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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. 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. 5
Clearly, the original ive Rights and their subsequent additions are important. However, although these basics are vital, much more is required to achieve the therapeutic objective. The Rights guarantee only that a drug will be administered as prescribed. 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. As the pitcher must be ready to respond to the consequences of the interaction between ball and bat, you must be ready to respond to the consequences of the interaction between drug and patient. 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. Just as the pitcher must understand the abilities of the opposing batter, you must understand the patient and the disorder for which the patient is being treated. As the pitcher must know the most appropriate pitch (e.g., fastball, slider) to deliver in speciic circumstances, you must know what medications are appropriate for the patient and must check to ensure that the ordered medication is an appropriate medication. Conversely, as the pitcher must know what pitches not to throw at a particular batter, you must know what drugs are contraindicated for the patient. As the pitcher must know the most likely outcome after the ball and bat interact, you must know the probable consequences of the interaction between drug and patient.
Although this analogy is not perfect (the nurse and patient are on the same team, whereas the pitcher and batter are not), it does help us appreciate that the nurse’s responsibility extends well beyond the Rights. 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.
Nurses, together with healthcare providers and pharmacists, participate in a system of checks and balances designed to promote beneicial effects and minimize harm. Nurses are especially important in this system because it is the nurse who follows the patient’s status most closely. As a result, you are likely to be the irst member of the healthcare team to observe and evaluate drug responses, and to intervene if required. 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. The better your knowledge of pharmacology, the better you will be able to anticipate drug responses and not simply react to them after the fact.
Within our system of checks and balances, the nurse has an important role as patient advocate. It is your responsibility to detect mistakes made by pharmacists and prescribers. 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. Because the nurse actually administers drugs, the nurse is the last person to check medications before they are given. Consequently, you are the patient’s last line of defense against medication errors. 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. In serving as patient advocate, it is impossible to know too much about drugs.
The two major areas in which you can apply pharmacologic knowledge are patient care and patient education. The applica-
tion of pharmacology in patient care and patient education is considered in the following two sections. the liver, we need to assess baseline liver function to evaluate this potential toxicity. Obviously, to collect appropriate baseline data, we must irst know the effects that a drug is likely to produce.