Describe what it is you thought, observed, experienced or did
I am reflecting on an incident that happened during one of my clinical placements. I have used the Gibbs reflective model to reflect upon various stages that includes description, feeling, analysis, conclusion and action plan (Smith & Roberts, 2015). It aims to reflect on a critical incident involving medication error. With the on growing reliance on the medication therapy as the nursing intervention for most illnesses, patients receiving them are prone to a lot of benefits as well as potential harms. Use of medication consists of a broad range of activities that encompasses multi healthcare professionals and a variety of steps such as prescribing, transcribing, dispensing, administering and monitoring that leads to multiple opportunities for medical error (Saghafi, & Zargarzadeh, 2014). As a nursing student, one of my placements was in a critical care setting. I was working under the supervision of a senior registered nurse in the process of providing care to Mr. Harry (pseudonym) aged 62 years is a type-2-diabates patient has suffered a major heart attack last week and is on medications. The patient has been prescribed with saxagliptin, glipizide once a day, metformin twice a day whereas morphine when in extreme pain conditions.
It was about a day in the ward when I was observing the ECG of Mr. Harry after the daily tests and observations and was taking the vital signs when I noticed some abnormalities in heart rate. I noticed that there has been an extensive swelling on both the feet and he also complained about having chest pain and vomiting from last night. I informed this to the registered nurse after which we checked the medication chart. After checking the medication chart, we concluded that the nurse in the previous shift has overdosed morphine. The maximum morphine dosage for the patient was 3 gm per day as prescribed by the doctor, but had already had overdosed 4 gm by the nurse. Vomiting and swelling are the two indicative signs that the patient’s health has been adversely affected by the overdosage of morphine (Liu, Yang & Tao, 2018).
Describe your thoughts and feelings. If relevant, describe your physical, intellectual or emotional reaction to it I realized that it is just a matter of one bad experience that is enough to change the person’s outlook towards the healthcare settings. This crucial incident made me felt worried about the patient’s condition due to the overdose of morphine. Morphine is a kind of pain-relieving opioid that is harmful for the cardiac patient. The adverse effects of the drug include chest pain, irregular heart rhythm and rate, swelling, agitation and dizziness (Manglik et al., 2016).
I felt devastated on realizing that the nurse at the previous shift did not read the medication chart properly and administered the same medicine twice. The behaviour and negligence of the nursing staff can be considered as the two factors that impacted the patient’s health and attitude outcomes. I believe that it is the duty of the nurse to be vigilant enough while administering medications to the critically ill patients in order to maintain his health and wellbeing. Medication safety is very much important where administrating right dosages to the patients is important in treating or preventing illness of the patient (WHO, 2017).
What can be learned from your reactions or the reactions of others? Can the event be analysed with the aid of theory or related to other experiences?
Looking back on the incident, I have gained a strong understanding about the medication safety and importance of providing right dosages for maintaining optimal patient well-being. It has been found that the medication errors involving improper dosages accounts for 41% of the fatal medication errors (Marks, 2018). The case was thought-provoking for me that made me the realize the importance of medication safety and medication dosage. It has been observed that most of the opioids including morphine tends to have a direct negative impact on the cardiac contractility. However, administration of opioid medications combining to other medications can be taken seriously as it is associated with decreased cardiac function (Chen & Ashburn, 2015). According to the standards of Medication Safety, the five rights of medication involving right patient, right drug, right dose, right time and right route (Smeulers et al., 2015).
I evaluated this incident with having a deep insight about the proper maintenance and checking of medication chart before administering any medication to the patient. It also made me noticed that the nurse on the previous shift was on double shift. Medication errors generally occurs due to a variety of reasons that includes fatigue, carelessness, stress, long work hours and poor communication (Bolandianbafghi et al., 2017). The use of opioids has been observed associated with the increased risk of coronary heart disease. Medication error occurs due to the wrong medicine regimen to incorporate involving the wrong dosages (Wahr & Merry, 2017). The acknowledgment of the situation made me realize that due to the prolonged working hours and lack of proper understanding, the nurse rushed to administer the patient with wrong dosage.
