Hospital Scenario Issues - Essay Example

Running Head: Scenario HOSPITAL SCENARIO YOUR FULL Part Medication incident What is happening here and why (identify and define any problems) There are several mistakes in this scenario, and not just the wrong medication for the wrong patient. First, the charts for a.c. medications does not correspond with the request of the patient as it states glibenclamide whereas the patient asks for Daonil. Second, should the doctor in-charge give the patient a different medication from the one she takes, I should be well informed about this because I will be the one to monitor and assist the patient when the doctor is out. Although both drugs are for the same use Diabetes type II, Daonil and Glibenclamide has different indications and its uses vary from one patient to the other. Daonil is an oral sulphonylurea antidiabetic preparation with a hypoglycaemic effect. It is indicated as an adjunct to diet to lower the blood glucose level in patients with non-insulin dependent (Type2) diabetes mellitus whose hyperglycaemia cannot be controlled by diet alone (Asa, 2006). On the other hand, Glibenclamide is for insulin-dependent diabetes in adults with partially preserved synthesis of insulin and for patients with resistance to other antidiabetic medicines. This happened wrong-patient-wrong-medication happened because I did not ensure the Five Rights, which are the right medication, the right dose, the right patient, the right route and the right time (Galbraith, Bullock & Manias, 2003). I did not check the patient's identity and double-check her medications. I became too complacent and did not verify the patient's name, date of birth, allergies, unit record number and ID arm-band with the date on the patient's medication chart (Crisp & Taylor, 2005). I also failed to inform the patient of the name of the medication that the doctor gave her. I was too preoccupied of the right time she should take the medicine that I lost track of the right medication for the patient. I also did not ensure the right procedure of preparing a medication. I missed to compare the label of the medication with the prescription on the medication chart when getting the Daonil tablets. I even forgot to wash my hands prior to the preparation of the medication (Crisp & Taylor, 2005; Ignatavicius, 2000). In addition, I should have checked Miss Irwin's medication chart as soon as the patient requested to have her Daonil tablets because patients are usually familiar with their medication (Galbraith, Bullock & Manias, 2003). Although at this point, I should have checked with the doctor because the patient is asking for a different medication from the one on the medication chart. What information do I need in order to understand the situation better Why is this information relevant and to whom (collect and analyse relevant data) To understand the situation better, I need to know how to manage and prevent mistakes in giving the right medication for the right patient at the right time. First, the five rights is the most important way to prevent mistakes in giving medication since medication errors tend to occur when a nurse pays little attention to the five rights (Dennison, 2005; O'Shea, 1999). Right patient: Always check the patient's identity, such as the patient's name, date of birth, allergies, unit record number and ID arm-band comparing this with the data on the patient's medication chart (Galbraith, Bullock & Manias, 2003; Ignatavicius, 2000). Right drug: Double-check the label and the right dosage of medication and any particular order in the medication; compare this with the data on the medication chart. Inform the patient of the name of the medication and should the doctor fail to explain why this is given to her, the attending nurse should be ready and able to give details as to why this is given. This gives a patient a chance to prevent or inform the nurse about a possible medication error. A nurse should also have enough information on medications, such as the effect, adverse reactions and precautions of the drug so she can verify if the drug used is the right one. She should be well acquainted with the pharmaceutical references so she can check if she has doubts with the given medication for a patient (Galbraith, Bullock & Manias, 2003; Ignatavicius, 2000). Right dose: Make sure of the ordered dose and drug calculations. A nurse should check a patient's condition, age and weight for correct calculations. Right time: Give the patient one medication at right time. A nurse needs to pay attention to medication schedule as this is of utmost importance (Galbraith, Bullock & Manias, 2003; Ignatavicius, 2000). Right route: Administer the medication by the ordered route. A nurse must use the right clinical skills for medication administration. She must not leave a patient until she is sure that the patient has completed taking the medication (Galbraith, Bullock & Manias, 2003; Ignatavicius, 2000). Second and last, I must ensure proper personal hygiene in preparing and assisting a patient before and during taking his medication. It is significant that you prepare the medication for the