Nursing Assignment Registered Nurse RN - Free Sample

Question: Discuss about the Nursing for Registered Nurse (RN). Answer: Scenario 1 I am a first year Registered Nurse (RN) and working with my friend David in the medical ward. I come across a situation where I found David administering the wrong dilution intravenously to a patient and upon inquiring, he informed that he had the dosage form a registered nurse. On further investigation from another RN, I was confirmed that I was right that the medication needed further dilution. This is a case of critical incident reporting and such type of situation lead to patient safety issues. Nurses are the most involved among the medical professionals in the phase of medication administration and are responsible for detection and prevention of errors. However, when they get involved in errors, it causes serious harm to the patients, particularly with the intravenous medications. According to the Code for professional conduct for nurses in Australia, the nurses are expected to uphold exemplary standards of conduct when performing their duties in a competent and safe manner (Nur singmidwiferyboard.gov.au 2016). They should have accurate knowledge before administering medications to the patients and should be aware of the consequences of medication errors. Therefore, in this essay, the incident, analysis and response will be discussed according to the scenario with appropriate action to be taken. Critical Incident The primary responsibility of medication administration across settings lies with the nurses and they are also involved in the preparation and dispensing of the medications. Most of the medication administration errors are due to the wrong dose, wrong rate and wrong time of administration and are mostly for the injectable drugs causing drug overdose. Some of the identified factors responsible for these medication administration errors are performance or knowledge deficits, name confusion, misleading or similar labeling and inappropriate packaging. In this scenario, David a first year RN was found to be administering improper dilution of an intravenous medication and it required further dilution. As I approached him, he had already administered half of the medication and upon my request to stop the administration of the medication, he replied that he has already checked the medication with an RN and he was confident about the dilution. Upon cross checking with another RN, I discovered that David was wrong with the dilution and I was indeed right. From this scenario, it is obvious that since I was more experienced compared to David, I had better knowledge regarding dilutions of intravenous medications. Experience of the nurse play a major role in administration of medications and its accuracy gets better with continuous working. Since David was comparatively new to the job, he did not have the correct knowledge of dilutions of intravenous medications. David was not aware of the eight rights of medication administration that increases patient safety and makes the nurse aware of the appropriate medication and its administration. These eight rights of medication administration are right patient, right medication, right dose, right route, right time, right documentation, right reason and right response (Keers et al. 2013). The Australian Injectable Drug Handbook also gives ample information regarding the administration of injectable medications of which, David was pr obably not aware of. Apart from this, David was misguided by another RN who informed him that the dilution is appropriate. According to the Nursing and Midwifery Board of Australia and its rules for enrolled nurses and medication administration, it is evident that not all the enrolled nurses who do not have a notation can administer the intravenous medications (Nursingmidwiferyboard.gov.au 2016). The RN who misguided David did not verify his knowledge thoroughly and inquired about the notation and allowed him to administer intravenous medication. It was a case of neglecting the Code of Ethics for nurses which state that nurses should value informed decision making (Nursingmidwiferyboard.gov.au 2016). The RN neglected this fact and did not cross check the information passed by David regarding his decision of the dilution of the medication. Another violation of the rules can be traced in the scenario of the National competency standards for the RN which lies down several regulations a nd obligations for the RNs in accordance with their standards of professional practice (Nursingmidwiferyboard.gov.au 2016). The nurses are expected to do critical thinking and analysis of the available evidence which the RN seemed to ignore may be due to several reasons like heavy workload, insufficient training, unfamiliar with the medication of the patient and poor supervision. Overall, it can be said that both David and the RN did not observe the rules and regulations laid down by the Nursing and Midwifery Board of Australia that led to the medication administration error and compromised with patient safety. The correct procedure for administration of the intravenous mediation should have started with the thorough knowledge of the eight rights of medication administration. Checking the right dose would have given David the notion of the amount of the medication prescribed and the calculation required to be done for dilution and determining the dosage prior to administration. David was required to identify the clinical errors by reviewing the preparation to determine if it was made in accordance with the Australian Injectable Drugs Handbook and compared the dose of the preparation with the prescribed dose of the medication (Day and Snowden 2016). Experience plays a major role here and since David is new to the system, he consulted the RN who further misguided him. Therefore, only after David had been confident about his duty, he should have administered the intravenous medication which could save him from the misguidance. Since intravenous drugs readily enter the systemic circulation, it can cause serious damage to the patient health and therefore David should have been cautious about this prior to his administration of the medication. It is evident that knowledge and skill deficiencies have a greater contribution to the severity and is associated with the administration errors of the intravenous medications (Keers et al. 2014). However, the severity of the errors decrease as the RNs become experienced and since David do not have sufficient experience, he