What would you do in similar circumstances in the future? If relevant, how might similar circumstances be avoided?
By looking at the entire scenario, I have made it a point to never repeat the same in the future. It is very much important to cross check the medication charts. I have realized that it is very much important to comply to the standards of the medication safety in the healthcare environment. Non-compliance to the safety standards can cause the deterioration of the patient’s health (Fuzzell et al., 2018). I have learned about the five rights of the medication safety which works in accordance to the medication chart of the patient to administer medicines to the patient. Thus, the similar situations can be avoided by being vigilant and having a thorough reading about the dosages of the medicines being prescribed to the patient to avoid medication errors and also to deliver optimal quality care to the patients. Also, education and training can be provided to the nurses in order to make them more confident to perform safe medications administrative practices on critically ill patients (Lee, Jang & Park, 2016).
The education practices will also help in coping up with the extra workload and in prioritizing the tasks to ensure the patient safety and health. Documentation of the medications can also be a helpful strategy that will help in maintaining the records of the patients and promotes health safety of the patients (Ni Chroinin et al., 2016).
From thinking about and writing about this event, what have you learned about your learning and development?
As a result of the entire incident, I realized that the complete incident was thought-provoking for everyone. Mr. Harry’s deteriorated condition with the continuous chest pain and vomiting has reflected the medication error that has been caused by the overdosage of morphine. Medication errors are the adverse drug events that can be caused by a variety of reasons (Saghafi & Zargarzadeh, 2014). The negligence and fatigue of nurse due to prolonged shifts and stress has led to medication error (Bolandianbafghi et al., 2017). However, the medication errors are preventable that needs more sincere approach to deal with. Adhering to the medication safety helps in overcoming the medication errors in the future. Reflecting back upon the incident now I feel much more confident and responsible now in working accordingly for prioritizing the safety of the patient and to challenge the practices that are not culturally safe. In the future as a Registered nurse, I will aim at complying to all the standards and procedures related to the medication safety.
I will make it as a goal for my learning and will be extra cautious and accountable for maintaining an enhanced nurse-patient relationship. As a healthcare professional, I will abide to my duties while taking care of the patients and will always ensure in promoting the safety of the patient and health related quality of life by reducing the harms caused to the patients in the healthcare settings.
Have you thought about how you might tag this plan to make it more searchable in the future? You can add multiple tags to reflect personal, professional and/or academic goals.
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Chen, A. amp Ashburn, M.A. (2015). Cardiac Effects of Opioid Therapy. Pain Medicine, 16(1), 2731.
Fuzzell, L. N., LaJoie, A. S., Smith, K. T., Philpott, S. E., Jones, K. M., amp Politi, M. C. (2018). Parents adherence to pediatric health and safety guidelines Importance of patient-provider relationships.Patient education and counseling,101(9), 15701576.
Lee, N. J., Jang, H., amp Park, S. Y. (2016). Patient safety education and baccalaureate nursing students patient safety competency A crosssectional study.Nursing amp health sciences,18(2), 163-171.
Liu, Y., Yang, L., amp Tao, S. J. (2018). Effects of hydromorphone and morphine intravenous analgesia on plasma motilin and postoperative nausea and vomiting in patients undergoing total hysterectomy.European review for medical and pharmacological sciences,22(17), 56975703.
Manglik, A., Lin, H., Aryal, D. K., McCorvy, J. D., Dengler, D., Corder, G. amp Huang, X. P. (2016). Structure-based discovery of opioid analgesics with reduced side effects.Nature,537(7619), 185.
Marks, J.W. (2018). The most common medication errors. Retrieved from https//www.medicinenet.com/drugs_the_most_common_medication_errors/views.htm
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Smeulers, M., Verweij, L., Maaskant, J. M., de Boer, M., Krediet, C. P., van Dijkum, E. J. N., amp Vermeulen, H. (2015). Quality indicators for safe medication preparation and administration a systematic review. PLoS One, 10(4), e0122695.
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WHO. (2017).Patient safety making health care safer. Retrieved from https//apps.who.int/iris/handle/10665/255507
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