Medication Interactions, what are nurses' responsibility?

[aureliey]

I am a recent graduate, about to take boards. But I am still confused about medication protocol and nurses' responsibility.

I know that nurses are liable for any mistakes on meds, even if the doctor ordered it wrong. Nurses have to catch these errors.

But when I was in clinicals and we checked each med, there were many times that some meds showed interactions with each other, but the doc still had ordered it. When I asked my professor she said that sometimes docs prescribe certain combo of meds even if there may be some interactions, as long as they aren't severe and not completely contraindicated.

But when I read the info about meds and nursing, it always says that nurses must be aware of all side effects and interactions and notify the doc if they see anything wrong. But what if the doc did it while knowing the interactions? This happened many times during my clinicals and I never heard any nurse constantly calling the docs to check twice on their orders.

My question is, do nurses have to check each med, with all possible side effects and interactions and call the doc each time, to make sure he did it right? What if they are minor interactions, could they possibly become major?

My prof. said just to know the basics about the drugs but it's impossible to predict all possible side effects for each pt. and some interactions listed don't always happen and sometimes docs prescribe a combo of drugs for a reason.

I just don't know where my responsiblity falls and it just seems like so much to know all facts/interactions on every single drug for every Pt. Some of them in clinicals had 7-8 drugs.

I would look them up since we had time but as a nurse, is there enough time to look up each drug thoroughly? Are we supposed to be as informed as pharmacists? I studied alot of Pharmacology but no way can memorize every single drug and side effects, interactions with others, etc.

It justs gets scary when I hear of stories where nurses got in trouble for giving a drug that had an interaction and they didn't notify the doc.

How do you nurses do this daily?

[Altra, BSN, RN]

there may be some interactions, as long as they aren't severe and not completely contraindicated.

...

But when I read the info about meds and nursing, it always says that nurses must be aware of all side effects and interactions and notify the doc if they see anything wrong. It justs gets scary when I hear of stories where nurses got in trouble for giving a drug that had an interaction and they didn't notify the doc.

...

How do you nurses do this daily?

Hi aureliey, your concerns are understandable. Part of the transition from student to practicing nurse is learning to manage these new responsibilities.

As you'll remember from Pharm, all meds can have some side effects. If you read your drug books, med inserts and/or journals, you'll also find that all meds have caused some serious adverse effect in someone out there. This is a given in patient care. Meds/treatments are prescribed which have been demonstrated to be the best standard course of treatment, with the understanding that there may be side effects that require management and that the plan of care may require adjustment based on the patient's response. XYZ med may indeed be the "gold standard" treatment for Patient A's condition, but if Patient A cannot tolerate XYZ med, then it's time for Plan B.

Some side effects are fairly predictable and manageable. Nausea, diarrhea & constipation are often short-term and can be managed with anti-emetics, anti-diarrheals, stool softeners, etc. Rashes & itching, if mild, are often alleviated w/Benadryl or a topical steroid. Thus, the patient can continue taking the prescribed med with some help to alleviate side effects.

More serious side effects & interactions need to be considered, and generally are by MDs when orders are formulated. If you are in doubt, you can always call your facility's pharmacy and speak to a pharmacist before giving a med.

The key here is assessment & re-assessment. As you point out in your post, the time when nurses will run into "trouble" is when the MD is not notified appropriately. As you begin working you'll develop the sense of when to call, and you'll also learn what standing orders you have available to you - for Benadryl, stool softeners, etc.

Hope this helps -- good luck to you as you begin your nursing career! :)

[classicdame, MSN, EdD]

Another thing, you will eventually memorize certain meds that are used often on your nursing unit. Also, ask the charge nurse or another nurse until you get comfortable. Heck, I still ask after many years of nursing! Two heads are better than one.

[aureliey]

Thank you both for your responses, that was really helpful. :)

[purple1953reading]

I would hope that the pharmacist that fills the meds would also give you a heads up,or call the physcian and ask should there be a crisis type situation between two meds. Drs. don't always"think" as they write orders,as certain orders become routine for certain diagnosis. ICU cardiologist I worked with loved to give Potassium riders, mixed with lidocaine, I hated them. Too many potential problems.BUT he did it anyway. Also there will always be combos that books say DO NOT MIX WITH, and we will be giving them EXACTLY for those side effects. IT s difficult, but time makes it better, as famliarity with drugs increase.The new ones are the ones I always have to detail. When in doubt, look it up, or call the pharmacy.