patient (Ignatavicius, 2000). What are the consequences (review the outcomes) Ms. Irwin and Ms. Allen, may have adverse reactions on the drug given to them. Knowing that Ms. Irwin has Diabetes Type II, she have hyperglycaemic signs such as lethargy, headache, thirst, passing large amounts of urine and blurred vision because she has not taken the prescribed medication, which is Daonil tablets (MIMS, 2005). On the other hand, Ms. Allen, who underwent a mastectomy may experience adverse reactions of medication because she took Daonil tablets which were not prescribed to her. According to MIMS (2005), stressed patients because of surgery or infection and patients without diabetes should be careful in taking Daonil tablets as they are prone to have side effects. What actions will I take and why (plan your actions based on the decisions you have made) I should immediately report the incident to the doctor and to our nurse manager (Ignatavicius, 2000). I will also identify the mistakes I did so I may prevent it from happening again. I will monitor and observe patients constantly to assess and evaluate their conditions, such as their vital signs (Cohen, 2002; Manias, Aitken & Dunning, 2004). I will also complete a medication error report, such as documenting of a medication incident form to prevent recurrent events and try to request for a database containing risk management and quality improvement in hospitals (Cohen, 2002; Ignatavicius, 2000). Part 2 The 8 o'clock drug round Given what is happening in the scenario, is it consistent with normal or is it a deviation from acceptable limits I must know and ensure the scheduled time of prescribed medication as nurses should administer patients all regular medications within 30 minutes of the prescribed time (Crisp & Taylor, 2005). For this however, I have started at 08:45, a little late in administering medication to my patients. I prepared Methopt eye-drops after Mrs. Green requested for it which should not be the case. The patient is already feeling discomfort when I have given her the medication whereas it should be given before the patient experiences eye sore. I failed to give my patient their 8 o'clock medication within the prescribed limits. It is a deviation from acceptable standards. Why is this happening What are the possible influencing variables and the causal factors This is happening because I failed to get rid of external factors, such as distraction and interruption. Since nurses have many demands from patients from time to time, I should be able to eliminate distractions and concentrate on schedule, preparation and administration of medications (O'Shea, 1999). According to Conkin, MacFarland, Kinnie-Steeves and Chenger (O'Shea, 1999), 32% of nurses considered that recurrent distraction or interruption resulted in medication errors. Therefore, I should adapt and be familiar with the environment to prevent medication errors. I should also have concentrate on the most important thing, which is administration of medications. What are your responses and feelings to what is happening I felt like I tried to make up for my being late in giving medications by responding to all my patients' demands despite insufficiency in time. I should have given routine ordered medications to my patients early to avoid such mistakes and to avoid discomfort on my patients' side. Therefore, I failed in time management. Moreover, I should have checked Ms. Irwin's chart as soon as I found she did not have breakfast, so to detect and possibly avoid medication errors. I should have been familiar with the medication chart and with my patients' conditions. What breakdown processes may be occurring in light of the deviations Several breakdown processes occurred in this scenario. First, the patients may not get therapeutic effects from the medications because they failed to take it on the right time. Some medications, such as antihypertensive agents, subcutaneous insulin and intravenous antibiotics must be given at a specific time to reach their maximum effect (Galbraith, Bullock & Manias, 2003; Ignatavicius, 2000). Second and last, Ms. Irwin and Ms. Allen may have adverse reactions because Ms. Irwin has not taken Daonil tablets with breakfast and Ms. Allen took the wrong medication. Ms. Irwin may have hypoglycaemic signs, and the wrong medication which is Daonil may have side effects on Ms. Allen (MIMS, 2005). Do these interfere with the activities of daily living - to what extent Yes. Failure in the five rights brings out medication errors. It may have serious side effects on the patients and undermine my credibility in the nursing field (Gibson, 2001). Moreover, distraction and interruption delay the scheduled time of administration of medication, so the patient may not maximize the effects of their medications. In addition, the patient may complain about delayed responses to their demands and it may result to chaos. Does something need to be done What With what urgency and by whom Yes. The most important urgency is to realise my medication error, which I administered for the patient who took the Daonil tablets. I should immediately inform the doctor and