may  order  an  inappropriate  dosage  or  route of administration.It is ethically and legally unaccept-
able  for  you  to  administer  a  drug  that  is  harmful  to  the patient--even though the medication has been prescribed by a licensed prescriber and dispensed by a licensed pharmacist.Nurses, together with healthcare providers and pharmacists, participate  in  a  system  of  checks  and  balances  designed  to promote  beneicial  effects  and  minimize  harm.More recently, various other rights--right assessment, right documentation, right evaluation, the patient's rights to education,  and  the patient's right of refusal--have been recommended for inclusion.To  observe  and  evaluate  drug  responses,  and  to intervene rapidly and appropriately, you must know in advance the  responses  that  a  medication  is  likely  to  elicit.Correct administration, without additional interventions, cannot ensure  that  treatment  will  result  in  maximum  beneit  and minimum harm.The  limitations  of  the  Rights  can  be  illustrated  with  this analogy: The nurse who sees his or her responsibility as being complete  after  correct  drug  administration  would  be  like  a major league baseball pitcher who felt that his responsibility was  over  once  he  had  thrown  the  ball  toward  the  batter.The applica-
tion of pharmacology in patient care and patient education is considered in the following two sections.