Present case study deals with a 72-year-old male patient who was admitted to medical ward with probable diagnosis of pneumonia. It is a form infection associated with lung/pulmonary parenchyma (Mandell, 2015). Pneumonia is one of the prime causes of morbidity and mortality globally (Lanks et al., 2019). Various types of microorganisms (bacetria, virus and fungus) may result in pneumonia. Treatment of pneumonia depends on the nature of causative organisms. In this case patient was prescribed with benzylpenicillin. This essay focuses on the validation of the medication order given, justification of the charted medicine in context to pneumonia and its therapeutic interaction, discussion on the process of administration strategy and about documentation of medications.
Medication order is a written documentation of the medicines given by a medical practitioner, which is to be administered to a patient for treatment of a particular disease. A medication order is valid if medical practitioner includes all the following information into the order. The order must have the date at which the medication order was written and complete signature of medical officer along with contact number. It should have the Generic name of the prescribed drug, as there may be different brand names of the same drug. In medication order format it is always recommended to give a red tick to guide whether the standard release form of the drug is necessary or not. Commonly used abbreviations are to be mentioned for indicating the route of drug administration.
Drug doses should be written in metric or Arabic systems. There must have an indication of context for prescribing the medication. There are six rights for medication administration: right patient, right medication, right dose, right time, right route and right documentation (Baraki et al., 2018). In this case study the patient was prescribed for intravenous injection of benzyl penicillin. The principal treatment modality for pneumonia is antibiotic treatment (Mantero et al., 2017). Therefore the choice of medication was right. Intravenous injection is FDA approved route for penicillin administration which is also valid in this case (Spencer et al., 2018).
Identification of the causative organism of Pneumonia is very challenging through clinical examination. Pneumonia may also be characterized as community-acquired (CAP) or hospital-acquired (HAP), nosocomial (NAP), and ventilator-associated (VAP). Antibiotics are the mainstay of treatment for bacterial pneumonia. In this case, patient is suspected to be infected from the CAP as he had no history of recent hospital admission. Benzylpenicillin is a narrow spectrum of antibiotic for treatment of several infections caused by Streptococcus pneumoniae (Agweyu et al., 2015).
Herein, Sputum sample test and blood culture was done for the diagnosis followed by IV injection of benzylpenicillin which supports the treatment strategy reported for CAP treatment (Komagamine J 2018). Before the IV intervention of the prescribed antibiotic, patient was asked about any previous hypersensitivity to any other penicillin/ carbapenems/ cephalosporins. Furthermore, patient was educated about the possible side effect associated like fever, joint pain, dizziness etc. Some rare effects were which was also explained to Patient. Benzylpenicillin has reported to have high activity against pneumococci (Komagamine, 2018). Fat emulsion and some drugs, such as aminoglycosides, heparin sodium, tranexamic acid interfere with the excretion of benzylpenicillin.
Intravenous (IV) administration is the rapid pushing of medication into the vain of patient through IV catheter. The recommended dose for benzylpenicillin IV injection is 60 mg/ml. This medicine is available in two vials 600 mg, 1.2 and 3 g. For dose preparation, 600 mg vial, at first is reconstituted in 5 ml water followed by further dilution in 5 ml water to make the final concentration to 60 mg/ml. Similarly, for the 1.2 g vial, firstly it was reconstituted in 10 ml water followed by further dilution to 10 ml water. The dose must be injected slowly for at least 3-10 minutes as high levels of benzylpenicillin cause irritation of CNS , hypokalaemia and hypernatraemia (Veltri & Mason et al 2015).
Benzylpenicillin is compatible with glucose (5%), Plasma-Lyte 148 via Y-site, and 0.9 % sodium chloride Before use, the solution must be shaken vigorously, filtered (0.2 micron filter), and should not be mixed with other drugs, blood products, IV solutions. Finally, the line should be flushed with normal saline before and after penicillin infusion. Three times check for medication consists of first check when benzylpenicillin is pulled/retrieved from the dispensing machine, medication drawer, etc. The second check is to determine the time when preparation of the benzylpenicillin has taken place. Finally the third check happens at the bedside of patient before medications. A nurse should critically follow these to avoid any fatality and mistake.
Proper documentation of patient records is of prime importance in medication process. Improper and wrong documentation may lead to incorrect clinical decision and thereby resulting in implementation of inappropriate treatment for the patient (Hammer et al., 2019). Documentation must be: concise, accurate, authentic, reliable, clear, date and time mentioned, readable, relevant which reflects nursing process and contain timely maintained information of the patient. Documentation can be paper or electronic and documentation method can be writing, recording, charting and reporting (Mathioudakis et al., 2016).
Documentation of medication and relevant patient related information is a legal need for most of the healthcare systems. Transmission of patient related information and discussion is also important to ensure proper care. Erroneous, incomplete, and inefficient medication related documentation often lead to Medication-related adverse events (MRAE) (Hammer et al., 2019). So development of improved and efficient method of documentation is need of the hour.
Proper patient care involves several guidelines and practises. Validation of medication is very important in this regard. Administration of drugs should be abided by six right and three checks. Efficient documentation of medication and keeping clinical records of patient ensure effective and improved treatment modality to a patient. In this case study the patient diagnosed with Pneumonia was treated with intravenous injection of Benzylpenicillin which was valid. Intravenous administration with this drug should be slow and patient should be aware of this before the intervention. This essay demonstrates the theoretical understanding of administration of an IV medication to a patient.
Agweyu, A et al., (2015). Oral amoxicillin versus benzyl penicillin for severe pneumonia among kenyan children: a pragmatic randomized controlled noninferiority trial. Clinical Infectious Diseases : an official publication of the Infectious Diseases Society of America, 60(8), 1216–1224. https://doi.org/10.1093/cid/ciu1166
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Spencer, S., Ipema, H., Hartke, P., Krueger, C., Rodriguez, R., Gross, A. E., & Gabay, M. (2018). Intravenous Push Administration of Antibiotics: Literature and Considerations. Hospital Pharmacy, 53(3), 157–169. https://doi.org/10.1177/0018578718760257
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