Challenges Faced By Newly Graduate Nurses In Medication Management

Importance of Medication Management

Question:

Identifies Strategies to overcome Challenges in regard to Safe Medication Management.

Medication management can be defined, as a patient specific care to optimize effective, safe and suitable drug therapy. A patient is provided with care, with the collaborative action of a multidisciplinary team. Registered nurses (RNs) are one of the important members of the multidisciplinary team that influence a safer management of medications.  As a new graduate nurse I have received elementary knowledge about medication management through our entire nursing program, yet I have faced with several new challenges while making a transition from the university ambience to a clinical setting (Cheragi et al., 2013). As a nurse I should be able to apply my knowledge about the patient and the medications. The process of nursing is not a very linear process. A continuous assessment is being done at all the stages of the medication management (Mirbahaet al., 2015).  Newly graduate nurses are inexperienced; hence, it can be difficult for them to monitor the medication protocol of a patient.

Apart from the types of drugs that have to be delivered, the correct method of drug administration also plays a pivotal role in patient’s safety. Nurses play a very significant responsibility in the prevention of the medication errors. Most of the time, this is caused due to the clinical personnel failing to do his duty correctly (Cheragi et al., 2013). Some of the common medication errors that can, be caused by the registered nurses are omissions, administering wrong drugs or wrong dosage of drugs, improper methods of delivery and wrong prescriptions. It has to be noted that the work load, the responsibilities in a proper clinical setting is far more than the student workload, exams, and placements, which can be some of the main causes of medication errors (Keers et al., 2013). Newly graduated nurses are encountered with problems like lack of pharmacological information, lack of monitoring of the pre- administered drugs. I have come across one of my peers, who forgot to find out history of the adverse drug reaction in a concerned patient.

When a nurse is undergoing training, the last thing that they are concerned is about the documentations. there are few things that has to be kept in mind while charting for a patient- Proper documentation of the drug administration and the doses, records of any discontinued medications, records about drug allergy (Campbell et al., 2012)(if any).

Role of Nurses in Medication Management

I have grown and have developed skills through my personal experience placement so that I can think, collect and foster a safe medication management. The correct procedures of safe medication administration involve maintenance of an electronic medical record. In my nursing course I have learned that liquid medications are measured by standard measuring containers. Notably, while splitting the tablets, it should be ensured that the medications are scored by the manufacturer and the medication is splitted evenly. According to Campbell et al., (2012), it is important to carry out the some assessments before the application of certain medications. I have learnt that it is necessary to monitor the heart rate before the administration of antidysrhythmic medications. The duty of a nurse does not end with this. It is necessary to monitor the response of the patients to the medications, especially when we are applying the medications for the first time. In my learning career I have also learned about the importance of recording the site of injections. For high alert medications, it is essential to double check the doses. The Australian commission on safety and quality in health care (ACSQH) has developed medical charts in order to standardize the medication management and increase medication safety. There are separate medication charts for the paedriatics, aged care and more. I have always tried to keep an eye on these charts in order to develop my pharmacological skills.

The NSQHS safety standard 4 for the medication errors in nursing ensures that the nurses safely administer medications to the patients. In order to meet the standard, the frame work proposes that it is essential to document the medication allergies and previous anaphylactic reactions (Flanigan, 2016).

I have faced problems related to the administration of the intravenous medicines. In accordance with my problem I would like to share that Ohasi et al., (2014) have proposed that Intravenous application of medications involve a lot of complexities and preparations. The reports by Campbell et al., (2012), shows severe patient harm related to intravenous medications. It was found that most of the intravenous errors are due to the wrong intravenous rates, wrong volume and mixtures and drug incompatibility, previously I faced challenges in the preparation of the intravenous medications. Later on I have learned to check the medication standards provided in the Australian Injectable drugs handbook (AIDH).

I should mention that the problems I encountered regarding the IV, during my learning career were much different from those in the actual clinical setting. In order to ensure a safe management of medications, a nurse should undergo extensive research to practice evidence based practice and should have an avid knowledge of pharmacology, pharmacokinetics (Kim & Bates, 2013).   From the problems, I have realized that it is very important for a nurse to have a foundational knowledge regarding human growth and development, physiology, human anatomy, nutrition and more. Surprisingly, the mathematical skills will probably help one out in the dosage calculations (Ohasi et al., 2014). According to the NMBA standard of nursing, nurses should indulge in critical thinking and clinical judgment while planning the drug dosage (Flanigan, 2016).

Common Medication Errors

Another thing that most of the new nurses are encountered with the catheter related medication errors (Kim & Bates, 2013). Most of the errors that are caused by nursing students are related to intravenous tubing. Like any other fresh students, I am faced with problems related to the catheter tubes. Reports related to tube catheter misconnection involve a number of devices, such as peripheral intravenous, central venous, peritoneal dialysis).

