When to ask about medication questions?
0Oct 27, '10 by JBMmommy, RNI'm in all of my second week of clinicals, and I'm well aware that I'm not expert on, well, anything. Doing our weekly paperwork we're obviously responsible for looking up all the meds that our patient is taking. I know that there must be many reasons that I'm not seeing in my drug guide for why meds are being taken, but it seems that people are really overmedicated and some of the combinations don't make sense to me. I have one med that says in the nurses notes in Davis "advise patient not to take within two hours of antacid", well it's prescribed for administration at the same time as an antacid. I'm sure I'll bring that up with my clinical instructor. There are also three different depression medications- including an antipsychotic and an ADHD med for a patient with no diagnosis beyond depression- and two of them cause insomnia. Then there are two sleep medications because the patient complains of insomnia.
With full understanding that I don't know everything, and I'm unlikely to uncover any life-changing medication interactions. Do you question every med order that doesn't make sense to a beginning student? With 8 students, our clinical instructor will never get through anything if she has to spend an hour on meds with each of us. And I don't really want to be the dork that comes across as trying to look like a know-it-all if I question things. Will this all just become more clear?
0Oct 27, '10 by berean4everDear JBMmommy,
Being a nursing student myself, I think that it is expected that you will have many, many questions. Remember this is your chance to learn. How else will you understand unless you ask questions? Never feel too shy to ask why. If you ask in a humble way, most people will not be offended by the question. Also ask yourself are all these medications being given by the primary physician at the hospital your patient is being seen at? Are some of them coming from consulting or other physicians in the community or out of town? Sometimes different physicians are giving medications that can interact but because of a loss in communication, may not even be aware of the problem. Here is a great resource on the web, and this year they have a free newsletter due to a grant they received. Hope it helps you.
Institute for Safe Medication Practices. 2010. 27 October 2010 <http://www.ismp.org/>.
Neka-Elsevier Student Ambassador
0Oct 27, '10 by NSALVADORECongratulations, your thinking is right on target!!! It's great that you are picking up these things and questioning them.. Your instructor should have no problem answering these questions! If she is busy and your RN that you are working with happens to have time you could ask them too (when asking the RN though I wouldn't run down a whole list I'd ask about the most important question ?why is s/he taking this med) You are a student and there to learn. Don't ever forget that asking questions, being curious, and researching things when you're not sure are the best ways to learn!!!!
Things to keep in mind.. Meds are taken for multiple reasons i.e. anti, depressants/antiseizures/beta blockers for migraine prophalaxis, *some* antipsychotics are used in depression, some depression meds are used for sleep,or etc..
Another thing is some hospitals the secretary puts the med orders in, then a nurse checks it off. Now if it's a drug that causes insomnia or sedation for example the secretary may not realize this and the nurse should and change the order to in the am or at night depending on the effect. Sometimes the nurse may just check it over comparing the order not really thinking about the effect.. Kwim? So I've picked these errors up before and you may notice something like this and it'd beneficial to speak up!
Anyways I'm blabbing but don't be afraid to ask questions and keep up the good work!
0Oct 27, '10 by birthrevolutionQuote from JBMmommyHonestly, that's the kind of thinking they are looking for and I would absolutely bring it up! Also, as a nursing student I have caught important medication errors. One time I had a patient have a controlled release opioid pain medication and the order said to crush it and give through the NG tube--not a good idea! Sometimes you can also call pharmacy and ask questions--especially about drug/drug interactions.With full understanding that I don't know everything, and I'm unlikely to uncover any life-changing medication interactions. Do you question every med order that doesn't make sense to a beginning student? With 8 students, our clinical instructor will never get through anything if she has to spend an hour on meds with each of us. And I don't really want to be the dork that comes across as trying to look like a know-it-all if I question things. Will this all just become more clear?
0Oct 28, '10 by caffronIt was always interesting to me when I found medication errors. I'm just about to finish in a couple of days. I can honestly say that some questions you have will be answered within time. One day, you will have the magical lightbulb and thinks just start clicking.
When I was just starting in my first couple of clinicals, we had 8 students in our group. I had a couple of methods that kinda worked for me when I couldn't get to my instructor about a possible medication error or interaction--- Humbling befriend a nurse early on so when you ask a simple question, ask the nurse who is also assigned to my patient, call pharmacy, or simply just wait till your instructor is free.
Good Luck and never be afraid to question an order even as a student!!!
0Oct 28, '10 by JBMmommy, RNThanks everyone. As it turned out, yesterday afternoon my patient was complaining that her pain med (Neurontin) wasn't working well and why did the hospital always mess up her medications? I had just read that Neurontin shouldn't be given within 2 hours of an antacid, but Neurontin and Pepcid were both administered at 2200 the night before. So, I did mention it to my instructor and she said it was a good catch. (woohoo for first real day of clinicals success!) We gave the Pepcid at 2000 and Neurontin at 2200 and even if it doesn't work, the patient was thrilled that I had been able to listen to her complaint of pain and make an effort to help. It was a great clinical day.