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Medications And Safe Administration Workbook Nursing Essay

Introduction

Medication incidents associated with drug therapy can be defined as events related to the administration, prescribing, dispensing, storage or disposal of a medicine that may have adverse consequences for the patient or staff, The definition also incorporates adverse drug events, adverse drug reactions and medication errors (Lawler, Welch & Brien, 2004: 174).

The above quote highlights that the administration of medication is a cycle that involves several individuals (e.g. prescribers, pharmacists, nurses, clients) and therefore incorporates a number of opportunities where errors or omissions can occur. The circumstances under which such errors or omissions occur can be unpredictable, and it is therefore imperative that practitioners engaged in the administration of medicines develop effective practices to minimize error.

This assessment item requires you to complete this workbook and submit it via SafeAssign, in addition to submitting a hard copy, by the due date.

This workbook assesses the following 1802NRS learning outcomes

Learning outcomes:

5. Demonstrate safe administration of medications

6. Demonstrate the ability to access accurate and good quality information about medications for evidence-based care

7. Critically analyse the medication types, causes and risks associated with near miss and error events and strategies for preventing these medication events

8. Engage and educate individuals and/or their families about their medications and resources for safe medication use

This table identifies the learning outcomes being assessed in each question:

Question

1

2

3

4

5

Learning outcome

5, 6

5, 6

5, 6, 7, 8

6, 7, 8

5, 6, 8

Completing this assessment workbook:

The questions within this workbook are short answers. Each answer must be correctly structured using the conventions of academic writing (sentences, paragraphs, grammar, spelling, referencing).

Referencing:

Referencing style APA 6th edition

In text referencing is required

Please provide your reference list at the end of this workbook

Outline the roles and responsibilities of the Registered Nurse, Medical Officer and Pharmacist involved in the medication cycle?

(300 words/ 15 marks)

In accordance with the Health (Drugs and Poisons) Regulations 1996 (Qld), a Registered Nurse is authorised to possess a controlled drug (Section 67) and is responsible for administering a controlled drug to a patient on a doctor’s oral or written instruction (Section 175); and administering a Schedule 2 or 3 poison (Section 263). The Medical Officer is authorised to obtain and possess a controlled and/or restricted drug and is responsible for administering, dispensing and prescribing the drug, giving someone who may administer or supply a controlled and/or restricted drug an oral or written instruction to administer or supply the drug (Section 161). The Pharmacist is authorised to obtain, possess, dispense and sell a controlled and/or restricted drug (Section 171).

The Australian Pharamceutical Advisory Council (2007) states that the medication cycle comprises nine key components and outline responsibilities as follows –

Decision about appropriate treatment and decision to prescribe medicine:

Medical Officer as the Prescriber;

Record of medicine order or prescription:

Prescriber, Pharmacist and Registered Nurse;

2a. Administering the medicine and assessing the effect of using the medicine:

Registered Nurse;

Review of medicine/prescription to verify and confirm the prescribing intention and expected outcome:

Registered Nurse, Medical Officer and Pharmacist.

Issuing of medicine ensuring correct labelling of medicine:

Pharmacist and Registered Nurse;

Provision of medicine information including how to use and store correctly:

Pharmacist;

5a. Appropriate administration and preparation of medicine:

Registered Nurse;

Distribution and storage which includes distribution to the hospital ward and storage dependant on the regulatory and safety constraints:

Pharmacist and Registered Nurse;

Administration of medicine and re-assessment before medicine is administered, ensuring the correct patient, drug, dose, route, time, right to refuse and accurate record of the administration of the medicine:

Registered Nurse;

Monitor for response:

Registered Nurse;

8a. Monitor for response if self-medicating:

Medical Officer or Registered Nurse monitors with the patient.

Transfer of verified information, crucial for the continuum care of patient shared by health care professionals:

Registered Nurse.

Only medications that have been approved can be sold in Australia. Outline the process involved in approving a new medication including the role of the TGA and the PBS. The web link below will help

(300 words/ 15 marks)

The Therapeutic Goods Administration (TGA) is an initiative of the Australian Government Department of Health and Ageing. The TGA administers the Therapeutic Goods Act 1989. This legislation is based on a risk management framework that provides the Australian community with access to therapeutic goods which are consistently safe, effective and of high quality. This framework is comprised of pre-market assessment, post-market monitoring, enforcement of standards and licensing of Australian manufacturers. It also verifies overseas manufacturers' compliance with the same standards as their Australian counterparts. The TGA applies scientific and clinical expertise to its decision-making to ensure that the benefits of a product outweigh any risk.

National Prescribing Service Limited is funded by the Australian Government Department of Health and Ageing formed to coordinate and disperse quality use of medicine services in Australia. The Service describes a medicine’s journey from lab to the public as –

Laboratory Experiments to show if medicines could be useful and safe for humans;

Phase 1 Clinical Trials testing safety and working out doses with 20 – 80 volunteers;

Phase 2 Clinical Trials testing how well and how safe the medicine is with 100 – 150 volunteers;

Phase 3 Clinical Trials giving more information about efficacy and safety with 1000 – 3000 volunteers;

Approval by TGA following phase 3 trial results meeting national standards and quality manufacturing national standards;

Approval for subsidy of cost of medicines by the Pharmaceutical Benefits Scheme, an initiative of the Australian Government;

Phase 4 Clinical Trials comparing other treatments for the same illness and monitoring the ongoing safety of the approved medicine.

The National Prescribing Service (2012) also states that it is a lengthy procedure for a medicine to be developed and to gather enough evidence to be approved for sale in Australia, sometimes as much as a decade, and that many medicines don’t make it through this long process because they don’t do well enough in the early trials.

