Medication errors are preventable occurrences, potentially causing a patient harm or death, when the medication is in the control of the healthcare
Medication errors are preventable occurrences, potentially causing a patient harm or death, when the medication is in the control of the healthcare worker (Crisp, et al., 2021). A busy and distracting environment with multiple patients which can cause fatigue and cognitive burden to nurses (Bucknall, et al., 2019). Then, as seen with Mr Lau's case, the interruption caused by IT outages can intensify medication errors.
Registered nurses (RNs) form part of a multi-disciplinary team, which prescribes, dispenses and administers medications (Australian Commission on Safety and Quality in Health Care (ACSQHC, 2021, Standard 4). By understanding pharmacology, the RN is able to understand the reasons for administering the medication, effectiveness of the medication, possible contraindications, and potential adverse reactions (Crisp, et al., 2021).
Being diligent in my future RN role and adhering to the relevant processes, policies and standards of practice will minimise my risk of making a medication error, and uphold my patient's safety. However, I am human and the fear of making a medication error, such as Paul Lau's is confronting and once again reflects the level of responsibility about to be awarded to me as I graduate. As a new graduate RN, I understand that my uni degree will have provided me a foundational understanding of concepts such as critical thinking, pharmacology and patient safety which will take time to consolidate as I gain experience.I know when I have been on placement, I have noted with an RN medication prescription errors for our patients. I have also witnessed RN's who aren't aware why they are administering medications and I've had to advise them on the class or mode of action of a medication if I knew it.
Mr Lau received a high-risk medication as listed within the APINCHS acronym. Recently an "S" has been added to include systems. These systems include double medication checks, medication charts, and PCA care (ACSQHC, 2021, Action 4.15). Throughout my placements I have seen APINCH posters within the medication rooms - however I wonder if RN's don't "see" them after a period of time as they become part of the environment.
Registered nurses have a legal obligation to openly disclose if a medication error has occurred (NMBA, 2018, Principle 2.4).I have discussed with RN's and some admit they have made medication errors, but with minimal harm to their patient. If I find myself within this situation I hope I'm in a supportive team, as I can see how these occurrences would alter a RNs self-confidence, and depending on the adverse outcome, may see nurses leaving the role.
In addition, currently I work as an AIN and it is out of the scope of practice to for AIN's to conduct observations. I have witnessed AIN's with no basic understanding of how to assist with activities of daily living, let alone critical thinking of vital signs.The nurse within this coroners case placed a great deal of responsibility onto an AIN.I recognise that whilst having an extra resource, the patient is under my care and not the AIN, with adverse affects being detrimental to my role and maintaining registration as well as the patients safety.
Australian Commission on Safety and Quality in Health Care. (2021).National safety and quality health services standards, 2nd ed.https://www.safetyandquality.gov.au/standards/nsqhs-standards/medicationsafety-standard(Links to an external site.)Bucknall, Tracey; Fossum, Mariann; Hutchinson, Alison M; Botti, Mari; Considine, Julie;Dunning, Trisha; Hughes, Lee; Weir-Phyland, Janet; Digby, Robin; Manias, Elizabeth. (2019). Nurses' decison-making, practices and perceptions of patient involvement in medication administration in an acute hospital setting.Journal of advanced nursing,75(6), 1316-1327. https://doi-org.ezproxy.canberra.edu.au/10.1111/jan.13963
Crisp, J., Douglas, C., Rebeiro, G., & Waters, D. (2021).Potter and Perry's Fundamentals ofNursing(6 ed.). Elsevier.
Delirium refers to a syndrome of cognitive, psychiatric, and motor abnormalities that are commonly observed in acutely medically unwell patients, following surgery or trauma, or in the context of drug intoxication or withdrawal. The mental status changes arise rapidly, over hours to days, and often fluctuate. As a result of its fluctuating course, and multifactorial aetiology, delirium often remains undetected and misdiagnosed in healthcare settings. It is commonly seen in the acute healthcare setting, affecting about 18-35% patients, yet it is often neither detected nor managed appropriately.
Assessment of delirium makes the diagnosis, more objective, valid, and documented. Diagnosis of delirium helps to prevent both short term consequences such as increased risk of falls, pressure ulcers, accidentally removing intra venous access and most certainly prolonged hospital stay and long-term consequences such as post-traumatic stress disorder, depression, anxiety, risk of developing Alzheimers disease and early mortality. It is a frightening and unpleasant experience for both patients and their families. So, the assessment and diagnosis of delirium is important to promote detection and improve management of delirium.
Tools such as 4AT, which is a validated rapid initial assessment tool, testing for alertness, abbreviated mental test, attention, and acute changes. It can be used to assess signs and symptoms and detect delirium in hospital setting. Also, considering 5Ps (Poo, Pee, Pill, Pus and Pain) is essential when assessing patient for delirium.Non-pharmacological ways to approach agitated/confused patient are interventions and structured activities with reduced stimulation environments, creating a safe environment by removing possible hazards and presence of family members or friends, if possible,sensory interventions such as music, light or pet therapy, psychosocial therapy such as validation therapy, reality orientation and reminiscence therapy.
Falk, A & Stenman, M. (2021). Delirium assessment Often ignored, always important.Intensive & Critical Care Nursing, 62,102958102958.https://doi.org/10.1016/j.iccn.2020.102958(Links to an external site.)Tieges, Z., Evans, J. J., Neufeld, K. J., & MacLullich, A. M. . (2018). The neuropsychology of delirium: advancing the science of delirium assessment. International Journal of Geriatric Psychiatry, 33(11), 15011511.https://doi.org/10.1002/gps.4711
