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  • Subject Name : Nursing

Effect of Simulation on Nursing Students' Medication Administration Competence

Introduction to Safe Medication Management

Safe medication management is important and it is necessary to provide a provision for the safe and the quality healthcare. The Registered Nurses has an integral role in maintaining the patient safety and even providing the decreasing role to overcome the risk of medication and ensure the provision of the safe and quality healthcare (Schutijser, et al, 2019), The role of the Registered Nurse aims to provide the patient safety and aim to decrease the decreasing the risk of medication-related harm and ensure to plan out and draw an assessment that could provide optimum care to the person-centric care for the person experiencing acute health issues. Medication management is an important step to be part of the health care provider that could provide the best municipal nursing along with the care services (Vandewaa, 2017).

Nursing Care when Monitoring for A Response After Medication Administration

Medications administration has been identified to be a common source of error within the practices of Australian healthcare. Instances have been observed in the clinical cases, where there have been several compromises in the medication safety protocols that have been breached, as a result of the patient’s death. One protocol is to administering medication within the new facility that has not been registered in the Information Technology (IT) (Santavirta, 2020). The registration staff needs to deem capable in preparing, dispensing and even prescribing or administering medication, therapy keeping it up to date and largely made accessible, so the other listed staff can follow the tasks (The Clinical Oncology Society of Australia [COSA] 2017). As a part of the register staff, they should be appropriately is trained, be able to follow their competency levels and be aware of the disastrous outcomes that are linked with administering the incorrect drug (COSA 2017). NSQHS Standard 4 on medication safety aims to reduce the errors within the medication management and to provide the practising clinicians with the safely prescribe, dispense, administer and even monitor medicines (ACSQHC 2017). As per the Standard 4.1 identifies that it is an integration of clinical governance that can be followed by the clinicians who can implement the policies or procedures that could relate with medication management and to manage medication risks that can identify training requirements. Additionally, as per the 4.15, it refers to the identification along with obligating the safe management practices of the high-risk medications (ACSQHC 2017). Standard 4.2 to apply quality improvement systems, Standard 4.2 to partner with consumers. Action 4.3 to follow the Medicines scope of clinical practice and as per the Action 4.4, it is necessary the stages, that can follow the protocols and policies would help to ensure to follow a high standard of care and to provide the maximum care to limit the risk of error (WHO 2016). Health facilities protocols need to provide the correct process and should follow the prescribing, dispensing and administering medications (COSA 2017). In any risky situation, it is important to follow the policies and protocols that can reduce the risk of error and even aim to reduce or eliminate adverse events (WHO 2019). The health facility has to be provided with the relevant protocols and aim to provide the staff need to register the administering medications that they have not been allowed to.

Importance of Medication- a Process

As per the Standard 4 practices (ACSQHC, 2017), risks associated with every part of the medication management cycle can be avoided with the proper adherence to the systems and processes (Molloy, 2017). The main goal of the medication safety practices ensures to improve safety, and also provide the quality services to demonstrate the significant benefit. Such initiatives would focus on contributing factors in medication error that covers the below-:

  • Experiencing the lower knowledge of the medication
  • Having a low scope of information related to patient
  • slips or having the memory lapses
  • transcription errors

National Medicines Policy released by the Australian Department of Health.

About the National Medicines Policy

It was launched in December 1999, known as the National Medicines Policy (NMP)

  • quality care that would be more responsive the people’s needs;
  • incentives to provide preventive health with cost-effective care;

Changed policy was to provide better people’s expectations and it should be followed with the healthcare and information systems, medicines themselves. The policy also ensures that it is the medicines subsidies along with the health services remuneration and to follow over and include the digital technologies, along with the pharmaceutical industry. The changes can be followed by the certainty of the National Medicines Policy (Alomi, 2017).

When Preparing for And During Medication Administration

Medication errors can be challenging in health care (Centers for Disease Control [CDC], 2013). To have safe and accurate medication administration can help to reduce the errors and make the nurses more responsible. When administering the medication Standard 6.1 of the Safe Medication Administration has to be followed-:

Safety Considerations:

Safety consideration required training and to check for any allergy.

Be vigilant and then to prepare for the medications (Alomi, 2017).

To check for the patient identification.

Assessment should come after the medication administration.

Be diligent and also being able to do medication calculations.

Avoid dependency on the memory or the low use of checklists and memory aids.

Communicate with the patients and to know the effects and alertness before and after administration.