should have been accompanied by an experienced supervisor while administration of the medication. I tried to stop David while he was administering the medication as he was halfway through his job and stopping the administration would have lessened the damage. Although David was confident about his job after a consultation with the RN, there should have been a discussion with me regarding the dilution and this should have taken somewhere away from the patient. Overhearing the conversation created confusion and panic in the mind of the patient and this should not have happened. Therefore, the correct procedure of this critical incident would have been based on the codes and regulations of the Nursing and Midwifery Board of Australia. Analysis of the Situation According to WHO, patient safety has become a global concern and RNs are the direct care providers who plays an integral role in patient safety (World Health Organization 2016). The most preventable mortality and morbidity cause in hospitals include medication administration error and therefore, have been identified as the priority issue of patient safety along with a concern for the nursing profession. The behavior of medication administration by the RNs incorporates two different phenomenon or action. This includes recommended behavior violation or unintended errors and the actions of the RNs undertaken for keeping the patients safe during administration of the medication. Therefore, there is a difference between medication administration error and medication administration behavior that the RNs are known to commit and the behavior aspect has been regarded as an outcome of the human behavior (Keers et al. 2013). Scenario 1 depicts a situation where two first year RNs were working in the medical ward with different durations where, the first RN (me) finds out that the second RN David (my friend) was administering an intravenous medication to a patient with improper dilution. Upon intervening, he informed that he has confirmed the dilution from an RN and therefore he was confident about the dosage. The first RN upon further investigation with another RN came to know that he was right was David was wrong regarding the dilution. Therefore, the main players in this scenario are the two first year RNs and the other RN who misguided David. To begin with David, it can be said that there are two domains that contribute significantly to the medication administration errors by the nurses. These domains are environment and person. The environmental domain includes the working environment disposition and the clinical activities undertaken in the healthcare settings. The person domain includes the work ex perience of the RN and the characteristics of the RN (Berdot et al. 2012). It is evident from the scenario that the medication administration error of David was a result of person domain as his experience was limited and his characteristics were not professional while administering an intravenous medication. As an RN, David is expected to adhere to the Code of professional conduct for nurses and National competency standards for the registered nurse by the Nursing and Midwifery Board of Australia. He should have referred to the Australian Injectable Drugs Handbook prior to the administration for confirmation of the administration procedure. He should have paid attention to the advice of his friend who was more experienced compared to him for cross-checking the dilution of the medication. In addition, neglecting the eight rights of medication administration further aggravated the problem. A thorough understanding and knowledge of the steps of medication administration is essential an d the RN should be adequately trained for the job (McLeod et al. 2013). David was accountable for the health and safety of the patient and it is quite obvious that he might have lacked the basic numeracy skills required for calculation of the medication dosage. All this factors collectively led to the mishap of administration of inappropriate dilution of the intravenous medication by David. The RN who misguided David is also responsible for his mistake. According to the Code of Ethics for nurses in Australia, the guiding framework states that the RNs should abide by the eight value statements that are also applicable for the colleagues (Nursingmidwiferyboard.gov.au 2016). The RNs should take appropriate steps to help their colleagues to provide quality nursing care. In this scenario, the RN ignored this code of ethics due to probable reasons of heavy workload and distractions that ultimately caused David to commit an error in the dilution of the medication. According to the conduct statement 8 of the Code of professional conduct for nurses in Australia, RNs are expected to provide accurate information related to the healthcare products and the RN in the scenario neglected this statement as well (Nursingmidwiferyboard.gov.au 2016). He did not pass the accurate information to David regarding the process of dilution of the medication and David, being a first year RN, could not follow the calculation accurately due to lack of experience. It was also the responsibility of the other RN to effectively intervene in the process of administration of the medication by David. According to the National competency standards for the registered nurse, the nurses are expected to collaborate and communicate with the healthcare team for providing effective nursing care (Nursingmidwiferyboard.gov.au 2016). Since he noticed there was a discrepancy in the dilution of the medication by David and that he was not amending it in spite of making him aware, he should have reported it immediately to his supervisor for the maintenance of effective nursing care. Although he tried to rectify the mistake of David by asking him to verify his dilution volume, he did it in front of the patient that made him anxious and doubted the abilities of David. According to the value statement 7 of the Code of Ethics for nurses in Australia, the RNs are expected to value the ethical management of the obtained information among their colleagues and therefore, this information should have been passed with utmost care without letting the patient know about the dilemma regarding the dilution of the medication (Nursingmidwiferyboard.gov.au 2016). Therefore, it can be stated that all the three RNs had a crucial role to play in the scenario and had they followed the guidelines of the Nursing and Midwifery Board of Australia along with the person-centered medication