Administration of medicines is an essential clinical procedure and the manner in which some medicines are administered determine the effects that they will create on the physiology of the service users or the person being treated (Keers et al. 2013). Medicine management encompasses an evidence based approach that is primarily used for balancing the tolerability, safety, cost, effectiveness, and simplicity of medical treatments. Good management of medicines ensure that the patients are receiving a better and safe care.
Review and monitoring of policies
The Nursing and Midwifery Council (NMC) acts as the major UK regulator for nursing and midwifery and their primary objective is protection of health of the public. This is ensured by maintain a register of the midwives, nurses and the specialists who practice within the UK. The organisation has set forth several standards for safe practice associated with administration and management of medicines by these registered midwives and nurses. The council considers medicine administration as an essential aspect of professional health practice for people whose names feature on the register (NMC 2015). The council takes into consideration the cost-effective, clinical, and safe usage of medicines for ensuring providing maximum benefit to all patients from the medicines they are prescribed, while minimising potential harm. The standards put forth some policies regarding the supply and administration of medicines such as the medicinal products must only be in accordance with some of the process namely (1) patient medicine administration charts (2) exemption of medicines act (3) standing orders (4) patient group discussions (5) prescription forms and (6) home remedy protocols.
Other standards and policies state that all any directions for medical product administration must be checked. Compliance is also shown to the standards related to administration of medicines that illustrate maintaining professional accountability of the registrants in the best interest of the patients. This is usually maintained by being certain of the patient identity, checking presence of allergic reactions, being aware of the medicine’s therapeutic uses and the care plan, reviewing the labels and expiry dates and considering the dosage, route of administration and timing. Furthermore, adverse events related to medicine administration are also managed by reporting all kinds of potential harm that might occur due to medication errors, immediately to the line managers or prescribers. Clinical audit acts as an important way of finding out whether the healthcare provided is in line with the proposed standards and allows the care givers and patients realise the benefits of the medical services and regions of improvements (Gillam and Siriwardena 2013).
The National Clinical Audit and Patient Outcomes Programme (NCAPOP) is commissioned by the HQIP and comprises of an estimated 30 national audits that collect and analyse information supplied by clinicians for the care standards regarding medication administration and management (England NHS 2018). Directives are also proposed by the NHS England for improving reporting and learning of medication errors incident. The NHS also runs a range of clinical registries and audits for the healthcare system. Furthermore, with the aim of matching the healthcare needs of the ageing population, the government is working towards providing an adequate supply of trained health professionals. An estimated shortage of 7.2 million health workers are found in the UK, which are expected to rise to 12.9 million by 2035 (WHO 2018). Thus, the healthcare education and training system of the UK is ensuring that all generations of healthcare professionals are provided the opportunity of continuous learning to develop their skills to highest medical standards. Close collaboration between universities, colleges and Health Education England has been found effective in ensuring seamless delivery of superior quality training and education, thereby reducing adverse events of medication management and administration (England NHS 2018).
With the growth in reliance on medications as the key intervention for most diseases, patients receiving such interventions are most often exposed to potential benefits as well as harms. Some of the major benefits are associated with effective disease management, delayed disease progression, and improved patient outcomes, with reduced medication errors (Kwan ET AL. 2013). Harms from medication administration arise from unintended consequences, and wrong dosage, medications, and timings (Ekor 2014). Absence of adequate nursing education regarding patient quality and safety, excess workloads, burnouts, staff shortage, illegible handwriting, flawed drug labelling and wrong dispensing systems, nurses are continually challenged for ensuring that the patients receive proper medications. Look-alike or sound-alike names of medications can result in medication errors (Ciociano and Bagnasco 2014). Misreading names that appear similar a common mistake and errors can also occur from verbal prescriptions.
Commonly used medicines such as, opiates and NSAIDs to which most patients are allergic also lead to errors, thereby violating the safety of the patients and creating a negative impact on their health (Magrabi et al. 2013). Another common reaction are ‘adverse drug events’, commonly referred to as injuries occurring due to wrong medication use. Complementary medicines are also found to react with the prescribed medications, taken simultaneously, thereby increasing the risks of side effects due to the active ingredients present in them (Wittich, Burkle and Lanier 2014). The NHS also takes into account the safety culture of healthcare organisations that is defined as a product of group and individual values, perceptions, attitudes, behaviour patterns and competencies that determine the commitment to the safety and health management standards. This is primarily ensured by producing higher motivation levels among the employees, talking about health and safety and demonstrating the commitment by appropriate actions and enhancing good conversation between employees at all levels (England.nhs.uk 2018).
The NHS England considers hand washing as an effective procedure to prevent the onset of a range of illnesses. The National Institute for Health and Care Excellence (NICE) highlights the role of basic hygiene protocols that include hand hygiene, failure to adhere to which might threaten patient safety (Nhs.uk 2018). This is correctly pointed out by the fact that 1 in 16 people, being treated by the NHS acquire nosocomial infections such as, methicillin-resistant Staphylococcus aureus (Eastcheshire.nhs.uk 2018). A set of quality standards are set by the NICE regarding ways to prevent and control infection, thereby maintaining a safety culture. The standards advice all healthcare staff to thoroughly clean their hands, before and after contacting a patient, even after putting on gloves. They stress on washing hands with soap and water and alcohol-based rubs (Al-Tawfiq et al. 2013). These quality standards state that effective hand decontamination lead to significant reduction in the transfer of pathogens on the hands, thereby reducing incidence of preventable HAIs. The NHS Hand Hygiene Policy also provides a standardised approach to maintain hand hygiene, which is considered as an effective risk management strategy and an indicator for patient safety.
