Archive for the ‘Medication Error’ Category

200,000 Americans Killed Each Year in Hospitals by Medical Error, comment

July 7, 2010

The advent of medication distribution machines may give health care providers a false sense of security when administering medications to patients.  As health care providers, we need to recognize that human error is still a potential part of this new medication administration process.  The orders are entered by a human, then checked by a human.  As nurses we need to review the 5 rights each and every time we administer a medication to a patient.  If we become relaxed because the information is coming from a computer, or the medication pops out of a machine, then we are opening ourselves up to “high-risk” nursing practice.   Each and every medication you administer to a patient needs to be considered independently.  Medication errors should be reviewed monthly by nursing staff in a “morbidity and mortality conference” type of review meeting in order to educate ourselves and learn from others mistakes rather than shame ourselves with a discreet incident report.  This may further bring to light the fact that we are human and we make errors, but accountability is key for us to reduce the numbers and make it a safer environment for providers as well as patients. Using machines and computers as tools, not as a replacement of our own cognitive skills, is the balance we need to embrace to reduce medication errors.

Original Post

March 31, 2010

Title: 200,000 Americans killed each year in hospitals by medical errors, comment

I definitely think this is a drastic number and being on the front lines, I can see how this happens. Especially in today’s ever changing healthcare field. First, you have EMR which has completely changed our world. There have been so many changes recently that it is very hard to keep up with it all. Not only they way we chart things, but how we administer medications. Caremobile, the pt scanning device, is supposed to help catch errors. But with the Electronic charting, the charts and orders are not getting checked like they were because it is too difficult to do and navigate around. Not to mention that there are alot of issues with connectivity, timeliness of entering meds by pharmacy, etc. That by the time the med could be given, alot of unnecessary time has passed, so you may just do a work around to get the task accomplished which defeats the purpose of using Caremobile to begin with! Throw long hours, after hours “catch-up”, high acuity, understaffing, and a whole slew of other issues that are dealt with daily, it is easy to see how these unfortunate things could take place. I definitely think that issues that are causing unnecessary deaths should take precedence over anything else. And fix what is the current problem before you add something else into the mix.

Original Post
March 29, 2010
Title: 200,000 Americans killed each year in hospitals by medical errors, comment
There is no simple answer to why medication errors occur. People die every year from preventable medical errors; wrong limbs are amputated, wrong organs removed, people receive the wrong medications, orders are incorrectly transcribed, medication reconciliation is often flawed, the list could go on forever. Errors are a result of human nature. While every effort is made to minimize and prevent errors, they still occur. Nursing education, annual and ongoing review of the Joint Commission National Patient Safety Goals, time outs prior to surgical procedures, are all great ways to work to prevent errors from occurring. Responses to errors should not be punitive; they are situations from which we learn. Errors result because processes fail.

Original Post
March 4, 2010
Title: “200,000 Americans Killed Each Year in Hospitals by Medical Error”
Listed in the above are common causes of medication errors: lack of sleep in caregivers, poor communication, illegible handwriting, poor staffing. These problems are encountered in all areas of patient care. There are never enough nurses, nurses have too many patients, work too many hours, and in reality are often rushed . Home medications are often not reported accurately and many physicians (who are also often rushed) write poorly. Several of the 2010 National Patient Safety Goals focus on medication administration as a result of reported medication errors. How do we change this? Change begins with education. Nurses must continue to learn about new medications and review old ones, never hesitating to consult resources if unsure about any aspect of a medication. As the last line of defense between the patient and a medication error, nurses must be dedicated to practicing the 5 Rights and the nursing process as it relates to medication administration, providing thorough assessments and evaluations even when rushed. Patients must be educated as well, and taught to ask and know about their medications, to report untoward effects and to learn about lifestyle changes which could reduce or eliminate the need for some medications. As nurses, we must continue to promote better nurse to patient ratio in all areas of care. We must exhibit professional and safe medication administration in our own practice and in mentoring new nurses just beginning their profession. The amount of reported medication errors is a sobering fact which should incite a call to all nurses and facilities to performance improvement in this area.

