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When I was in my clinical placement, I was appointed in the Intensive Care Unit (ICU). I was taking care of 2 patients. One of the patients was having a high potassium level in his body and the other one have a low potassium level. Their beds were side to side. The doctor who was treating the patients came and told the other nurse to write the medication for the patient having a low potassium level as I was not around at that time. After some time, I asked the nurse for the prescription for my patient she showed me the board while she was busy taking over the phone. The board was partially covered by her fingers and the patient bed number was hidden. I did not think much and gave the medication to the patient though I felt something was wrong.
After, giving the medication, I realised, I overdosed the patient with a high potassium level with more potassium. I felt horrible and thought that I mightkill a person. I was also very worried about my career.
After the incident, I immediately told my supervisor about my mistake because according to Nursing and Midwifery Board Ahpra (NMBA), a Registered Nurse (RN) should provide a safe and quality practice so as to achieve the goals and results that are receptive to the people's nursing need. An RN should work under the scope of practice. They should also provide effective supervision to make sure the practice is accurate and safe. They should manage resources efficiently and effectively for the actions which are planned. An RN should be engaged with the nursing profession actively. In addition to it, RN should also admit accountability for actions, responsibilities, decisions and behaviour which is inbuilt in their role (Nursing and Midwifery board Ahpra, 2020).However, the patient was normal the whole day and the medicines do not affect his health.
The miscommunication happened because the other nurse did not convey the information about medication with clarity. The use of the board for written communication was used very poorly. The nurse should also convey the medication with the help of oral communication as well. The attendant nurse should also recheck the patient bed number and the medications with the other nurse and the doctor. It is mentioned in Introduction, Situation, Background, Assessment and Recommendation (ISBAR) framework, that 5 elements are needed for proper communication so only relevant information can be provided. The framework talks about introducing oneself, telling about the current situation, the background of the situation, the evaluation of the problem and the recommendation about what should be done to handle the situation correctly. With the help of this framework, the information which will be transferred will be clear and accurate and the important data will not be missed (Australian Commission on Safety and Quality in Health Care, 2019). It will also improve the safety and quality of handover of the information about the patient in ICU (Ramasubbu, Stewart&Spiritoso, 2017).
Through this experience, I learned that I should be more aware of each of my patients and their conditions. I should work with full attention while attending a patient. I will also recheck with the other nurses and doctors before giving the medications to the patient. I will personally ask the doctor about the patient's medicines so that no third person will be involved. I will also work with the presence of mind. If I feel that something might not be right I will stop then and there and will recheck all the facts and figures. I will work with my instincts and also will listen to my gut feeling.
With the increment of the burden on health care facility, I might have to take care of multiple patients at the same time. Many of them may also be suffering from similar or different kinds of diseases. I realised if I want to work as a registered nurse, I have to take several steps. They are: I should be aware of patient history. I will also assist the doctor while making a therapeutic plan for the patient. I will correct the doctor if I think I might know better treatment opportunity for the patient. I will have clear communication with the doctor. I will not respond immediately when I am provided with information and will think practically before taking any step in the forward direction. I will recheck the medications with doctors and nurses so that the risk of committing any mistake will be eliminated out. I will keep evaluating the patient again and again once I gave him the medication.
Australian Commission on Safety and Quality in Health Care. (2019)ISBAR revisited: Identifying and solving barriers to effective clinical handover - project toolkit. Retrieved from https://www.safetyandquality.gov.au/sites/default/files/migrated/ISBAR-toolkit.pdf
Nursing and Midwifery board Ahpra. (2020). Nurse practitioner standards for practice- Effective from 1 January 2014. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/nurse-practitioner-standards-of-practice.aspx
Ramasubbu, B., Stewart, E., &Spiritoso, R. (2017). Introduction of the identification, situation, background, assessment, recommendations tool to improve the quality of information transfer during medical handover in intensive care. Journal of the Intensive Care Society, 18(1), 17–23. https://doi.org/10.1177/1751143716660982
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