devices, such as oral dosing syringes; color coding of age–weight dosing zones, particularly for liquid medications administered to children; and better presentation of use information and safety warnings (Frush et al., 2004).
Other types of dosing errors are associated with the frequency or duration of treatment. One study found that only 38 percent of patients correctly administered medications when instructed to do so every 6 hours; most thought they were to consume the medication every 6 hours when awake and thus to take three rather than four doses (Madlon-Kay and Mosch, 2000). In other cases the prescriber may write “q6h,” the abbreviation for every 6 hours, when intending that the patient take the medication three times per day. Additionally, unnecessary use of antibiotics for the wrong infections or when no infection is present and not taking all doses through the prescribed treatment duration are important factors contributing to antimicrobial resistance (Davey et al., 2002).
Monitoring (also referred to as assessment, evaluation, observation, and surveillance) involves obtaining and evaluating clinical indicators and other relevant information to determine a drug’s effect in an individual patient (Knowlton and Penna, 2003). Monitoring for desired and undesired effects is a crucial step in the care process and in the prevention or detection of adverse drug events. In every setting in which care is delivered—ambulatory care sites, hospitals, schools, workplace health sites, home health care, and nursing homes—assessment and monitoring is a primary responsibility of licensed nurses (IOM, 2004b). Pharmacists also may play a role in assessing beneficial or adverse effects during inpatient care, as may patients (including family members) in ambulatory and self-care.
At its best, monitoring is individualized, taking into consideration that different patients may experience different therapeutic results and outcomes, and it is responsive, correcting the regimen if an adverse effect is found (Knowlton and Penna, 2003). Assessing the effect of medications can be accomplished through direct observation of the patient, use of monitoring devices, and/or information technology (e.g., predefined triggers in a laboratory database) (Forester et al., 2004; Manasse and Thompson, 2005). The type and frequency of patient monitoring activities vary by care setting, clinical condition, and other characteristics of the patient (IOM, 2004b).
In acute care hospitals, bedside monitoring of the patient’s condition prior to, during, and following medical procedures such as initiation of new medications, surgery, or a course of medical therapy typically includes monitoring vital signs (i.e., temperature, heart rate and rhythm, breathing rate and character, blood pressure), airway, risk/presence of infection, fluid