Medication Safety and NSQHS Standards in Nursing Practice

Introduction

The standards set by the National Safety and Quality Health Service (NSQHS) are designed to ensure that health service consumers receive the same quality of care in any healthcare facility across Australia (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2016). The primary objective of the NSQHS standards is to protect users of health services from harm and to enhance the quality of care provided nationwide. The standards function as mechanisms for monitoring the quality of health services (ACSQHC, 2019). However, despite the existence of these standards and several other safeguards, clinical and professional issues continue to arise in nursing, resulting in harm to health service consumers or a negative impact on the quality of care being offered (Government of Western Australia, 2017).

One of the key standards, Standard IV, establishes requirements to ensure medication safety (ACSQHC, 2019). It deals with drug prescription, administration, and monitoring. Part of the guidelines contained in this standard recommend explaining to patients the use and risks associated with certain medications before prescribing or administering them (Davies, Coombes, Keogh, & Whitfield, 2019). The objective of this essay is to outline an issue related to medication safety and to analyse its legal, ethical, delegation, teamwork, conflict management, and clinical leadership dimensions.

The Incident

In a simulation class, a student nurse and a registered nurse were providing care to a patient who was in severe pain and had asked for pain relief medication. When asked to rate her pain out of ten, the patient said it was eight. She also stated that her leg felt uncomfortable and tight in the cast that had been placed on it. However, the registered nurse was distracted while taking the patient's vital signs and failed to notice the patient's pain level. While the registered nurse measured the vital signs, the student nurse recorded them. Before the end of the measurement session, the student nurse brought the patient's pain to the registered nurse's attention, and together they decided to administer Tramadol for pain relief. While the student nurse was genuinely concerned about the patient's pain, the registered nurse was in a hurry to complete other tasks and rushed to administer the medication (Endacott et al., 2015).

In her rush, the registered nurse did not adequately follow the standards and rights for medication administration. The medication, being a Schedule IV substance, ought to have been checked, counted, and signed by two registered nurses in the treatment room prior to administration (Government of New South Wales, 2013; Government of Western Australia, 2013). This did not happen because the student nurse was not a registered nurse and was therefore outside her scope of practice, and the registered nurse failed to identify this deviation from standard procedure. The medication that was administered ended up being wasted, and the entire administration process had to be re-initiated when a second registered nurse arrived.

Several factors can compromise medication safety. In this particular case, the main factors were a lack of delegation and clinical leadership (Claffey, 2018). The case also raises ethical and legal questions about what occurred (Ben Natan, Sharon, Mahajna, & Mahajna, 2017). Inconsistency in medication administration can negatively affect both the patient and the nursing team (Davies et al., 2019).

Impact on the Nursing Team and Patient

Impact on the Nursing Team

A number of factors can compromise medication safety and negatively affect the nursing team. In this case, team members could be left with negative feelings such as doubt, guilt, and shame (Yung, Yu, Chu, Hou, & Tang, 2016). The nursing student was operating outside her normal scope of practice, and the registered nurse permitted this to occur in an attempt to support the student's learning (Bucknall et al., 2016). Embarrassment following such errors can lead the involved members of the nursing team to avoid admitting what went wrong (Yung et al., 2016). Those involved may also fear consequences such as loss of employment or suspension of their professional licence, leading to stress and diminished performance (Al-Ghareeb & Cooper, 2016). Because nurses are at the forefront of care provision and drug administration, a loss of confidence following an error can significantly impair their work (Jember, Hailu, Messele, Demeke, & Hassen, 2018). Nursing students must also understand their scope of practice and restrict their duties and actions accordingly (Reid-Searl, Happell, Burke, & Gaskin, 2013).

Impact on the Patient

The patient in this scenario had to wait longer than necessary for her medication while in severe discomfort. Her experience was unpleasant and could affect her satisfaction with the care she received (Claffey, 2018). Such an experience could also cause her — and those who learn of it — to distrust medical professionals and the health system (Claffey, 2018). This erosion of trust could further harm both the patient and care providers. Additionally, the scenario could have resulted in adverse events that increased the risk of harm or mortality for the patient (Jember et al., 2018).

Conclusion

The administration of medication is a complex process with registered nurses at the forefront of it. If done incorrectly, or if standards are not adhered to, errors can and do occur. These errors can lead to adverse events for patients and professional consequences for nursing staff. Nursing students require appropriate preceptorship and must handle only those duties that fall within the boundaries of their scope of practice. Regular evaluation of medication administration procedures and ongoing investigation of errors are essential strategies for reducing their future occurrence.

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