Applied Bioscience for Health Instability 2

Module: Quality Use of Medicines

Key Terms

• Australian Pharmaceutical Health and Rational Use of Medicines (PHARM)

• compliance
• drug interactions
• National Medicines Policy (NMP)
• National Prescribing Service (NPS)
• Nurse role with respect to drugs
• Midwife role with respect to drugs
• Modifying drug usage over time
• pharmacodynamics factors
• pharmacoeconomics
• pharmacokinetic factors
• polypharmacy
• prescription
• quality use of medicines
• six rights of drug administration
• therapeutic drug monitoring

Summary

• With the enormous range of drugs available and the increasing costs of new drugs, it
is essential that quality use of medicines be encouraged; government policies on
prescribing, schemes limiting availability of drugs, educational bodies disseminating
objective information, and studies of drug usage in hospitals all contribute to cost-
effective clinical pharmacology.
• Using medicines safely is a core principle of QUM.
• Effective use of drugs in the clinical situation requires thorough knowledge of all
aspects of the drugs and understanding of the patient's condition as it relates to how
the drug is affected by the body and how the body responds to the drug.
• Before a drug is prescribed or administered, the health professional needs to: identify
the patient's problem and its likely course; attempt to find a solution to the problem,
considering possibly useful drug groups; choose a suitable drug about which
pharmacokinetic and pharmacodynamic details are known; relate the drug to this
patient in terms of relevant conditions that may affect therapeutic or adverse effects;
determine how drug response will be monitored; and decide what warnings need to
be given to patient and carers.
• Selecting management options wisely is a core principle of QUM.
• Prescriptions are legally regulated documents, with specific requirements for format;
abbreviations in prescriptions should be used only cautiously to avoid confusion.
• Drugs may be formulated in many dose forms to maximise effective administration
and clinical effect; formulations for oral and parenteral administration are common in
general practice and hospital use, respectively.
• Choosing suitable medicines is a core principle of QUM.
• Many factors may affect how a person responds to drugs, including
pharmacodynamic and pharmacokinetic aspects; in the clinical situation, compliance,
drug interactions and polypharmacy are particularly important.

Faculty of Health Sciences | School of Nursing

CRICOS Provider Code 00301J
 Applied Bioscience for Health Instability 2

• Responsible prescribing and use of drugs require that therapy be monitored, and
altered if ineffective or potentially toxic; drug therapy may be monitored by measuring
the therapeutic effects, adverse reactions and/or plasma concentration of drug.
• The six rights that must be checked prior to drug administration are the right patient,
drug, dose, time (frequency), route and documentation.

Incorrect dose of medication, missed dosage of medication or drug error.

• Always assess the patient for vital sign stability, general stability e.g. neurological
status and manage any instability immediately.
• Report the error to the Doctor and the nurse coordinator promptly.
• Follow the Dr’s written instructions.
• Monitor the patients’ vital signs or other measurements as ordered by the Dr.
• Assess the medications serum half-life to determine how long it could take to
metabolise and excrete the drug. This may provide the Dr and nurse with a guideline
for the duration and frequency of any required additional observations.
• Document the error according to the hospital policies e.g. medication error form.

Glossary
• Australian Pharmaceutical Health and Rational Use of Medicines (PHARM)
Committee: comprised of multidisciplinary health care professionals.
• Compliance: whether the patient follows all aspects of a treatment plan. Does the
patient take the medication correctly?
• Drug interactions: the responses to the drug may be affected by interactions with
any other drug taken, including non-prescribed over the counter drugs (OTC) and
complimentary alternative medicine (CAM) therapies, as well as other ingested
compounds such as food and drinks.
• National Medicines Policy: timely cost-effective access to medicines, medicines
meeting high standards of quality, safety and efficacy and quality use of medicines.
• National Prescribing Service (NPS): set up in 1998 by doctors and pharmacists to
improve health outcomes for the public.
• Nurse role with respect to drugs: taking drug history, assess the patient,
administration of drug using six rights, monitoring effects and side effects, education
of patient and other responsibilities.
• Midwife role with respect to drugs: taking drug history, assess the patient,
administration of drug using six rights, monitoring effects and side effects, education
of patient and other responsibilities. May include administration of inhaled nitrous
oxide, oral medications, intramuscular injections, intravenous injections and epidural
drugs.
• Modifying drug usage over time: monitor patient response to drug therapy. The
doctor may alter the prescription and drug dose or frequency as required.
• pharmacodynamics factors: what the drug does in the body, its mechanism of
action, therapeutic effects and side effects.
• pharmacoeconomics: economic rationalism regarding decisions for drug
prescription, containing costs, if possible without compromising good health care.
• pharmacokinetic factors: factors that affect how the body handles drugs e.g. how
the drug is absorbed, distributed around the body in the bloodstream, eliminated by
metabolism and excretion and how much serum drug is generally available in the
body.
• polypharmacy: the concurrent use of multiple medications, usually five or more
drugs, including prescribed, OTC and CAM.

Faculty of Health Sciences | School of Nursing

CRICOS Provider Code 00301J
 Applied Bioscience for Health Instability 2

• prescription: a written direction for the preparation and administration of a drug for a
specified person, containing the names and quantities of the active drug; there are
legal requirements for a valid prescription.
• quality use of medicines: selecting management options wisely, choosing
medicines if a drug is considered advisable and using medicines safely and
effectively.
• six rights of drug administration: the right patient, drug, dose, route, frequency
and documentation.
• therapeutic drug monitoring: observing and/or measuring therapeutic effects,
adverse drug reactions (side effects) or monitoring the levels of the drug in the body.

References

Bryant, B. & Knights, K. (2011) Pharmacology for Health Professionals (3rd ed).
Elsevier Mosby.

Faculty of Health Sciences | School of Nursing

CRICOS Provider Code 00301J