Forensic Healthcare Medication Error Attorney Lawyer

Monitoring patients on pain medication, comment

May 26, 2010

Pain management and overdose is an interesting topic. I notice that some providers provide a patient with unlimited amounts of medication and others put their foot down and say they will limit the amount. Often in the Emergency Department, there are some people who have a nickname of “seekers”. This refers to them as patients who come to the ED and all they want is pain medication. They refuse and get angry if labwork or radiology reports are ordered, they state ” just give me a pain shot so I can go home”, are comfortable and then become Al Pacino when you walk in the room and are rolling around on the floor in pain (Literally) and then watch TV calmly when you leave the room. No one takes the time find out what is at the root of the problem, refer them to pain management or have empathy. Can we help these patients? So, you give a patient a narcotic and then they have respiratory arrest. What are we doing? We are not treating the problem. We need more education as nurses and need to learn about how to teach those patients with pain how to treat it properly. There is no absolute answer to resolve this very complicated issue. More research needs to be done on this topic.

Original Post

May 3, 2010

Title: Medication safety

It is completely devastating to make any type of medication error, even if there is no negative outcome to the patient. Although there are guidelines in place to check and recheck before giving medications, we are human and can easily overlook some steps. I agree that newborns are at risk and that there should be additional steps in place to even triple check medications given to them. Of course textbooks can tell us to check the patients name, dose, route, and allergies, but can they be missed. Yes! They can easily be missed. Often, many of the stories I have read about involve new graduate nurses still in training and student nurses. Although they are not the only ones, many nurses and varying degrees of experience can make errors. I myself made an error when I was still in training as a new nurse that completely turned my life around. There was no negative outcome, but I sure did learn the biggest lesson I could imagine. Why was the error made? I was in a hurry, didn’t follow all the steps to verify the correct medication and patient. I read the patients name on the medication and quickly hung the IV piggy back. Something popped in my head just moments later to check everything the pharmacist had typed on the bag. Quickly I turned off IV pump just in time. The medication was 4 times the needed dose for an infant! The pharmacist had made an error in the weight of the patient and gave me medication that was way more than what was needed. Thankfully this ended well. Never again am I in too much of a hurry to look at every detail of a medication.

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Medication errors have not been reduced with electronic med administration, comment

May 26, 2010

Recently we have acquired a vending machine to give us our medications… Well it is an electronic way of typing in what you need and a little drawer opens. This does not help much in reducing errors. I was beginning to think that someone in our hospital owns stock in the company that provides the machines. The doctor can order the wrong med/dose, the nurse can type in the wrong med/dose, the pharmacy can place the wrong med/dose in the drawers, nurses can misread the order on the computer if it sounds like another med. If there were some magical way to reduce errors and administer medications without killing patients and saving thousands of lives, it would be great. Actually, we as nurses are paid pretty well in order to provide the best care and to use our brains to avoid errors. Yes, we are only human, but we are humans that live in the United States where there are courts and families who want to sue. It is ultimately up to everyone in the process to evaluate orders and reduce errors.

Original Post

March 31, 2010

Title: 200,000 Americans killed each year in hospitals by medical errors, comment

I definitely think this is a drastic number and being on the front lines, I can see how this happens. Especially in today’s ever changing healthcare field. First, you have EMR which has completely changed our world. There have been so many changes recently that it is very hard to keep up with it all. Not only they way we chart things, but how we administer medications. Caremobile, the pt scanning device, is supposed to help catch errors. But with the Electronic charting, the charts and orders are not getting checked like they were because it is too difficult to do and navigate around. Not to mention that there are alot of issues with connectivity, timeliness of entering meds by pharmacy, etc. That by the time the med could be given, alot of unnecessary time has passed, so you may just do a work around to get the task accomplished which defeats the purpose of using Caremobile to begin with! Throw long hours, after hours “catch-up”, high acuity, understaffing, and a whole slew of other issues that are dealt with daily, it is easy to see how these unfortunate things could take place. I definitely think that issues that are causing unnecessary deaths should take precedence over anything else. And fix what is the current problem before you add something else into the mix.

Original Post
March 29, 2010
Title: 200,000 Americans killed each year in hospitals by medical errors, comment
There is no simple answer to why medication errors occur. People die every year from preventable medical errors; wrong limbs are amputated, wrong organs removed, people receive the wrong medications, orders are incorrectly transcribed, medication reconciliation is often flawed, the list could go on forever. Errors are a result of human nature. While every effort is made to minimize and prevent errors, they still occur. Nursing education, annual and ongoing review of the Joint Commission National Patient Safety Goals, time outs prior to surgical procedures, are all great ways to work to prevent errors from occurring. Responses to errors should not be punitive; they are situations from which we learn. Errors result because processes fail.