a nurse manager about it. I should also monitor and assess Ms. Allen's condition and complete a medication incident report to improve her state and prevent this from happening again (Cohen, 2002; Ignatavicius, 2000). Furthermore, I should request for assistance from other nurses to respond to my other patient's demands because medication errors happen when there are many patients to think of while preparing the medication for the other patients. A collaboration with other members of the healthcare team may contribute to better medication administration system (O'Shea, 1999). Could the problem have been avoided If so, how Yes. The problem could have been avoided if I had ensured the five rights because most medication errors occur when nurses do not follow the five rights (Gibson, 2001). Also, if I had taken time to be familiar with my patients' status such as their medications and their disease and recognised potential medication errors to improve medication safety, I could have prevented my mistakes (Cohen, 2002; Davidhizar & Lonser, 2003). Part 3 Group b What possible adverse reaction is Ms. Allen likely to manifest and how may their effects be minimised Ms. Allen may have possible adverse reactions because Ms. Allen underwent a mastectomy two days ago, so her physical condition may still be weak, she also received Morphine, which delays gastric emptying (MIMS, 2005). If a patient has any other medical problems, such as surgery, infection, weakened physical condition or slow stomach emptying, the medical condition may affect the use of the sulfonylurea antidiabetic medicines, which are used to treat type II diabetes. (Medline Plus, 2004). Daonil tablets makes her blood sugar level lower, so she may feel symptoms of low blood sugar level such as: anxious feeling, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, fast heart beat, headache, nausea, nervousness, restless sleep, shakiness, slurred speech, unusual tiredness or weakness (MIMS, 2005). First, I should have immediately informed the doctor and my nurse manger about an adverse reaction of the patient (Ignatavicius, 2000). Second, I should have monitored the patient to identify the adverse reaction and assess the patient's condition, like doing vital sign observations. Third, I should complete a medication error report, such as documenting of a medication incident form to prevent the error to recur (Cohen, 2002; Ignatavicius, 2000; Manias, Aitken & Dunning, 2004). Finally, I should document the following information: Patient information (initials/UR No, DOB/age), Reporter information (name, address, phone number), A description of the reaction, Any medicines suspected of causing the reaction, Any other medicines, Date of onset of reaction, Dates of starting and stopping the suspected medicine, Dates of starting and stopping any other medicines, Details of any treatment of the reaction, Outcome of the reaction and date of the outcome (Department of Health and ageing, 2006). References Asa org (2006). Daonil. Retrieved on October 24, 2006 from http://www.asa.org.za/pharm/hmr/daonil.html. Australian government:Department of health and ageing (2006) Retrieved on October 24, 2006, from http://www.health.gov.au/ Bulgarian Phramaceutical group. Retrieved on October 24, 2006, from http://www.sopharma.com/glibenclamide.phtml. Care Manager, 22(3), 211-219. Retrieved October 16, 2006 from the Expanded Academic ASAP Database. Cohen, H. (2002). Shrinking medication errors down to size: What you can do about this far-reaching problem. Nursing, 32(1), 6-12. Retrieved September 18, 2006 from Proquest Database. Crisp, J. & Taylor, C. (2005). Fundamentals of Nursing (2nd ed.). Marrickville NSW: Elsevier. Davidhizar, R. & Lonser, G. (2003). Strategies to decrease medication errors. The Health Dennison, R. (2005). Creating an organizational culture for medication safety. Nursing Clinics of North America, 40(1), 1-23. Retrieved September 18, 2006 from Sciencedirect Database. Galbraith, A., Bullock, S. & Manias, E. (2003). Fundanmentals of pharmacology (4th ed.). Forest NSW: Pearson Education Australia. Gibson, T. (2001). Nurses and medication error: A discursive reading of the literarure. Nursing Inquiry, 8(2), 108-117. Retrieved October 16, 2006 from Blackwell Synergy Database. Ignatavicius, D. D. (2000). Asking the right questions about medication safety: Learn how to get the answers you need to safeguard your practice. Nursing, 30(9), 51-54. Retrieved September 18, 2006 from Proquest Database. Manias, E., Aitken, R. & Dunning, T. (2004). Medication management by graduate nurses: Before, during and following medication administration. Nursing & Health Sciences, 6(2). 83-91 Retrieved October 16, 2006 from Blackwell Synergy Database. Medline Plus (2004). Type 2 diabetes. Retrieved on October 24, 2006, from http://www.nlm.nih.gov/medlineplus/ency/article/000313.htm. MIMS Online. (2005). Danoil. Retrieved October 16, 2006 from MIMSONLINE Database. O'Shea, E. (1999). Factors contributing to medication errors: A literature review. Journal of Clinical Nursing, 8(5), 496-504. Retrieved September 18, 2006 from Blackwell Synergy Database. Read More