ABGS shall ensure that patients are monitored after administration of medication depending on the medicines’ pharmacotherapeutic action. Drugs requiring closed monitoring include drugs with low therapeutic index, sedatives, concentrated electrolytes, high-risk medication. Patients shall also be monitored for acute drug reactions. Monitoring shall be done in a collaborative way by doctors and nurses. Medications are stopped/changed whenever appropriate and the dose or infusion rate altered when indicated.
Monitoring is done in Casualty, wards, ICU’s, Post-ICU’s, Operation Theatre and the responsibility is with doctor, Nurses.
- Monitoring of Patients on Medication
The purpose of monitoring is to see that the drug is having its intended effect. In addition it helps in identifying near misses, medication errors and adverse drug events.
While administering medication the nurse should be alert and watch patient for any unusual symptoms and any change in vital parameters.
Symptoms associated with adverse drug events are:
- After administration of the medicine, patient shall be monitored for any symptoms and signs for allergy, breathing difficulty, giddiness, light headedness, drowsiness, sinking sensation, nausea, vomiting, diarrhea, shivering, cold sweats, hot flushes, any other abnormal feeling.
- Suspect an Adverse Drug Reactions (ADR) if any of the above symptoms occur.
- Temperature, pulse, B.P. is also monitored and the abnormal symptoms are recorded.
- Adverse drug events are reported immediately to the residents by the nurses. Management of a suspected ADR if serious should be attended to immediately by the department doctor and nurses. The first step in management is to withhold or withdraw the suspected drug
- Further treatment should be decided on an individual basis
Drugs requiring close monitoring include all high risk medications, ionotropes, anaesthetic drugs, sedatives and concentrated electrolytes.
- Monitoring of patient shall depend on the drug administered.
- Nurses and doctors administering drugs must be aware of the adverse effects of drugs they are administering. When in doubt, they must refer to drug literature or consult the senior doctor or pharmacist.
- Many of these patients have these drugs administered in ICU where they can be under close monitoring.
- Parameters to be monitored are as follows:-
- Concentrated electrolytes – Calcium infusions, KCl infusions and increased concentrations of saline infusion.
- Blood gas monitoring will be done in critical patients on ionotropes and bi-carb.
- Sodium levels are monitored when concentrated sodium chloride is administered.
- Insulin Infusions: Glucose level will be monitored
- Ionotrope Infusions: Dopamine/dobutamine, adrenaline, BP and HR will be monitored.
- Sedatives and anticonvulsants Heart Rate, Respiratory Rate, Pattern of respiration and oxygen saturation should be monitored.
- Anaesthetic drugs – close monitoring is done in the operation theatre.
- For Digoxin –In certain high risk medication eg. Digoxin, there is monitoring of known adverse effects eg. Bradycardia.
- Anticoagulants – INR is monitored
- Nephrotoxic Drugs – Renal parameters should be monitored.
If any adverse effect is noted the nurse and doctor must make a decision regarding whether the drug should be stopped or the infusion rate, dose be altered.
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