Medication Practice Improvement Episode Medication Intercept

An intravenous antibiotic Benzylpenicillin (Benpen) course was prescribed for a child to treat acute osteomyelitis. The 30mg/kg dose calculation was duly followed. The child weighed 28kg and so 840mg Benpen dose was to be given every six hours and this was charted accordingly. The chart showed these times: 06:00, 12:00, 18:00 and 24:00. Dose number two was to be taken at 14:00 and two RNs -registered nurses - that administered the dose signed on the column of 12:00 and indicated 14:00 above the signatures. At the time of the handover, no communication was made to the fresh team that the antibiotics had been administered late. When it reached 18:00, me and my colleague went to ready the patient for the next Benpen dose; since it is a requirement that two nurses check an intravenous medication. I discovered that the last dose had been administered at 14:00 and so the following dose was to be administered at 20:00 hrs. Benpen should be administered every 6 hours, and the time frame hadn't elapsed. The administration times, as recommended, were altered on the chart and the new administration time was changed from 18:00 to 20:00.

As medics rely more on medication therapy as most illnesses' primary intervention, patients on medication intervention may be exposed to possible harm and also benefits. The benefits arise from effectively managing an illness, the slow disease progression and better outcomes devoid of many errors. Medications can come from consequences that were not intended and also medication error (wrong time, wrong medication, wrong dose, etc.). With fatigue, inadequate education concerning safety of patients, huge workload, inadequate staffing, bad handwriting, labeling problems and weak dispensing systems, nurses continue to face the challenge of ensuring that the patients get the right medicine and at the correct time.

The system approach to safety lays emphasis on fallibility of human beings and expects that errors will be made, even with the most talented workforce and in the best organization. The approach has a focus on identifying the predisposing factors in a work environment or the systems which can lead to people making errors. As described by the accident causation model, an error can be predicated by 3 conditions:

Latent conditions -- management decisions, organizational processes and system elements like turnover, medication administration protocols and inadequate staffing.

Error-producing conditions - individual, team, task or environmental factors that have an effect on performance like interruptions and distractions (e.g. food tray delivery), patient transportation and performance of ancillary services (e.g., delivering blood products and medical supplies).

Active failures -- involve slips (where there is a selection or recognition failures), mistakes (wrong objective choice, or wrong path for the attainment of the objective), lapses (attention or memory failure) or violation which involves consciously ignoring right behavior.

Some of the threats to medication safety are miscommunication between or among providers of healthcare, inaccessible or outdated drug information, inadequate knowledge about drugs, incomplete history of patient medication, absence of redundant safety checks, absence of protocols that are evidence-based, and various staff taking up roles that they are not competent on (Evans, 2009). An extrinsic factor that had an influence on this "good save" outcome was the presence of senior staff that ensured a good skills mix. According to Volpe et al. (2004) study, it was discovered that taking care of a huge population of patients (8-9) raised timing error risk by an 8.27 factor.

Health facilities and Hospitals are continually striving to reduce medication errors by way of technology, education and monitoring. Possible medication errors can be avoided if various nursing strategies are implemented as it is always nurses that administer medication. One of the strategies is double checking (Evans, 2009). Australian Commission on Safety and Quality in Health Care (ACSQHC) posits that using visual reminders as well as checklists like posters has ensured that awareness is raised over certain issues, like the "clean your hands" NPSA campaign. A campaign of a similar nature highlighting the vitality of medication administration protocols that are safe could be worthwhile as well (Jones, 2009). Jones (2009) made a suggestion that checklists be used to ensure adherence to protocols in the course of administering medication.

Being involved in the intervention helped me appreciate that on their own the 5 rights aren't adequate in preventing high medication error rates. This will have a significant effect on my practice as I acknowledge...

This is right response, as per Evans (2009). Its focus is on evaluating the medication effectiveness, and asserts the importance of providers taking responsibility for medication administration (Evans, 2009).
Medication Intercept 2:

Paracetamol 240 mg, charted as a PRN analgesic, was to be administered every 6 hours to a child having abdominal/appendicitis pain. The order was in the paediatric NIMC. The child on complaining about pain was given a paracetamol dose at 08:30. The anaesthetic registrar came at 10:15 to the ward for a review and charted Paracetamol 240 mg and Midazolam 4mg as a per-medication in the Anaesthetic Record Assessment Form. The medications were to be given on call before the child went to surgery. The theatre called at 10:50 for the child to be readied for the surgery. The registered nurse who was to administer the pre-medication order requested another registered nurse to check the Midazolam dose with her. On carrying out the five checks before the administration of the medication, the checking RN checked the NIMC and discovered that Paracetamol had been administered to the patient earlier. This is how the registered nurse about to administer another Paracetamol dose was made aware of the child being given Paracetamol in less than six hours before then. The RN who administered the medications did not check for other administered medications in the NIMC.

Medication errors are the most prevalent kind of errors in medication. They take place in various phases including administration, transcription, distribution and prescription. While there is a prevalent belief that the errors aren't as harmful as other errors, very little evidence exists in support of the belief. Intrinsic factors contributing to the save I made was my motivation of ensuring safe practice for our patients. This is an instance of personal commitment, it refers to a nurse's involvement in decision making that regard the safety of patients and the efforts that they are engaged in to ensure their maintenance. A demonstration of this was manifested by actively looking for clarification on the medication. This active approach shows incorporation of intrinsic factors in the practice. A further demonstration of this is complying with the requirements of the Australian Commission on Safety and Quality in Health Care (ACSQHC) by providing and coordinating care by being able to give effective, safe and comprehensive evidence-based care so as to attain the identified outcome, like avoiding Paracetamol overdose (Jones, 2009). The availability of senior staff provided a good skills mix to avoid the accident.

There are certain interventions which could be made use of so as to enhance intervention, the most applicable being conducting regular and comprehensive medication assessments so as to identify the risks present and so increase the safety of patients. This will be in compliance with the criteria of Governance and Systems for Medication Safety (ACSQHC, 2012).

Identifying the "good save" had a great influence on my practice and gave me encouragement to double check a patient's medication always and comprehend the composition of the medication as concerns their composition so as to avoid accidental overdose or under-dose.

Medication Intercept 3:

A child aged six having otitis media was admitted at 20:10 to the ward. As the child was being admitted, the father of the child who was not very good in English stated that the child did not have any known allergies. The box for nil known allergies was checked while the other one for allergies and drug reactions was left unchecked. The hospital had a policy that just one parent could stay over to watch the child at night and so the mother of the child came and the father went back home. Charted by the medical officer was Augmentin 125mg TDS. The first dose was to be administered at 21:00. As another nurse and I were carrying out the five rights of medication administration, I inquired form the mother if the child could have had some allergies. The mother noted that the child had shown a rash in reaction to Penicillin when she was still a baby. The Augmentin dose wasn't administered as it ought to be avoided in case there is a known reaction to Penicillin. This was made known to the medical officer who did further investigation. The correct box was then checked and the Ceftriaxone was given instead.

Its true that the nursing environment can be stressful at times. There is predisposition to error as the hospital tasks are usually done in a fast-paced environment full of distractions (Teunissen et al., 2013). While such an extrinsic factor might have an impact on the nature of work done at the hospital, nurses should be committed to certain values and be…