Original Post
March 4, 2010
Title: “200,000 Americans Killed Each Year in Hospitals by Medical Error”
Listed in the above are common causes of medication errors: lack of sleep in caregivers, poor communication, illegible handwriting, poor staffing. These problems are encountered in all areas of patient care. There are never enough nurses, nurses have too many patients, work too many hours, and in reality are often rushed . Home medications are often not reported accurately and many physicians (who are also often rushed) write poorly. Several of the 2010 National Patient Safety Goals focus on medication administration as a result of reported medication errors. How do we change this? Change begins with education. Nurses must continue to learn about new medications and review old ones, never hesitating to consult resources if unsure about any aspect of a medication. As the last line of defense between the patient and a medication error, nurses must be dedicated to practicing the 5 Rights and the nursing process as it relates to medication administration, providing thorough assessments and evaluations even when rushed. Patients must be educated as well, and taught to ask and know about their medications, to report untoward effects and to learn about lifestyle changes which could reduce or eliminate the need for some medications. As nurses, we must continue to promote better nurse to patient ratio in all areas of care. We must exhibit professional and safe medication administration in our own practice and in mentoring new nurses just beginning their profession. The amount of reported medication errors is a sobering fact which should incite a call to all nurses and facilities to performance improvement in this area.

Forensic Healthcare Medication Error Attorney Lawyer

Tags: 

Medication safety

May 3, 2010

It is completely devastating to make any type of medication error, even if there is no negative outcome to the patient. Although there are guidelines in place to check and recheck before giving medications, we are human and can easily overlook some steps. I agree that newborns are at risk and that there should be additional steps in place to even triple check medications given to them. Of course textbooks can tell us to check the patients name, dose, route, and allergies, but can they be missed. Yes! They can easily be missed. Often, many of the stories I have read about involve new graduate nurses still in training and student nurses. Although they are not the only ones, many nurses and varying degrees of experience can make errors. I myself made an error when I was still in training as a new nurse that completely turned my life around. There was no negative outcome, but I sure did learn the biggest lesson I could imagine. Why was the error made? I was in a hurry, didn’t follow all the steps to verify the correct medication and patient. I read the patients name on the medication and quickly hung the IV piggy back. Something popped in my head just moments later to check everything the pharmacist had typed on the bag. Quickly I turned off IV pump just in time. The medication was 4 times the needed dose for an infant! The pharmacist had made an error in the weight of the patient and gave me medication that was way more than what was needed. Thankfully this ended well. Never again am I in too much of a hurry to look at every detail of a medication.

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Medication errors haven’t been reduced with electronic med administration in my facility

April 26, 2010

With the start-up of EMAR (electronic medication administration record) in my facility in November 2009, we were certain of improving med administration and reducing errors. I also assumed Pharmacy would be able to deliver the new meds ordered to the floor sooner. Not so….it actually has been taking Pharmacy longer to profile the med orders. And the number of profiling errors has not reduced. It still falls on the shoulders of the harried floor nurse as the last set of eyes, to catch errors. Now I’m hoping Physician electronic orders will be the solution. Let’s just hope we get to the end point we so desire, for the patient’s sake!

Original Post
March 31, 2010
Title: 200,000 Americans killed each year in hospitals by medical errors, comment
I definitely think this is a drastic number and being on the front lines, I can see how this happens. Especially in today’s ever changing healthcare field. First, you have EMR which has completely changed our world. There have been so many changes recently that it is very hard to keep up with it all. Not only they way we chart things, but how we administer medications. Caremobile, the pt scanning device, is supposed to help catch errors. But with the Electronic charting, the charts and orders are not getting checked like they were because it is too difficult to do and navigate around. Not to mention that there are alot of issues with connectivity, timeliness of entering meds by pharmacy, etc. That by the time the med could be given, alot of unnecessary time has passed, so you may just do a work around to get the task accomplished which defeats the purpose of using Caremobile to begin with! Throw long hours, after hours "catch-up", high acuity, understaffing, and a whole slew of other issues that are dealt with daily, it is easy to see how these unfortunate things could take place. I definitely think that issues that are causing unnecessary deaths should take precedence over anything else. And fix what is the current problem before you add something else into the mix.

Original Post
March 29, 2010
Title: 200,000 Americans killed each year in hospitals by medical errors, comment
There is no simple answer to why medication errors occur. People die every year from preventable medical errors; wrong limbs are amputated, wrong organs removed, people receive the wrong medications, orders are incorrectly transcribed, medication reconciliation is often flawed, the list could go on forever. Errors are a result of human nature. While every effort is made to minimize and prevent errors, they still occur. Nursing education, annual and ongoing review of the Joint Commission National Patient Safety Goals, time outs prior to surgical procedures, are all great ways to work to prevent errors from occurring. Responses to errors should not be punitive; they are situations from which we learn. Errors result because processes fail.