I consider patient safety as a matter of great concern and try to take all possible efforts for protecting my patients from harm and accidents due to wrong medication administration. I hold the belief that healthcare quality likely means varied things to the patients, depending on their experiences, expectations and age. My role as a nursing professional requires me to consider healthcare quality as a way that ensures delivery of a safe and affordable care service to all my clients. I think it is imperative to equip all healthcare professionals and the organisations with appropriate tools that will help in caring for the patients, while preventing adverse incidents.
I have found that we, nursing professionals spend more time will our patients, than any other professional. As such we act not only as the gatekeeper but also as the thin line between safety and clinical experiences of our patients. I have realised the importance and impact of my role and duties that are required to be fulfilled to keep my clients safe. Owing to the fact that patent safety is at the forefront, I always try to embed this attribute in every corner of the overall organisational culture, in which I work and also try to maintain transparency and alignment with the values of my organisation. I try to act as a role model for my subordinates by avoiding injuries to the clients, while delivering care that is intended to provide help. I had also utilised the approach of patient-centred care while treating two dementia patients, by aligning the care services in a way that was responsive to and respectful of their preferences, values and needs. This helped me ensure that their values guided the major clinical decisions. In several instances
I also worked hard to reduce the waiting time, thereby eliminating the harmful effects of delays. My role also encompasses avoiding wastage of medical supplies and equipment, which in turn facilitates me to maintain a safety culture in the organisation. In the constantly altering world of healthcare, I need to remain updated on all the recent researchers and trends for being a successful professional. Although it becomes difficult at times to keep up with the emerging information, I use several nursing applications that help me gain a deeper understanding of these aspects, while efficiently managing my schedule.
Conclusion
To conclude, protecting patients from injuries, errors, infections and accidents are an integral role of the healthcare organisations and all associated professionals. While several hospitals are good in maintaining safety of their clients, a lot of adverse events occur in situations involving noncompliance to medication administration and management guidelines. Thus, the set of standards proposed by the NHS England and NICE should be strictly followed for reducing chances of such hostile events and upholding a safety culture in the healthcare setting.
References
Al-Tawfiq, J.A., Abed, M.S., Al-Yami, N. and Birrer, R.B., 2013. Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections. American journal of infection control, 41(6), pp.482-486.
Ciociano, N. and Bagnasco, L., 2014. Look alike/sound alike drugs: a literature review on causes and solutions. International journal of clinical pharmacy, 36(2), pp.233-242.
Eastcheshire.nhs.uk., 2018. INFECTION PREVENTION & CONTROL- Hand Hygiene Policy [online] Available at: https://www.eastcheshire.nhs.uk/About-The-Trust/policies/I/IC%20Hand%20Hygiene%20Policy%20ECT2496.pdf [Accessed 8 Jul. 2018].
Ekor, M., 2014. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Frontiers in pharmacology, 4, p.177.
England NHS., 2018. NHS England » Clinical audit. [online] England.nhs.uk. Available at: https://www.england.nhs.uk/clinaudit/ [Accessed 8 Jul. 2018].
England NHS., 2018. NHS England » Strengthening our workforce. [online] England.nhs.uk. Available at: https://www.england.nhs.uk/five-year-forward-view/next-steps-on-the-nhs-five-year-forward-view/strengthening-our-workforce/ [Accessed 8 Jul. 2018].
England.nhs.uk., 2018. Stage Three: Directive Improving medication error incident reporting and learning [online] Available at: https://www.england.nhs.uk/wp-content/uploads/2014/03/psa-sup-info-med-error.pdf [Accessed 8 Jul. 2018].
Gillam, S. and Siriwardena, A.N., 2013. Frameworks for improvement: clinical audit, the plan-do-study-act cycle and significant event audit. Quality in Primary Care, 21(2).
Keers, R.N., Williams, S.D., Cooke, J. and Ashcroft, D.M., 2013. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy, 47(2), pp.237-256.
Kwan, J.L., Lo, L., Sampson, M. and Shojania, K.G., 2013. Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Annals of internal medicine, 158(5_Part_2), pp.397-403.
Magrabi, F., Aarts, J., Nohr, C., Baker, M., Harrison, S., Pelayo, S., Talmon, J., Sittig, D.F. and Coiera, E., 2013. A comparative review of patient safety initiatives for national health information technology. International journal of medical informatics, 82(5), pp.e139-e148.
Nhs.uk., 2018. NICE highlights how hand washing can save lives – Health News – NHS Choices. [online] Available at: https://www.nhs.uk/news/2014/04April/Pages/NICE-highlights-how-hand-washing-saves-lives.aspx [Accessed 8 Jul. 2018].
Nursing and Midwifery Council., 2015. Standards for medicines management. [online] London: Available from https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-medicines-management.pdf.[Accessed on 08 July 2018].
Who.int., 2018. WHO | Global health workforce shortage to reach 12.9 million in coming decades. [online] Available at: https://www.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/ [Accessed 8 Jul. 2018].
Wittich, C.M., Burkle, C.M. and Lanier, W.L., 2014, August. Medication errors: an overview for clinicians. In Mayo Clinic Proceedings (Vol. 89, No. 8, pp. 1116-1125). Elsevier.
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