administration error of David, this mistake could have been avoided. Response to the Incident Patient safety is a growing concern in the global healthcare system and the number of near miss and death cases is alarming. The scenario was a near miss case where the wrong dosage was administered to the patient by a first year RN. Such type of incidences also results in death depending upon the potency of the medication and the condition of the patient. The incidence can be responded effectively with the application of incident reporting system (Anderson et al. 2013). It is a key tool used to enhance learning and improve safety by reporting incidents on the belief that patient safety can be improved by learning from the reported incidents. There are several tools and strategies that have been developed for reducing medication administration errors and response to the incident includes a detailed analysis of the series of events that caused the incident (Lawton et al. 2012). RNs are the front line staff of the hospital and they are expected to report the medication administration e rror even if they are an observer of the incident. Since I was an observer of the incident, it is my responsibility to report the incident in the appropriate manner following the hospital protocol for reporting medication administration errors. I will be completing the medication administration error notification form and forward it to the QI (Quality Improvement) department. Then the QI department will sent the notification form by attaching the medication error sheet to David who is responsible for the medication administration error. This will be followed by sending a corresponding email to David by the QI department regarding the incident. David will be completing the medication error sheet and forward it to the QI department. Then the QI department will file and record the received medication error sheet from David and will forward a copy of the sheet to the responsible nurse manager in the medical ward who was the supervisor of David. The nurse manager will be investigating on the complete incident and I will be assisting him in this process as I discovered the incident. Upon completing the investigation, he will be filling up the follow up section present in the medication error sheet and return it to the QI department. The QI department will follow up, file, track and ensure that the medication error sheet is completed and necessary action has been taken to prevent the occurrence of such incidences in future. In the entire process, I will have to be attached to the investigation and reporting process as I was the prime witness of the incident. Medication administration errors can be prevented only with the accurate reporting of the incidents. It is evident that only 25% of the medication administration errors are actually reported by the nurses (Hartnell et al. 2012). The prime reason for this underreporting is the fear of staff punishment that might include loss of job. The other reason for underreporting is that the nurse fears that they might get la beled and revealed as the one who committed a medication administration error. It also hampers the reputation of their unit or service (Radley et al. 2013). Although David is my friend, it is my responsibility to report the medication administration error as it is concerned with patient safety and nursing responsibility. According to the value statement 1 of the Code of Ethics for nurses in Australia, nurses are expected to value the quality nursing care for all the patients (Nursingmidwiferyboard.gov.au 2016). Since it was a case of negligence by David, it has to be reported accordingly. Many of the medication administration errors are near miss and do not result in a potentially serious event. Even such near misses should not be neglected as it was still an error and considering them for rectification can improve the safety of the patients. Enabling proper reporting channels helps to set up a process for effective communication of the errors and near misses to the key stakeholders . After compilation of the data, the agencies of healthcare evaluate the causes of the error and create processes for reducing the risk of errors. Implementation of strategies like staff advice elicitation, budget appropriateness and staff education can result in making easy the patient safety system implementation and help to improve the internal reporting process to the patients and their families as well (Pham et al. 2012). As the patients get informed of the potential and actual errors, they inquire about the quality improvement efforts that the management has taken up and is supported by shared learning for preventing similar errors in future. They also wish to stay informed of the incident as they support reporting errors and appreciate the efforts that the organizations and clinicians take up in acknowledging errors immediately after their detection. The South Australian (SA) Health has an application named Safety Learning System (SLS) that enables the services of SA Health to analyze, investigate, manage and record the patient incidents. Consumer feedbacks are also recorded and the formal notifications are recorded that includes medical malpractice and coronial matters (Sahealth.sa.gov.au 2016). After the discovery of the incident, I could have reported the incident according to the protocol of SLS. After the incident, the patient will be provided treatment and immediate care followed by recording the incident in the SLS. Then the manager reviews the report followed by investigating the incident and documenting the action. The relevant committee reviews the data according to the location and type of incident for planning the improvement related to the patient care quality. Conclusion Medication administration errors are common in almost all the settings that may result in an adverse drug event especially with the medications that are administered in the specialty areas and have complex dosage regimen. Wrong route of administration, wrong drug and wrong dose are the most common forms of the medication administration errors. In the present scenario, David was found to commit an error with the wrong dose and he was confident about his job in spite of the error because of misleading by an RN. This could have resulted in severe complications not only in the scenario but also in future if David was not made aware of his mistake in the dilution of the intravenous medication. 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