Good Saves Related To Medication Management

Case 1: Alerting Doctor on Incorrect Medication Use

Discuss about the Good Saves Related to Medication Management.

As a registered nurse who worked in a mental health facility, administration of medication was a major part of my role in the institution. During the administration of medication to patients, several situations arose that may put the patients at risk Most of the patients in the mental facility used schedule eight medications which require a proper prescription and use. Therefore, as a nurse, it was important that I stayed alerted in order to recognize and respond effectively to the possible risks that arose from medication management. This paper will identify three good saves that I made in relation to medication management. It will also outline the intrinsic and extrinsic factors that contribute to these high-risk situations during the administration of medications to the patients and the possible solutions to minimize risks related to the administration of medication.

While going through a patient’s admission, I noticed that a patient was still taking his Ritalin medication despite the instructions from the doctor to terminate this. I notified the doctor and sought clarification on the instruction in the patient’s chart. The doctor was able to confirm that the patient was indeed no longer supposed to be on these medications and was able to take the appropriate action to eliminate the medication. The nurse in charge of the patient’s admission had not noticed that the patient had continued taking his Ritalin medication despite the doctor’s instructions. In such case, it is important for nurses and doctors to make a follow up on the patient to make sure that they take the correct medication to avoid the risk that might arise from the use of certain drugs. Further, an updated chart containing patient records is essential to ensure the patient takes only the prescribed medicine.

The intrinsic factors that may be involved in such a case include knowledge, motivation, and stress. Nurse’s motivation to ensure patients safety during medication would have enabled the nurse to thoroughly go through the patient’s details to identify the specific instructions given by the doctor (Altranais, 2014). Stress could have also led the nurse to overlook the instructions by the doctor. The nurse may have been under too much work pressure as she attended to the several patients which led to the hasty admission of the patient without putting into account the specific details (Barlow 2014). Knowledge of procedures would have enabled the nurse to thoroughly check for any medications that the patient is restricted to take (Brady Malone, and Fleming 2013). Despite the routine work of the nurse, they should always be keen on the nature of medication administered to their patients to avoid future complications in the health of the patient.

Case 2: Notifying Doctor on Incorrect Medicine in Patient Drawer

Extrinsic factors that may have contributed to this situation may include the lack of understanding from the patient and the lack of proper communication between those responsible for the patient’s admission and those who administer the medication (Finkelman 2015). It is important that patient clearly understands the instructions given by the doctor regarding their medication and also ensuring that the nurses and the doctors have a clear view of the patient’s condition and the medication to be administered (Videbeck 2013). Therefore, a clear line of communication between the doctor, the nurse, and the pharmacist is essential so as to minimize the confusions that might arise from drug prescriptions.

An essential evidence-based intervention for such a case would be the safety action 4.6.1; this ensures safe prescription and medication continuity.  Using an admissions form that is standardized would reduce any possible medication risks by ensuring that there is knowledge of the patient’s medication (Hewitt, Tower and Latimer 2015) This will ensure that the nurse knows if there are any ceased medications or changes in medication upon admission. In addition t the use of admission forms, charts can also be used where the history of the patient can be recorded for future references.

I noticed that a patient’s schedule eight medications had been changed but the originally prescribed medication was still in the patient’s drawer despite the change. I notified the doctor in charge of the patient’s prescription and the authorized doctor managed to return the previous medication and got another prescription for the appropriate medication. I also ensured that the patients, medication chart clearly the indicated the medication that the patient was currently prescribed, this is important as it will clear state the current medication status of the patient. Further, updating the chart is essential so as to minimize confusions that might arise in future which might expose the patient to medication risks.

The intrinsic factors that may have contributed to this situation may include knowledge and skills. The nurse’s knowledge of policies that ensure safe administration of medication will reduce any risks related to medication management. The skills of medication administration will also reduce these risks (Healy 2016). The skills include identifying the right patient, the medication, the dose, time, reason and the response to the medication. Extrinsic factor that may contribute to such a case is the system of communication used in the facility. If there was clear documentation of the change in medication rather than the alteration of the original document, this error could have been avoided since it would be hard to overlook a clearly outlined documentation. The presence of a system that provides a clear protocol on returning of medication helped in sorting out this situation since the authorized doctor is given the mandate to change their patient’s medication (Hussain and Kao 2015). Therefore, it is substantial for healthcare providers to go through some form of training that will enable them to identify the needs of the patients to ensure safe administration of medication to minimize the risks related to drug prescriptions.

Case 3: Seeking Clarification on Inconsistent Medication Dosages

Medication safety could be enhanced by the evidence based intervention in action 4.1.2 from the Australian Commission on Safety and Quality in Healthcare. According to this action, there should be standardized guidelines that should be followed when administering or canceling medications (Keers, Williams, Cooke and Ashcroft 2013). Such guidelines ensure that there are clear rights for safe prescriptions and that the right protocols are followed. In this case, evidence-base interventions were necessary so as to minimize on situations whereby the patient is prescribed to wrong medications. Similarly, doctors, nurses, and pharmacist should follow the guidelines stipulated in the Safety and quality healthcare in drug administration to reduce confusions that might arise due to lack or insufficient communication.

