Complication

Medication safety and complication recognition are one skill seen from two sides. Before a dose, the nurse asks what could go wrong and puts a safeguard in the way. After a dose, the nurse asks what has changed and whether it is the expected effect or the start of harm. A medication that works well can still injure when the dose is wrong, the patient is unusually sensitive, two drugs interact, or the response goes unnoticed. The harm that follows is usually not sudden. It arrives as a trend: a patient who is a little sleepier, a respiratory rate that creeps down, a blood pressure that drifts, a urine output that thins. The nurse at the bedside is the person most likely to see that trend first. The mental model for this topic has four links. First, know which drugs carry the highest potential for harm when something goes wrong. Second, put independent safeguards between the order and the patient. Third, monitor for the expected and the unexpected response using a baseline and a trend. Fourth, escalate early, document, and...