Take these steps for most common ADEs
The three most common drugs involved in ED visits for adverse drug events are insulin, warfarin, and amoxicillin, says a new study from the Centers for Disease Control and Prevention.
If there is any compromise with the patient's airway, breathing, circulation, or neurological status, immediate action must be taken, says Sandra Bermudez, RN, BSN, shift coordinator for the ED at White Memorial Medical Center in Los Angeles. "Otherwise, we ask what they took, when they took it, whether they have any known allergies, and assess for any dystonic reaction such as involuntary muscle twitching, any rash, hives, wheezing, or shortness of breath," says Bermudez. "I would also assess their ability to speak and skin signs."
Here are ED nursing interventions for each medication:
• Insulin.
Nurses check the patient's blood sugar and reverse severe hypoglycemia with dextrose 50% 25 g via intravenous (IV) push, then they may place patients on a hypertonic solution such as dextrose 10% in water. "The IV rate would have to be monitored with a constant checking of the patient's blood sugar," says Bermudez.
• Warfarin.
Because this medication prevents coagulation, it increases the clotting time and ultimately increases the risk of the patient hemorrhaging, says Bermudez. ED nurses draw labs to check the clotting factors partial thromboplastin time (PTT) and prothrombin time (PT), and they also may perform an electrocardiogram. The ED provider may order vitamin K, with the dose depending on the lab results, approximately 1 to 10 mg by mouth or slow IV push. "This reverses the clotting factors, allowing the patient to clot faster and prevent hemorrhaging," says Bermudez.
• Amoxicillin.
Unless the patient is in anaphylactic shock, diphenhydramine, ethylprednisolone or a steroid usually is given to decrease inflammation, and the patient may be given a bronchodilator to open the airway. "We monitor the patient, and they most likely go home," says Bermudez.
Source
For more information on interventions for adverse drug events, contact:
- Sandra Bermudez, RN, BSN, Shift Coordinator, Emergency Department, White Memorial Medical Center, 1720 Cesar Chavez Ave., Los Angeles, CA 90033. Telephone: (323) 260-5800. E-mail: [email protected].
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