Original Post
March 4, 2010
Title: “200,000 Americans Killed Each Year in Hospitals by Medical Error”
Listed in the above are common causes of medication errors: lack of sleep in caregivers, poor communication, illegible handwriting, poor staffing. These problems are encountered in all areas of patient care. There are never enough nurses, nurses have too many patients, work too many hours, and in reality are often rushed . Home medications are often not reported accurately and many physicians (who are also often rushed) write poorly. Several of the 2010 National Patient Safety Goals focus on medication administration as a result of reported medication errors. How do we change this? Change begins with education. Nurses must continue to learn about new medications and review old ones, never hesitating to consult resources if unsure about any aspect of a medication. As the last line of defense between the patient and a medication error, nurses must be dedicated to practicing the 5 Rights and the nursing process as it relates to medication administration, providing thorough assessments and evaluations even when rushed. Patients must be educated as well, and taught to ask and know about their medications, to report untoward effects and to learn about lifestyle changes which could reduce or eliminate the need for some medications. As nurses, we must continue to promote better nurse to patient ratio in all areas of care. We must exhibit professional and safe medication administration in our own practice and in mentoring new nurses just beginning their profession. The amount of reported medication errors is a sobering fact which should incite a call to all nurses and facilities to performance improvement in this area.

Forensic Healthcare Medication Error Attorney Lawyer

Tags: , , , , ,

Monitoring Patients on Pain Medication, comment

April 19, 2010

With more and more people under pain management care overdose of medications is becoming more frequent. As nurses we have to be aware of the medications given very freely by pain management doctors and how to treat overdoses quickly. We see this everyday in the ER. It is unfortunate for the patients because the first thing we do is reverse the drug. This creates anxiety and pain for these patients. So education for the patients and the families is very important.

Original Post
March 21, 2006
Title: Monitoring Patients on Pain Medication

When monitoring patients on pain medications, such as morphine, dilaudid, and demerol; it is important to make sure that certain side effects do not occur. It is very important to monitor the respiratory status because decreased respiratory status is one of the main side effects that can happen from giving pain medications.

Narcan is another medication that it is important to be aware of. In one case, a patient was having apneic spells for about 30 seconds at a time and I had to administer narcan two times within a half an hour. I had my doubts about narcan through my readings, but seeing it personally really made me a believer. A simple medication can reverse respiratory depression and help the patient have a normal respiratory status.

It is also important to educate patients about pain management at home. When patients are taking pain medications at home, there is not a nurse or a physician there that can help if something goes wrong.

The main area that needs to be covered before discharge is side effects that need to be reported and the right dosage amounts that can be taken at certain times. Make sure that the patient is very knowledgeable about the medications they are taking and that they know when to call a physician or nurse when something is not right.

Pain medications are a wonderful thing, but can have their side effects that are not so good. However, by keeping a good eye on your patients and making sure that their vital signs are stable you will help the patient have a quicker and less painful hospital stay. Also, make sure that patients know what medications they are taking and what side effects may happen as a result of the medications before leaving the hospital.

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Falling Accidents and Seniors from a Forensic Nursing Perspective, comment

April 19, 2010

As a nurse in the ER we see most of our falls from seniors being over medicated. They are being treated with medications that slow them and alter their thought process such as for depression, insomnia, and a many other disorders. When we do our fall risk assessment it is amazing at how many medications they are on and put them at high risk. Many are on Xanax just because they have trouble sleeping instead of trying to figure out the problem. I feel this is way too much for most.

Original Post
February 13, 2006
Title: Falling Accidents and Seniors from a Forensic Nursing Perspective

I took great interest in an article in our local newspaper last weekend. It alluded to the fact that falls were causing an inordinate number of deaths in Minnesota and Wisconsin among senior citizens. At first glance, we might conclude that our winter weather with ice and snow was a
causative factor, but this has not proven to be the case.

There seem to be other factors in play here. Of 1564 Minnesota elderly who died from falls, only 21 died of snow and ice related falls. Some of the theories being discussed are around the cold weather causing blood to become more viscous, thus contributing to the formation of clots
which then dislodge and deposit in vital organs.