Research has demonstrated that medication near miss and error events are associated with common causative factors including environment, individual, team, task and systems. Collectively, examination of these factors in respect of errors has been referred to as the ‘systems approach’.

Describe how these factors increase the risk of medication errors (400words/ 20 marks)

Explain how the implementation of appropriate preventative strategies will reduce error.

(400words/ 20 marks)

A medication error is a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient. (Aronson, 2009). It also includes the manufacturing or compounding, prescribing, transcribing (when relevant), dispensing, and administration of a drug, and the subsequent monitoring of its effects. Harm describes the lack of benefit which is a form of treatment failure. The definition does not specify who makes the error. It could be a doctor, a nurse, a pharmacist, a carer, or another; nor does it specify who is responsible for preventing errors. Nichols et al (2008) carried out a qualitative study in 2005 of a 450 bed Fremantle Hospital. The study concluded that most errors were due to lapses in attention during routine prescribing, dispensing or drug administration as well as knowledge-based mistakes including failure to follow a protocol. The study also concluded that errors were more likely to occur after hours by busy, distracted staff, often in relation to unfamiliar patients and communication problems with senior staff and difficulty accessing appropriate drug dosing information contributed to knowledge-based prescribing errors.

Aronson (2009) states that errors can be divided into two main categories, action-based errors or ‘slips’ and memory-based errors or ‘lapses’. In Australian hospitals about 1% of all patients suffer an adverse event as a result of a medication error. (Runciman, Roughhead, Semple and Adams as cited in Aronson, 2009). Staff need training in how to recognise and deal with error-prone clinical situations. Safe prescribing practices, such as the absolute requirement to acquire information before prescribing unfamiliar drugs, must be emphasised. Improved access to drug information at the point of prescribing, attention to communication barriers, and increasing staffing levels in particular areas are other potential strategies for reducing error. (Nichols et al, 2008).

Agrawal (2009) states that there is mounting evidence that systems that use information technology (IT), such as computerised physician order entry, automated dispensing cabinets, bedside bar-coded medication administration and electronic medication reconciliation, are key components of strategies to prevent medication errors. Eight practices were randomised to either the web-based program or usual practice. There were four practices in each group. The primary outcome was adverse drug events (ADEs) in older adults reviewed at two twelve month periods before and after the intervention. The study concluded that ADEs decreased from 25.8 to 18.3 per 100 patients per year in the intervention group.

4. The following medications are frequently administered to patients:

Paracetamol, Oxycodone, Atrorvastatin, Warfarin, Frusemide, Clopidogrel. Choose ONE of these medications and:

Identify the brand name/s

Describe its indication for use

Identify the usual adult dose and route

Briefly explain the pharmacokinetic and pharmacodynamics of the medication

Identify potential adverse effects, interactions and relevant nursing considerations

(300words/ 15 marks)

The brand name for Oxycodone is Proladone, The usual adult dose of Proladone is 30mg by rectal administration (Pharmaceutical Benefits Scheme, 2012). It is an opioid deriving from opium and the risk of drug dependence is high. Indications for use are pain and trauma, severe pain in palliative care, surgery, myocardial infarction, acute pulmonary oedema and cough suppression in terminal care. Oxycodone targets opioid receptors in the brain stem to depress the activity of nerve and smooth muscle cells. Oxycodone will take approximately one hour to reach full effect with duration of analgesia for eight to ten hours. The most common side effects are nausea, vomiting, constipation and drowsiness. Other potential adverse effects and nursing interaction required include -

Respiratory depression: Assess respiratory rate, depth and rhythm;

Respiratory arrest: Avoid administration of high dose oxygen;

Chest infection: Ensure patient is hydrated and position and turn patient to reduce risk;

Hypotension: Monitor blood pressure and heart rate;

Bradycardia: Monitor blood pressure;

Sedation and cognitive impairment: Monitor consciousness/drowsiness;

Poor thermoregulation: Monitor temperature;

Hallucinations/Shadows in peripheral vision: Ensure patient is hydrated and offer reassurance;

Convulsions: Observe signs of irritability;

Myoclonus and muscular rigidity: Monitor oxygenation and discuss with Prescriber the possibility of excessive dose. (Jordan, 2008).

Mr Drago Davic is a 70 year old patient in your ward who has recently been prescribed the medication you researched in Question 4. Mr Davic needs some education to ensure that he uses this medication safely. Using relevant adult learning principles, explain how you would structure and deliver an education session with him. Refer to the Russell (2006) reading as a good guide and starting point.

(300 words/ 15 marks).

Effective communication is paramount to delivering an education session for the patient. As with all skills of intervening, sharing information is grounded in the nurse’s understanding of the patient. Some patients prefer being fully informed and others prefer not to know every detail. It is also imperative that the explanation is tailored to the individual patient by taking into account factors such as age and culture. This sophisticated process also relies on assessing the patient’s readiness to learn. (Stein-Parbury, 2009).

Mr Davic has been prescribed an opioid analgesic indicated for moderate to severe pain. As a therapeutic agent, my task is to focus on his needs and overall wellbeing. Giving consideration to his age and possible distress caused by pain, I introduce myself and ask how he is feeling. I listen to his response and paraphrase it back to him acknowledging my understanding. From his response and readiness to listen, I assess that he is prepared to communicate and to learn about his treatment. At this point, I check his chart for the prescribed medication and verify his name with his wrist band. I explain that the doctor has prescribed medication for his pain in the form of a suppository and how the suppository is administered, showing it to him and further explaining the effects and duration. As Mr Davic has listened to my explanation and had the opportunity to examine the suppository, the three learning styles of visual, auditory and kinesthetic have been utilised. I ask Mr Davic if he has any questions and then prepare administration asking him if he’s ready to begin. This discussion has also incorporated the six rights of drug administration including the patient’s right to refuse.

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