the dog!). Would you like to take them? Only use sealed bottles and unopened blister packs, I hear you say, but what if these had been stored on top of a heater for the last six months and their active ingredients have now become unstable?
MEDICATION PROCESS
The medication process is made up of four parts.
Prescribing: it is often the nurse who notices that a doctor has prescribed something to which the patient is allergic, perhaps because the nurse knows the patient better.
Dispensing and preparation: a nurse should not use trade names for drugs as confusion may occur, for example Voltarol instead of diclofenac sodium. Perhaps the pharmacist has reconstituted the medication with the wrong transport medium, for example sodium chloride instead of water for injection.
Administration: you need to be very clear which route a medication should be given through and that the dose has been calculated correctly.
Monitoring: you need to check the administration and effect of a medicine on the patient. For example, a patient prescribed diclofenac sodium must be checked to see whether they are asthmatic. Patients with hypertension or heart failure must be monitored carefully if they are given diuretics. Blood pressure, fluid input and output, and sodium and potassium, etc. must be checked.
Any one of these categories could be the weak link where a mistake can occur.
The Department of Health reports that the wrong dose, strength, or frequency of a drug accounts for over a quarter of all medication incident reports.
COMPLEMENTARY MEDICATION
What about complementary medication? As well as a nurse/nurse educator, I am also a complementary therapist and I am surprised at the number of individuals taking ‘natural’ remedies and not being aware of their interactions with more mainstream medications: Anticoagulants may react with ginseng, ginkgo Biloba (for improved memory and brain circulation) and should be discontinued 36 hours prior to surgery. Other complementary remedies that need to be considered in the conventional healthcare environment are:
Homoeopathic remedies – individuals may be advised to avoid coffee, peppermint, or menthol as these substances may counteract the effect of the homoeopathic remedy.
St. Johns Wort – which is often used to treat depression, may be harmful for individuals with bipolar disease as it may induce mania.
Liquorice root – should be avoided for those with chronic heart failure and those with hypertension.
Other food/drug interactions can be seen in Chapter 2. Very often complementary therapies are referred to as ‘alternative therapy’ as they may not be considered part of mainstream healthcare and this is known as CAMS (Complimentary and Alternative Medicine). If in any doubt speak to a pharmacist who can give advice. Never give a drug if you are unsure. Seek advice. Table 1.1 lists many of the complementary therapies which patients may discuss with you. See how many you have heard of:
A broad term used to describe medicines used in conjunction with conventional medicine.
Alternative medicine
A broad term used to describe medicines used instead of conventional medicine.
Table 1.1 CAMS.
| Osteopathy | Chiropractic | Acupuncture |
| Herbal medicine | Homoeopathy | Aromatherapy |
| Alexander technique | Massage | Counselling and mindfulness |
| Iridology | Stress therapy | Hypnotherapy |
| Reflexology | Shiatsu | Meditation |
| Relaxation therapy | Thermal auricular therapy | Traditional Chinese and Ayurvedic medicine |
| Crystal therapy | Colour therapy | Kinesiology |
Drug Administration Routes
When administering medications, we also need to be completely conversant with the mode of administration, or route. A very sad case involved a young boy called Wayne Jowett who died as a result of being given his medication intrathecal ‘ITH’ instead of intravenously (which is written as ‘IV’).
If you saw the route written as ‘ITH’ on a prescription chart, what do you think this would mean? Let's look at this and other abbreviations that you may encounter.
Here is a list of abbreviations for routes of drug administration. Can you work out what they mean?
| 1 ITH | 4 IV | 7 INH |
| 2 SC | 5 IM | 8 NEB |
| 3 ID | 6 O | 9 TOP |
Keeping Updated
As well as being conversant with the route abbreviations, if we are administering drugs we need to keep ourselves updated about changes to drug names, as well as contraindications.
Paracetamol (derived from coal tar; also known as acetaminophen) can now be given by the intravenous route, but is obviously much more expensive than oral paracetamol and has a shorter half‐life. This means that it is less effective over a longer time span and, as pain is