Others speculate that the low light conditions of winter contribute to accidental falls, especially for seniors whose vision is declining or who may be wearing multiple focus lenses in their glasses. There is also speculation about the reactions to some medications, decreasing alertness in some and maybe causing dizziness and unsteadiness.

Those studying this issue stress that seniors should get help in their environment so that throw rugs and multiple barriers to safe walking are not contributing to falls. They also stress that slowing down and not hurrying are very important. And exercise so keep balance and joint
range of motion optimal is very important.

As to why this is all happening in Minnesota and Wisconsin, I offer the theory that we are an
independent breed of people, trying to do for ourselves without asking for help and maybe taking risks that aren’t necessary.

I can recall coming upon my 92 year old mother balancing on the arm of the couch to reach a tall cupboard. She was independent and hardy and also in very good health, but with the risks I saw her take, she was also a lucky lady not to have an incident that could have caused a decline in her health sooner.

All the normal factors of aging play into the broken bone theory, such as osteoporosis and unsteadiness. But thus far they are only theories and maybe further studies will yield answers in the future.

Any other ideas about what may be causing so many falls among seniors?

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Medical Malpractice Related to Nosocomial MRSA Infections, comment

April 15, 2010

Although this entry was posted in January, 2007, nosocomial infection is still a political and safety topic in today’s health care. Reduction of health care associated infection is one of the 2010 National Patient Safety Goals, and MRSA is still a great concern in all areas of health care. It is present in all avenues of society and especially in close living conditions such as prisons, nursing homes and group homes. Most health care workers have been exposed to active MRSA infections and many are colonized as well as patients. According to the CDC "Campaign to Prevent Antimicrobial Resistance" (2002), health care practitioners are to use antibacterials wisely; yet many patients are still being treated for specimen contamination, and colonization as well as in the absence of a positive culture and for extended periods of time. Vancomycin is the drug of choice for active MRSA, and though it used to be a "last resort" drug, it is now frequently given. This is a potentially toxic drug with some serious side effects. Given IV it can cause a systemic reaction of hypotension and shock-like state with flushing (red man syndrome) and it is irritating to the vein, frequently causing thrombophlebitis. Ototoxicity can occur and is more probable with high doses and increased duration of therapy. Vancomycin can be nephrotoxic and should be used with caution in renal impaired. As stated in the above CDC publication, practitioners must "know when to say no to vanco." When it is ordered, nurses must be aware of meticulous infection control, using appropriate personal protection and educating patients and families on MRSA and infection transmission. IV sites must be monitored and changed frequently, and vancomycin infused at an appropriate rate. The patient must be monitored for side effects and toxicity and vancomycin peaks and troughs should be monitored. As nurses, we are called upon not only to help our patient heal, but to do our part in preventing infection transmission, not only in the hospital, but in all aspects of care.

Original Post
January 16, 2007
Title: Medical Malpractice Related to Nosocomial MRSA Infections

The media and government have educated the public in the “super bugs” some patients become infected with in the hospital environment. The most widely known “super bug” is methicillin resistant staphylococcus aureus (MRSA). In June 2006 there was a case brought to court regarding the death of patient who had been in the hospital for a knee joint replacement. Since the patient had not been screened for MRSA prior to hospitalization it could not be proved if he picked up the MRSA during the hospital stay. With the documented community acquired MRSA he could have had the bacteria dormant in his body when he was admitted for the planned surgery. The doctor and hospital were not found negligent in this case.

Many hospitals are fearful of similar lawsuits based on nosocomial infections. Some hospitals are now culturing high-risk patients prior to hospital admission to determine if they are colonized. There is now a nasal swab test that has a turn around time of two hours to identify MRSA. Certainly this can be helpful so that colonized patients coming in for elective procedures can have this treated and also be isolated from non-colonized patients. Patients that test positive for MRSA can be cohorted with like patients or put in private rooms. There are multiple hospitals in Europe starting to follow this intervention with positive outcomes in their nosocomial rates.

It would seem to me the hospital administrators would prefer paying for the MRSA culture versus facing the potential of law suits from patients who develop nosocomial MRSA infections while inpatient. If I had a family member going to the hospital I would much prefer they be tested for MRSA prior to a surgery as “knowledge is power” Having the knowledge of colonized MRSA prior to surgical intervention can allow for adjustments that lead to positive outcomes for the hospital, surgeon and patient. I can visualize hospitals even being forced to do it to allow them better leverage in the court system by being able to say, “this person was colonized with MRSA” prior to hospital admission. From the epidemiology stand point it would also allow the opportunity to keep the more virulent strain of community MRSA from entering the hospital environment.