While checking a patient’s medication chart, I noticed that the patient’s chart was not legible. The additional instructions written by the doctor were not so clear and it was, therefore, unclear about the dosage prescribed. Further inquiry enabled me to find out that the patient was being given a dosage that was actually below the recommended amount. I was able to alert the authorized doctor who was then able to clarify the dosage and changed the documentation to include the appropriate dosage. In this case, it is important of for the healthcare providers to maintain legible and reliable charts containing the patient history so as to avoid incorrect drug prescriptions and under/ over dosage of drugs.

Intrinsic factor that may have contributed to the situation includes the nurse’s knowledge of the patient and the condition. If the nurse has good knowledge of the patient’s condition, they would have been able to notice the inconsistencies between the dose the patient received and the nature of their condition (Keltner 2013). This knowledge would have prompted them to seek clarification from the authorized doctor regarding their instructions. Extrinsic factors that may influence this situation include communication between the professionals handling the patient. Clear communication about the required medication between the doctors and the nurses will prevent such risks from occurring. If the patient’s chart had legible instructions from the nurse, then the nurse would be able to identify what exactly the dosage is and any present inconsistencies (Manias Aitken and Dunning 2014). Therefore, it is important to understand the medical condition of their patients to avoid confusions in drug administration. In order for the nurse to understand the condition of the patient, adequate communication between the nurse and the patient should be maintained.

Intrinsic Factors in Medication Management

In the Australian Commission on safety and Quality Healthcare Medication Safety standards, the best evidence-based intervention would be action 4.1.2…This ensures that the procedures used in the administration of medication are legal and legible. If the procedures are not legible, it could lead to legal consequences as a result of the wrong medication administration (Puckett 2015). Therefore, this action ensures that the right procedures are followed for the sake of the patient’s legal rights and medical needs.

After experienced these three situations and being able to intercept these medical incidents, am now aware of the risks that exist during the administration of medication. This has enabled me to be more alert and recognize any risks that are likely to occur. This experience has also been helpful in knowing the right protocols to follow when handling medication related issues.  As a nurse who works in a mental facility, am now able to pay attention to the prescribed medications to avoid any risks to the patients. The intrinsic and extrinsic factors that contributed to these situations have enabled me to be aware of the possible factors within me and within the environment that may affect the administration of medication. Further, the experiences have made realize and appreciate the importance of maintaining legible, reliable, and updated charts so as to maintain a medical history of the patients. Also, I have learned the importance of constant communication between the health providers and the patient in order to ensure that the patient is taking the right medicine.

In conclusion, the paper has identified three good saves made in the cause of medical management. Further, the paper outlined the various intrinsic and extrinsic factors that have substantially contributed to the rise of risks in the medical administration to patients.  In this case, the above cases have illustrated the possible risks associated with medication administration. It is of great importance that the medical personnel remains vigilant and follows the right protocols that have been put in place to ensure the safety of the patients. The nurses have a duty to ensure the safety of their patients and this can be achieved through proper medication administration. Therefore, as a practicing nurse, it’s important to identify and respond swiftly to all situations that might expose the patient to risks that relate to medication

References

Allen, L. and Ansel, H.C., 2013. Ansel’s pharmaceutical dosage forms and drug delivery systems. Lippincott Williams & Wilkins

Altranais, A.B., 2014. Guidance to nurses and midwives on medication management. Dublin: ABoard Altranais

Australian Commission on Safety and Quality in Health Care (ACSQHC) 2011. National Safety and Quality Health Service Standards, ACSQHC, Sidney

Barlow, E.M., 2014. Acute mental health nursing and prn medication administration: a review of the literature. Mental Health Nursing (Online), 34(6), p.13.

Brady, A., Malone, A. and Fleming, S., 2013. A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal of nursing management, 17(6), pp.679-697

Finkelman, A., 2015. Leadership and management for nurses: Core competencies for quality care. Pearson

Hewitt, J., Tower, M. and Latimer, S., 2015. An education intervention to improve nursing students’ understanding of medication safety. Nurse education in practice, 15(1), pp.17-21.

Healy, J., 2016. Improving health care safety and quality: reluctant regulators. Routledge.

Hussain, E. and Kao, E., 2015. Medication safety and transfusion errors in the ICU and beyond. Critical care clinics, 21(1), pp.91-110.

Keers, R.N., Williams, S.D., Cooke, J. and Ashcroft, D.M., 2013. Causes of medication administration errors in hospitals: a systematic review of quantitative and qualitative evidence. Drug safety, 36(11), pp.1045-1067

Keltner, N.L., 2013. Psychiatric nursing. Elsevier Health Sciences.

Manias, E., Aitken, R. and Dunning, T., 2014. Medication management by graduate nurses: before, during and following medication administration. Nursing & health sciences, 6(2), pp.83-91.

Nassir, A.J., 2015. Medication Management in Mental Health.

Puckett, F. (2015). Medication-management component of a point-of-care information system. American Journal of Health-System Pharmacy, 52(12), 1305-1309.

Smeulers, M., Onderwater, A.T., Zwieten, M.C. and Vermeulen, H., 2014. Nurses’ experiences and perspectives on medication safety practices: an explorative qualitative study. Journal of nursing management, 22(3), pp.276-285

Videbeck, S. (2013). Psychiatric-mental health nursing. Lippincott Williams & Wilkins