Professional Nursing Practice

The medication safety standard can be observed to be practiced in various settings in Australian healthcare system. The main areas where this standard is being practiced include, transition of care, within acute hospital settings, in palliative care, in residential care facilities and so on. Transition of care can be considered as vulnerable points for the purpose of medical management (Hewitt, 2015). Studies have revealed that problem with medication occurred during transition of care in residential care facilities and the rate is also observed on an incremental pattern. Medication safety can also be seen as a major contributor to delay of medication administration. The rate of re admission is also quite large in patients who missed to get their doses on time for one reason or another. This rate is more prevalent in patient who are recently being discharged from various care facilities. Not many studies have however, being conducted to analyse for medication safety in acute hospital settings or home settings as well. However, the incidences of adverse medication applications have been quite evident and have been a major issue of concern.

This reaction has been observed more stringently in conditions where acute infections is manifested in its full capacity such as, bacterial endocarditis, cellulitis, deep vein thrombosis, acute septicaemia and so on (Roughead, 2016). Most of the cases were found to be directly associated with adverse medication events, and no other underlying cause was detected for the same. This problem is thus, the main issue to be taken into consideration. The issue is however, a bit complex with the application of the same in the palliative care units. The adverse drug reactions were observed both on the admission and as well as documented during admission. The greater harm was observed in individuals receiving palliative care on community basis as well. The connecting links for the same are yet to identified. Many of the studies pointed this adverse medication events, attributed to poor documentations, follow-ups, poor reviewing of physician care notes and so on (Westbrook, 2015). The highest level of reporting of such events were note din residential care facilities.

The underlying factors that were noted included, identifying the problems within the community, altering the form of doses for the patient and not documenting the same in a proper manner, poor supplies and so on. For these specific age groups, there have been an inappropriate medication administration has also been reported. There is also a lack of surveillance in such care facilities and thus, a constant monitoring for medication safety is rare occasion to be noted. It is also not deemed as a main clinical priority in such settings as well. The incidences were reported more often in aged care facilities as well. There is a constant reporting observed in each patient in these settings. The underlying factors remain, poor review of medications prescribed, untimely medication reconciliation, not being able to identify for adverse medication events and poor reporting of the adverse events to higher authorities, leading to grave negligence in action taking against the same (Sahay, 2015).

Multiple incidences reported can lead to adverse events, that in evidently increases the risk on patient safety and security as well. These errors can however be narrowed down by inculcation of multiple measures. Standardising medication charts can be one of these strategies. This can be implemented on larger national level as well. The studies conducted on the same topic have revealed that the chances of documentation errors were found to be reduced drastically with eth inclusion of standardization of medication charts (Morrison, 2018). This was thus, helpful in reducing the overall harm to the patient. The greater impact was observed in high-risk incidences such as insulin administration, prophylaxis treatment for venous thromboembolism and so on. By using this method of effective documentation, the drugs were also provided to the patient in a timely manner. The charts were also able to give back a positive feedback in cases where timely interventions were conducted, reducing the risk to the patient by greater amount. Use of electronic prescribing system is another way to deal with the ongoing situation (Zadeh, 2016).

This method has been found to have a greater impact in acute care settings, where chances of prescribing errors has been reported at a higher rate. These devices were however, found to be useful in reducing the prescribing errors largely, especially the one that were observed during various procedures. The main lacking point with inculcation of this method were the system related errors, that were reported largely. The medication errors were quite less when administered manually, in comparison to e-prescribing, thus, failing the system in attaining its main target. However, these errors can be narrowed down easily with the help of user-training system in the Australian hospital settings. Accurate clinical decision- making has also been noted helpful in reducing these errors drastically. Smart pump is another way of e-medication management (Balasuriya, 2017). These strategies will be helpful mainly in reducing the errors with the volumetric infusion of medications. Another implementation in lieu of reducing these errors can be inclusion of medicine reconciliation as it is reported as an underlying cause in many care settings.

This will be able to renew the medications of the patients on a regular basis and will also be helpful in narrowing down the discrepancies observed in between the prescribed medications and the medications that are being taken by the patient. This will eventually be helpful in reducing the length of stay in the hospital. This can be carried out with the help of a pharmacist as well (Chen, 2016). They are well-versed at comprehending the medication charts and can help significantly in reviewing the same. These reviews can also help in reducing the inadequate documentations regarding patient’s allergies and can thus, be helpful in reducing adverse medication events largely. This will also be helpful in maintaining the accuracy of medication history in the patient charts, as it will be reviewed over on regular and up to date basis. The same will be reflected upon directly in patient’s outcomes as these medications will be prescribed in a safer manner and will be re-reviewed and scrutinized effectively, before being prescribed to the patient population.