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Effective measures toward pain management, comment

April 6, 2010

Yes pain control is a very large part of our care in the ER. It is very frustrating for a busy ER nurse when you have a chronic pain patient on the call bell before the med is due and you are trying to run a code or even prevent one. Unfortunately there is no education for the chronic pain patients but we are suppose to stop what we are doing to wait on them. I think it needs to be understood by all the definition of triage!

Original Post
September 8, 2009
Title: Effective measures toward pain management
This post reminds us that the measurement of pain is primarily subjective. As providers, we must always remember that people respond to and express pain very differently. We must be culturally sensitive when assessing and treating pain. Pain is the 5th vital sign. Pain affects the physical and psychological well-being of our patients. It is our responsibility to ensure that our patients’ pain is being well managed. We must know our own biases and misconceptions and leave them at the door.

Original Post
September 2, 2009
Title: Effective measures toward Pain Management
Pain is an alteration in ones comfort level, which can significantly impact the physical, emotional, and psychological well-being. Pain is a subjective experience that can only be explained by the patient. Cultural and ethnicity are a few factors that influences patients response to pain, to improve outcomes nurses must be able to understand pain from a cultural perceptive. People respond to and view pain differently. Among various groups for various reasons emotions may or may not accompany pain it is viewed by some as an act of punishment or as a spiritual test. Having knowledge of patient’s views and how they define pain is very valuable in that it can assist the nurse in achieving positive outcomes by incorporating this information in the plan of care. Nurses who ignore or refuse to develop cultural sensitivity not only do they violate patients’ rights but also a chance of having a trustful relationship and without this you can expect poor outcomes. Pain is often poorly assessed and poorly managed due to reasons like misconceptions and nurses lack knowledge. This usually leads to under medications and poor outcomes, such as the post-op abdominal surgery patient that develop pneumonia because is unable to perform cough and deep breath exercises every 2hrs secondary to pain because of the nurses’ misconceptions about administering pain medication to a patient with history substance abuse. To achieve goals of effective pain management nurses must first be aware of their values and personal beliefs concerning pain and the behaviors associated with it, this will assist in developing an awareness and sensitivity to the patient’s need. Nurses must be knowledgeable and skilled in collection of both subjective and objective data (by accepting the patients’ assessment of pain by using pain assessment tools and observation of emotional behaviors such as crying or moaning), which will assist in identifying the intensity of patients’ pain and promote better outcomes. Misconceptions must be explored and addressed because these also impact outcomes, such as administering pain med on regular basis will lead to addiction or those who abuse drugs usually over exaggerate their pain, by acknowledging these misconceptions nurses will be able address patients’ pain related issues more professionally and improve steps toward effective pain management.

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Adverse Drug Reactions and Medication Errors

April 5, 2010

Review of Pharmacology for Nursing Care, 7th Edition.

Pharmacokinetics, is the study of drug movement throughout the body. You’re able to determine just how fast a drug may have been absorbed and or metabolized. Distribution of a drug throughout the body is determined by the rate of metabolization. Pharmacodynamics the study of what drugs do to the body and how they do it.

These are both very important areas in pharmacology. And they need to be understood. To help give our patients the best possible care that we can and the safest care. This information can also be very important information if a forensic case involving the use or the abuse of certain medications. Effects of certain drugs can be determined by examining the victim and information found at the sceen.
The way drugs interact with each other and with certain individuals is very important to be educationed about. So we can teach our patients and the public the importance of knowing what they are taking and how it will affect them. And to make sure clinically we are up to date. I did not realize the importance of not taking a calcium channel blocker with grapefruit juice, that it would increase the levels of the medication by 40%.

Adverse drug reactions and medication errors. Something you read in the news paper all the time. Adverse drug reactions have also been in the news a lot lately regarding certain stars. And how the did or did not realizing how certain medications will react with each other and what may occur when mixing it with alcohol. Most common reaction we have seen recently has been death. We cannot leave out the information regarding the world icon Michael Jackson and the administration of propol at his home with no proper monitoring of the patient. A tragic event that could have been prevented if the proper procedure for administering the medication was followed.

Within Pharmacology for Nursing Care, 7th Edition, Chapters 4-8 I personally found difficult, I really had to concentrate and visualize in my mind just how a drug moves about in our bodies and is processes. I found the information to be important and very interesting. But I was glad that we did not have to memorize it. I feel I have a good working knowledge and am ready to apply it to my clinical practice.

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