Avoid any possible workarounds.

Medication should not be expired.

Provide routine procedure and medication effects.

To use the available technology that can administer medications.

Any sort of miss’s errors or patient showing the adverse reactions should be reported

Be attentive and alert, incase patient shows concern, the drug should not be administered (Abdelmalak, 2017).

When Monitoring for Response

Medication monitoring is a process to check for the possible reactors and the adverse reactions in the blood (Armstrong, 2017). Drugs prescribed should be monitored for the quantities, timings, gaps and the duration. Possible reasons and the side effects should be noted and documented to be discussed with the multi-disciplinary team. As per the Action 4.10.2. The strategies are the Implement the recommendations for the process of monitoring, reviews, incident reports, and to check for any possible adverse events and near misses. For any possibility of the medication error and prevention strategies, it is important to safely store the medication storage and distribution and to provide the workforce training programs and efficient education sessions over medication safety.

During Transitions of Care

At the point of the transient, the healthcare has to be effective with the medication from the point of the starting, changing or discontinuing non-prescription and even for the OTC drugs. During the transients of care, it does not involve the handover during the staff transient. WHO advocates, that appropriate prescribing and risk assessment of the medication safety and practices should be followed, better medication review, when dispensing, preparing for the medication safety and to have the effective patient engagement (Armstrong, 2017).

Registered Nurse in The Promotion of Medication Safety

Two contributing safety issues that can result in the errors by the healthcare staff is of the staff ineffective communication and even having low safety medication procedures. It is highlighted from The Australian Commission on Safety and Quality in Health Care (ACSQHC 2017) and as per the National Safety and Quality Health Service (NSQHS) Standards, with Standard 4 relating to medication safety and Standard 6 communicating for safety. The role of the RN is important to understand how to have safe medication practices (Armstrong, 2017). The role of the RN is to provide the safe medication administration and even obligate the RN’s to check for any medication orders, that is correct and to be signed by the prescribing doctor. The RN and the doctor would be held responsible and accountable while regulating the administer medications and any complication in following the incorrect order (Levitt-Jones 2017). Further, to reduce the risk of error RNs it is important to check for the three checks of the medication against the order and even to follow the five rights of medication administration (Levitt-Jones 2017). The steps involve the verification of the right medication, dose, time, route and patient (Levitt-Jones 2017). The duty of the RNs is important to understand and to educate the patient that has been prescribed medications and to follow the risks and gain in informed consent. The patient’s allergy status would have to be checked, accurately and timely documentation has to be used with the equipment disposed of safely (Vandewaa, 2019)..

Conclusion on Safe Medication Management

Through the medication safety standards, it is important to follow the sub-process and to provide an overall treatment of patients and even ensure the subjective requirements for the overall professional accountability. Medication management is also challenging task that has to be provided with foremost strength and efficacy of medications when it is provided to the patients prescribed for patients that have more than one illness, also called as a comorbidity.Because of the complexity depending on medication management processes, it was important to adhere to the multidisciplinary collaboration. It is necessary partnerships with patients and careers that could achieve the best possible medication and follow the treatment outcomes.

References for Safe Medication Management

Abdelmalak, R., Quinones, I., & Wang, W. (2016). Creating a "quiet zone" for safe medication administration at a metropolitan hospital. Urban Medicine, 44.

Armstrong, G. E., Dietrich, M., Norman, L., Barnsteiner, J., & Mion, L. (2017). Nurses’ perceived skills and attitudes about updated safety concepts: Impact on medication administration errors and practices. Journal of nursing care quality32(3), 226.

Alomi, Y. A., Khayat, N. A. Y., Baljoon, M. J., Bamagaus, Y. A., & Jumah, H. M. A. (2017). National Survey of Hospital Medication Safety Practice during Mass Gathering (Hajj-2016): Medication Administration. J Pharm Pract Community Med3(4s), s36-s42.

Australian Commission on Safety and Quality in Health Care (ACSQHC) 2019, Action 6.7 clinical handover, viewed 9 October 2019, https://www.safetyandquality.gov.au/ standards/nsqhs-standards/communicating-safety-standard/communication-clinicalhandover/action-67

Australian Commission on Safety and Quality in Health Care (ACSQHC) 2017, National and quality health service standards, viewed 10 October 2019, https://www. safetyandquality.gov.au/standards/nsqhs-standards Australian Commission on Safety and Quality in Health Care (ACSQHC) 2019, ‘Communicating for safety resource portal’, Australian Commission on Safety and Quality in Health Care, Image, viewed 13 October 2019, https://www.c4sportal. safetyandquality.gov.au/

Blazeck, A., Faett, B., Reid-Kelly, L., Miller, S., Hromadik, L., & Haines, J. (2020). WARRIORS: An Educational Initiative Improving Clinical Judgment and Safety in Medication Administration. Journal of Nursing Education59(4), 231-234.

