As a nurse, one of your most important roles is giving patients the medications they need. This happens constantly throughout your day, sometimes as frequently as every few minutes. Because of this, nurses must have a solid understanding of medications and how they work, especially when it comes to preventing harmful drug interactions. These interactions, if not properly managed, can be dangerous, so it’s essential to be informed and vigilant at all times.

In the hospital setting, a nurse’s responsibilities go beyond simply giving out medications. Nurses check medication dosages, ensure the right route of administration, and confirm the time it needs to be given.

"As a nurse, you’ll also be responsible for assessing whether the medication is appropriate for the patient," explains Dr. Jessica Stokes-Parish, a Registered Nurse and academic. “As a nurse you will check the medication dosing and administration route, amongst other things such as the time to be administered. A nurse can also ‘nurse-initiate medications, such as paracetamol, in some facilities as they are deemed low-risk. What this means is a nurse can determine if the medication is appropriate and prescribe the medication for administration.”

However, this responsibility doesn't stop with administering medication. Nurses must also ensure that the medication is right for the patient, and sometimes that means making decisions about prescribing certain medications themselves.

To be able to safely administer medications, nurses need proper training. Registered Nurses (RNs) and Endorsed Enrolled Nurses are trained and authorised to give medications, while Enrolled Nurses must complete specific training to do so. Refresher courses are also a regular part of nursing practice to keep up with the latest guidelines and techniques.

While nurses don't need to memorise every medication, they do need to understand drug classes, their general effects, and where to find information if they’re unsure. Dr. Stokes-Parish stresses that “a good understanding of pharmacology is essential to the safe administration of medications”. Nurses should be able to answer key questions, such as: Why do medication errors happen? Which drug classes do I need to learn more about? And, what strategies can we put in place at work to reduce errors?

When giving medication, nurses follow six key steps to make sure everything is done safely:

1. Right Drug: Double-check the medication, its prescription and the expiration date.
2. Right Patient: Always confirm the patient’s identity with two identifiers, like their name and date of birth, and make sure they know what the medication is for and what side effects to look out for.
3. Right Dosage: Confirm the correct dosage using a current drug reference. If in doubt, calculate the dosage and double-check with another nurse or doctor.
4. Right Time: Ensure the medication is given at the right time and check with the patient when they last took it.
5. Right Route: Confirm the correct route of administration, making sure it’s appropriate for the patient.
6. Right Documentation: Record the medication administration as soon as it’s given, using clinical software to ensure accuracy

Drug interactions are an important factor when giving medications. These interactions happen when one medication affects the action of another, either reducing its effectiveness or causing harm. Without a solid understanding of these interactions, a nurse might miss something dangerous.

“If you have no knowledge of the medications and interactions, you are less likely to understand what a fatal drug interaction is,” says Dr Stokes-Parish. “A good example is the interaction between clarithromycin and calcium-channel blockers (like amlodipine). Administering these together can cause hypotension and acute renal failure.”

Being aware of both harmful and helpful interactions is crucial for patient safety. The risk of drug interactions increases when a patient is on multiple medications. Medication errors can also occur if orders are hard to read, or if verbal instructions are misinterpreted. To avoid these issues, it’s essential to double-check orders, especially if given over the phone.

In the case of a negative drug interaction, it’s important to act quickly. Follow the DRSABC protocol (Danger, Response, Send for help, Airway, Breathing, Circulation). Call for help if necessary, and if the patient is unconscious, make a Medical Emergency Team (MET) call. Continue to monitor the patient and record any changes in their condition.

In addition to administering medication, nurses are responsible for monitoring patients for both positive effects and any potential side effects.

“These include patient monitoring for both therapeutic effects of drugs and adverse drug reactions”, says Associate Professor Snezana Kusljic, pharmacologist and lead for pharmacology education at the University of Melbourne’s Department of Nursing.

"Adverse drug reactions can occur upon administration of a single medication at normal doses and unfortunately, these are not preventable as they are related to the intrinsic nature of a medication. For example, fluoroquinolones are associated with tendon inflammation, rupture or tearing and the risk of this reaction increases in patients who are over 60 years of age. Thus, it is important to know that age-dependent physiological changes can also alter response to a medication”, she said. Nurses need to be aware of these risks and know how to respond if side effects occur.
A growing area in medication safety is pharmacogenomics, which studies how a person’s genetic makeup affects their response to medications. Some patients may need different doses of the same medication, or may not respond at all, depending on their genetics. For example, the response to warfarin, a blood-thinner, can vary greatly based on genetic differences, so patients often need multiple dose adjustments before finding the right level.

Understanding pharmacogenomics can help nurses advocate for more personalised treatments for their patients. It’s important for nurses to know that genetic variations can influence how well a patient responds to a medication and, in turn, improve patient safety by adjusting treatment plans accordingly.

“Having a highly skilled and confident nursing workforce that will be able to recognise and respond more effectively to genetically influenced responses to medications is central to the 21st century healthcare industry," says Associate Professor Snezana Kusljic.

Nurses have a duty to stay updated on new medications, drug interactions, and best practices. Dr. Stokes-Parish suggests setting specific goals for learning. “If you have a particular area you want to improve in, focus on that with developing a specific outcome that you would like to achieve. Set a time frame to achieve this, and regularly check up on yourself."  Regularly increasing your CPD hours and learning about new medications will ensure you're always prepared to safely administer drugs and provide the best care to your patients.

The role of a nurse in medication administration is crucial for patient safety. By continuing your education, understanding the complexities of medications and their interactions, and staying informed about the latest advancements, you ensure that you're providing the highest level of care. Whether it’s learning about drug-drug interactions, staying on top of new treatments, or simply ensuring you’re administering medication correctly, ongoing learning is key to success in nursing.