Reflective journal of my first day of clinical practicum
During my first day of clinical practicum in MMW AQH, register nurse make medication error and did not reported instead she tried to cover it. I would like to reflect on the incident that is related to reporting medication error and what I have learned from that situation as a nurse.
This incident happened during- my first clinical day in MMW AQH around 1pm while administering drugs by a register nurse, I was observing her practice in drug administration she started to prepare the drugs on advance she asked me to collect the drug charts from patient bedside and nursing station .While she was distributing drugs for patient she was attending their needs and answering doctors order by the time goes she become distracted and lost her concentration this situation made me confused and not knowing which patient is next. The nurse had many task to do at the same time. She continued in drug administration but this time with improper way of patient identification, when we reach to the room where incident happen patient requested to take his drugs later as he still having his lunch she kept the drug near to him and left .After we finished three more patient she went back to him as remembered something she was looks stressed and panic, I asked her what happened she did not reply instead she asked the patient to give her back the tablet.
Patient handed the tablet back to her then she gave him another tablet, I realized this was a drug error it was her luck that patient did not take the medicine, she start to explain to him what happen and asked for apology, the patient was so angry yet feeling sorry for her. He questioned her if he had the drug who will take the responsibility? She did not answer. He was not willing to cause a trouble for her so he kept quiet. She proceeded with her work like nothing happen, I was expecting her to report but she did not, when I asked the reason, she reply as long as no harm happen there is no need to report beside that there is no time to report. This left me thinking how many medication errors left un-reported?
This experience left me disappointed it was hard for me to accept what happen because I have fixed believe that patient safety is first regardless how busy the nurses are. Since then so many question gushed to my head, why this incident happen? What are the causes? Was the staff nurse afraid? Is the nursing negligence acceptable? To answer these questions I have to recall the situation .It was obvious that the circumstances the staff nurse was in made her prone to such incident, her lack of concentration and her unprofessionalism in administering medication made her close to put patient health in danger. However this should not excuse her from responsibility. I can understand that she was in panic and in a stressful situation but she is accountable for her action since she decides to become a nurse and deal with human life. I believe that increased work load made her go for short cuts and malpractice just to finish the care .on the other hand she failed to identify the patient because of distraction. But the main reason why she did not report is maybe she thinks about her colleague's reaction and she may be punished for that. From what I experienced drug error could be preventable if the staff nurses adhere strictly to hospital polices no matter what.
There is no exact definition for drug error but, the National Patient Safety Agency and the US National Coordinating Council for Medication Error Reporting and Prevention define it as an any preventable event that may lead or cause inappropriate medication use or patient harm while the medication is in the control of health professional (smith, 2004). According to the latest researches which conducted by Food and drug administration association and the National Patient Safety Agency drug errors always left unreported for many reasons, some of these reasons are related to fear and work overload. These two factors were considered the most dominating factors when it comes to drug errors. Excessive work always leaves the staff fatigued and preoccupied with many task to do and less time to finish it (Mayo, Duncan& Chloe, 2004). Work over load lead the staff to go for the shortest and easiest ways which result in poor nursing practice. Failed patient identification is also another result of work overload, health care professional are not able to counter check and verify patient identity correctly with other staff because of excessive work. On the other hand Fear from consequences and the colleague's reaction are always the reason why health care professional tend to hide drug errors and not reporting it. Their self esteem will be badly affected in that moment because of that, they will loose the ability to judge and they will comet more vital mistakes. However not reporting drug error is worse and harmful to the patient life. Professionalism is the only way to develop the nursing practice in administering drugs. Right patient identification, Right dose, Right drug, Right time, Right route and Right documentation are the safest bath to follow(Clayton&Stock, 1997).
Drug errors are a common problem in health care facilities which always associated with serious events so reporting about errors becoming a must to improve the system and patient safety .Most of the international accredited hospitals such as Alwasl Hospitel are now blame free culture, encouraging staffs to report the errors and not to become intimidated by it. Also they deal with reports in confidential manner so the access to such documentation is restricted to authorize person. Their policy stat that all incident report should be written in narrative description which should be comprehensive description of facts containing no personal judgments or opinion and no implication or accusations (AWH. P&P,2004). These hospitals are providing educational session about errors reporting which is important to increase the awareness among the staffs in order to become a positive link in the hospital. These hospitals are maintaining yearly competences in medication management and use for all health care professional. One goal that all health care facilities are trying to achieve is minimizing work load on the health care professional. Most of these hospitals are controlling patient numbers and trying not to go beyond their capacity, they also trying hard to solve the staff shortage in way that will not affect patients and staffs. Other ways in improving medication administration system is by computerize the drug charts for more clarity and using unit dose system. This system helps the health care professional to minimize drug error, it include single unit package with generic and brand name, manufacture, lot number and expiration date. Following this system has many advantages. First it reduces the time spent by nurses in preparing drugs. The pharmacist will have a clear vision about patient situation regarding adverse reaction and contraindication. Patient identification will be easier as each single package has patient name and number so double –check may not needed in emergency cases(Clayton&Stock,1997).
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