Blignaut, A. J., Coetzee, S. K., Klopper, H. C., & Ellis, S. M. (2017). Medication administration errors and related deviations from safe practice: an observational study. Journal of clinical nursing26(21-22), 3610-3623.

Durham, M. L., Suhayda, R., Normand, P., Jankiewicz, A., & Fogg, L. (2016). Reducing medication administration errors in acute and critical care: multifaceted pilot program targeting RN awareness and behaviours. JONA: The Journal of Nursing Administration46(2), 75-81.

Jarvill, M., Jenkins, S., Akman, O., Astroth, K. S., Pohl, C., & Jacobs, P. J. (2018). Effect of simulation on nursing students' medication administration competence. Clinical Simulation in Nursing14, 3-7.

Kanjia, M. K., Adler, A. C., Buck, D., & Varughese, A. M. (2019). Increasing compliance of safe medication administration in pediatric anaesthesia by use of a standardized checklist. Pediatric Anesthesia29(3), 258-264.

Özkan, S., Kocaman, G., & Öztürk, C. (2016). Interruptions during pediatric medication preparation and administration.

Paparella, S. F., & Mandrack, M. M. (2016). IV push medication administration: making safe choices; choosing the best practice. Journal of Emergency Nursing42(1), 64-67.

Preston, P., Leone-Sheehan, D., & Keys, B. (2019). Nursing student perceptions of pharmacology education and safe medication administration: A qualitative research study. Nurse Education Today74, 76-81.

Martyn, J. A., Paliadelis, P., & Perry, C. (2019). The safe administration of medication: Nursing behaviours beyond the five-rights. Nurse education in practice37, 109-114.

Molloy, J. (2017). Reinforcing medication administration through student-directed simulation. Teaching and Learning in Nursing12(4), 307-308.

Nursing and Midwifery Board of Australia (NMBA) 2018, Code of conduct for nurses, viewed 11 October 2019, https://www.nursingmidwiferyboard.gov.au/documents/default. aspx?record=WD17%2f23849&dbid=AP&chksum=ki92NMPa9thp9f9ZhTQNJg%3d%3

Nursing and Midwifery Board of Australia (NMBA) 2016, Registered nurse standards for practice, viewed 10 October 2019, https://www.nursingmidwiferyboard.gov.au/codesguidelines-statements/professional-standards/registered-nurse-standards-for-practice. aspx

Santavirta, J., Kuusisto, A., Saranto, K., Suominen, T., & Asikainen, P. (2020). Electronic Medication Administration System Supports Safe Medication Administration. Studies in health technology and informatics270, 1267-1268.

Schutijser, B. C. F. M., Jongerden, I. P., Klopotowska, J. E., Portegijs, S., de Bruijne, M. C., & Wagner, C. (2019). Double-checking injectable medication administration: Does the protocol fit clinical practice?. Safety Science118, 853-860.

van der Veen, W., Taxis, K., & van den Bemt, P. M. L. A. (2017). Safe medication administration in hospitals. Nederlands tijdschrift voor geneeskunde161, D1778.

Vandewaa, E., Rudd, A. B., Estis, J. M., & Gordon-Hickey, S. (2019). Safe Medication Administration in Patients with Communication Disorders: A Simulation-Enhanced Interprofessional Education Approach. Journal of Allied Health48(4), 257-264.

World Health Organization (WHO) 2016, Medication errors: technical series on safer primary care, World Health Organization, viewed 10 October 2019, https://apps.who.int/iris/bitstream/handle/10665/252274/9789241511643-eng. pdf;jsessionid=370A717260AF6322EC9795FB7BB085BC?sequence=1

World Health Organization (WHO) 2019, Medication safety in high-risk situations, Technical report, World Health Organization, viewed 10 October 2019, https://apps.who.int/iris/ bitstream/handle/10665/325131/WHO-UHC-SDS-2019.10-eng.pdf?ua=1 World Health Organization (WHO) (dir.) 2008, video, Chapter 2 - learning

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