Nursing process: Patient safety during drug therapy
Drug therapy is a complex process that can easily lead to adverse patient events. In 2007,
the Institute of Medicine (IOM) released its report on the drug safety system,
The Future
of Drug Safety: Promoting and Protecting the Health of the Public. The IOM reported that
approximately 400,000 preventable adverse drug events occurred each year in the United
States. The IOM also estimated that preventable hospital medication errors occurred at a
rate of one/patient/day and contributed to 7,000 patient deaths/year. Although much progress
has been made, problems with using medications safely remain. Medication errors are
one of the top 10 most frequently reviewed sentinel events by The Joint Commission.
Applying the nursing process (assessment, nursing diagnosis, planning, intervention, and
evaluation) during drug therapy enables the nurse to systematically identify the drug therapy
needs of each patient, thereby reducing the number of adverse events and providing
safe patient care.
| Nursing process step |
Key points |
| Assessment |
- Collect data—subjective and objective
- Current/previous health status
- Cultural considerations
- Lab values
- Allergies
- Physical assessment
- Medication history
- Prescriptions/OTC drugs
- Herbal supplements
- Response to medications
- Knowledge of medications
- Medication adherence
|
| Nursing diagnosis/problem |
- Identify all associated nursing diagnoses.
|
| Planning |
- Review patient allergies.
- Review and reconcile prescribed medications.
- Identify possible adverse effects of medications.
- Identify potential interactions with other medications.
- Determine route of administration.
- Determine time of administration.
- Develop patient education regarding medication administration.
|
| Intervention |
- Administer medication utilizing the “eight rights”
- Right patient
- Right drug
- Right dose
- Right time
- Right route
- Right reason
- Right response
- Right documentation.
- Use technology such as bar coding to ensure safe and correct administration.
- Educate patient about each medication at time of administration.
|
| Evaluation |
- Monitor patient’s response to medication.
- Monitor for possible adverse effects of medication.
- Monitor for unexpected effects of medication.
- Document medication administration.
|
Comerford, K.C. & Durkin, M.T. (2024). Nursing2024 drug handbook. (44th edition.) Philadelphia: Wolters Kluwer.