Editor – Green and colleagues (Clin Med December 2009 pp 515–8) are right to highlight the problem of prescribed medications not being administered but appear to have omitted one of the more common reasons for this occurrence – failure of communication between medical and nursing staff. In our experience this is the key to ensuring prompt and efficient management of patients.
While doctors need to be informed if patients are unable to take their medication or if the medication is unavailable, it is essential that nurses are kept up to date regarding medications that have been prescribed or changed. Medications may take time to prepare, such as intravenous antibiotics, or may have complex dosing schedules, such as anti-Parkinson therapies. Good communication is especially important as nursing staff are often unable to accompany doctors on their ward rounds. Shift working also means that numerous medical and nursing staff may be involved in the care of a patient during a short time period necessitating clear communication.
If a patient is designated nil by mouth (NBM) we believe the doctor's responsibility is to ensure that a proper assessment of swallowing has taken place and that appropriate alternate routes of drug administration are instituted when medications are prescribed. It is precisely because nurses operate in a protocol-driven environment that clear communication and explicit instructions are required if NBM orders are to be overridden.
The advent of dedicated medical assessment units, with staff and systems designed for a rapid turnover of patients, has already addressed some of the issues raised by this study, such as greater availability of ward-based pharmacists. Many hospitals have introduced a ‘protected’ drug round with dedicated nursing staff to ensure that medications are administered as prescribed.
We consider the drug history to involve more than transcribing a list from a repeat prescription slip onto a drug chart. Clear communication regarding the importance of medications will save time, effort and ensure correct drug administration.