According to Alsulami et al.,(2012), a nurse should be able to support and advocate patient education regarding the adherence to medication regime.  I have tried my best to have a transparent knowledge regarding pathophysiology and pharmacology, so that I am able to deliver a proper instructions and knowledge to the patient. 

One of the important aspects of becoming a successful nurse is self regulation. Medication error can arise due to improper documentation and reporting of the health care errors. Verbal, written or other forms of communication for recording the near misses are one of the crucial initiatives from the side of nurses. 

I have gained efficiency in preparing ISBAR, clinical handovers. Clinical handover plays a major role in error prevention (Simonsen et al., 2014). A proper clinical handover are intended as the handing over of responsibilities from one health care professional to the other. It helps in mitigating the medication related errors. It helps the person in the next shift to get an overall idea of the patient history and the undergoing medications.  In my degree course I have gained knowledge regarding the medication reconciliation of each and every patient. As stated by Haw et al., (2014), medication reconciliation consists of three steps: – First is verification. I have always learned to verify the medication history of the patients, including the current medications, herbal or alternative therapies and more. It is important to get it clarified from the physician charge that all the doses are correct (Simonsen et al., 2014). The RN investigates, disseminate and document any further changes. As a freshly graduate nursing student I may make medication errors, but I should not deter to inform the higher authority regarding my mistake, as we know that medication error can be as lethal as death (Alsulami et al., 2012).

An RN should be able to work together with the families, patients and the care providers for ensuring comprehensive and accurate medications. It is required that all the medications of a particular patient are reviewed in order to ensure that appropriate medications are added, changed or stopped (Parry et al., 2015).

Documentation and Reporting in Medication Management

It is not that everyone should apply for a transition to practice, however they can motivate a nurse to strive more in his professional practice. It is important for ensuring a consistent, transparent and equitable process for the management of transition to practice nurses. This transition to practice can be done in any clinical setting .It helps a nurse to develop her inter professional skills.

I am well aware of the fact that medication error may lead to adverse drug reactions, which can bring about life threatening conditions in patients. Since, a collaborative care is not possible as long as I do not make any interaction with the other members of the collaborative team, it is better that I consult with my peer and my senior nurses in case of complicated situations. I should be able to work with the health care agencies for identifying the individual risk factors and implement a proactive measure for decreasing the medication errors

Each of these challenges is problematic for a newly graduate nurse. Proper help and guidance from the senior nurses and the peers can help the new nurses for a successful transition in to a new working environment. In conclusion it can be said as a graduate nurse, I can manage the medication challenges by practicing evidence based research work against pharmacology, proper assessment of the patient history and the current conditions, including the vital signs. Other things that I should keep in mind are proper clinical handovers, documentation, using technologies for monitoring and documentation. The nursing frameworks will also help me to overcome my fears.

References

Alsulami, Z., Choonara, I., & Conroy, S. (2014). Paediatric nurses’ adherence to the double checking process during medication administration in a children’s hospital: an observational study. Journal of advanced Nursing, 70(6), 1404-1413.

Campbell, R. L., Bellolio, M. F., Knutson, B. D., Bellamkonda, V. R., Fedko, M. G., Nestler, D. M., & Hess, E. P. (2015). Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. The Journal of Allergy and Clinical Immunology: In Practice, 3(1), 76-80.

Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurse’s viewpoint. Iranian journal of nursing and midwifery research, 18(3), 228.

Flanigan, K. (2016). NSQHS standard-patient identification. ACORN: The Journal of Perioperative Nursing in Australia, 29(1), 23.

Haw, C., Stubbs, J., & Dickens, G. L. (2014). Barriers to the reporting of medication administration errors and near misses: an interview study of nurses at a psychiatric hospital. Journal of psychiatric and mental health nursing, 21(9), 797-805.

Keers, R. N., Williams, S. D., Cooke, J., & 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), 237-256.

Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing, 22(3-4), 590-598.

Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to guidelines. Journal of Clinical Nursing, 22(3-4), 590-598.

Mirbaha, F., Shalviri, G., Yazdizadeh, B., Gholami, K., & Majdzadeh, R. (2015). Perceived barriers to reporting adverse drug events in hospitals: a qualitative study using theoretical domains framework approach. Implementation Science, 10(1), 110.

Ohashi, K., Dalleur, O., Dykes, P. C., & Bates, D. W. (2014). Benefits and risks of using smart pumps to reduce medication error rates: a systematic review. Drug safety, 37(12), 1011-1020.

Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), 403-420.

Simonsen, B. O., Daehlin, G. K., Johansson, I., & Farup, P. G. (2014). Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study. BMC health services research, 14(1), 580.

Weeks, K. W., Hutton, B. M., Young, S., Coben, D., Clochesy, J. M., & Pontin, D. (2013). Safety in numbers 2: competency modelling and diagnostic error assessment in medication dosage calculation problem-solving. Nurse education in practice, 13(2), e23-e32.