Avoiding inappropriate drug prescribing: fundamental principles for rational medication management

Drug therapy is not only the most common form of medical therapy, but it can be one of the most effective, if used appropriately. Rapid pharmaceutical development poses a challenge for all prescribing professionals, especially for advanced practice nurses who have only recently acquired prescriptive privileges and who do not have the extensive background experience that guides more seasoned medication managers. For nurse practitioners, nurse midwives, nurse anesthetists, and clinical nurse specialists, excessive reliance on diagnosis-based drug protocols can result in the selection of inappropriate drugs or the prescription of inappropriate doses or durations of therapy. A rational system of drug decision making is necessary to avoid common errors in prescribing. By considering the fundamental principles of pharmacotherapy and by focusing on pathophysiologic objectives, detailed pharmacologic analysis, and a patient-specific plan of therapy, nurse prescribers will avoid errors in prescribing and enhance the safety and effectiveness of drug therapy.