Plan-to-do-study-act cycles are a way by which continuous quality improvement can be attained in promoting medication safety (Dale, 2019). This will thus, be helpful largely in promoting patient safety as well. These plans have been very helpful in reducing the medication errors, adverse medication reactions and have also been useful in improving the process of documentation and reporting of these errors. The main method is by improving on the medication documentation and imparting education to the staff involved in patient care regarding the importance of the same. The method of SCRIPT can also be followed to reduce the number of medication errors as well improve on the efficiency of the administration of the drugs. SCRIPT method includes step-wise protocol to be followed, so that no step is missed in the process of medication delivery to the patient. The steps include, senior doctor cross-check, checking for underlying allergies of the patient, writing indications for prescription of antibiotics, noting for the initial date of medication prescription, printing and signing the name of the person prescribing the drug and lastly, selecting appropriate targets for infusion of medication.

The system can also work in order to promote multi-disciplinary approach so that various teams can be involved in effectively managing the same (Sponsler, 2015). By making use of this approach, local interventions can be examined and outcomes can be measured in respect with the appropriate interventions as well. An evidence-based approach will be able to help identify for the underlying issues and will thus, be helpful in providing an optimal solution for the same. The decision-making process can also be done on the basis of audit and feedback tools, that can be provided to the patient and their families in order to recognize for the root causes of these issues in a given particular setting. Educational initiatives can thus be formulated, not only for healthcare professionals and providers, but for patients as well (Wilson, 2016).

The baseline measures can be taken and the same can be compared in monthly basis, in order to note for the efficacy and reliability and authenticity of these measurement tools and interventions in place. This will also help in working on the grey areas of concerns and will be able to modulate these measures in sync with the current requirements and needs. Failure mode and effect analysis (FEMA) can also be helpful in mapping the steps of protocol involved in these intervention strategies (Vida, 2019). This will help in evaluating the probability of error and will thus, be able to correct the procedure before it is implemented in its full capacity. This will also enable the team involved in the process, in reducing the risk and harm the patient population might be subjected to, due to poor medication safety and administration. The introduction of the guidelines for the nursing staff can thus be accompanied with educational and promotional materials, that will be helpful in imparting about the unknown risks and harm, they and the patient might be subjected to, due to poor medication safety.

References for Professional Nursing Practice

Balasuriya, L., Vyles, D., Bakerman, P., Holton, V., Vaidya, V., Garcia-Filion, P., ... & Kurz, R. (2017). Computerized dose range checking using hard and soft stop alerts reduces prescribing errors in a pediatric intensive care unit. Journal of Patient safety, 13(3), 144-148.

Chen, T. F. (2016). Pharmacist-led home medicines review and residential medication management review: the Australian model. Drugs & Aging, 33(3), 199-204.

Dale, B. G., Lascelles, D. M., & Plunkett, J. J. (2019). TQM Practices and Customer Satisfaction among Small and Medium-Scale Enterprises in Nigeria: An Empirical Investigation. International Journal of Social and Management Sciences (IJS&MS), 6(1), 38-43.

Hewitt, J., Tower, M., & Latimer, S. (2015). An education intervention to improve nursing students' understanding of medication safety. Nurse Education in Practice, 15(1), 17-21.

Morrison, M., Cope, V., & Murray, M. (2018). The underreporting of medication errors: A retrospective and comparative root cause analysis in an acute mental health unit over a 3‐year period. International Journal of Mental Health Nursing, 27(6), 1719-1728.

Roughead, E. E., Semple, S. J., & Rosenfeld, E. (2016). The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia. International Journal of Evidence-based Healthcare, 14(3-4), 113-122.

Sahay, A., Hutchinson, M., & East, L. (2015). Exploring the influence of workplace supports and relationships on safe medication practice: A pilot study of Australian graduate nurses. Nurse Education Today, 35(5), 21-26.

Sponsler, K. C., Neal, E. B., & Kripalani, S. (2015). Improving medication safety during hospital-based transitions of care. Cleveland Clinical Journal of Medicine, 82(6), 351-60.

Vida, M. Á. C., de la Plata, J. E. M., Morales-Molina, J. A., Lázaro, J. J. P., & Robles, P. A. (2019). Identification and prioritisation of risks in a hospital pharmacy using healthcare failure mode and effect analysis. European Journal Hospital Pharmacy, 26(2), 66-72.

Westbrook, J. I., Li, L., Lehnbom, E. C., Baysari, M. T., Braithwaite, J., Burke, R., ... & Day, R. O. (2015). What are incident reports telling us? A comparative study at two Australian hospitals of medication errors identified at audit, detected by staff and reported to an incident system. International Journal for Quality in Health Care, 27(1), 1-9.

Wilson, A. J., Palmer, L., Levett-Jones, T., Gilligan, C., & Outram, S. (2016). Interprofessional collaborative practice for medication safety: Nursing, pharmacy, and medical graduates’ experiences and perspectives. Journal of Interprofessional Care, 30(5), 649-654.

Zadeh, P. E., & Tremblay, M. C. (2016). A review of the literature and proposed classification on e-prescribing: Functions, assimilation stages, benefits, concerns, and risks. Research in Social and Administrative Pharmacy, 12(1), 1-19.

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