Student Name: Kerrie-Anne Reason
Course:NURS12154 Pharmacology for Nursing Practice
Assignment:Assessment Two – Essay
Due Date:17 May 2018
Due Date:30 April 2018
Student Plagiarism Declaration:
I certify that this assignment is my own work, based on my personal study and/or research, and that I have acknowledged all material and sources used in the preparation of this assignment whether they be books, articles, reports, lecture notes, and any other kind of document, electronic or personal communication. I also certify that the assignment has not previously been submitted for assessment in any other course or at any other time in this course, unless by negotiation, and that I have not copied in part or whole or otherwise plagiarised the work of other students and / or persons. I have read the CQU policy on plagiarism and understand its implication. I can produce a hard copy of this assignment within 24 hours if requested.
The prevalence of avoidable medication errors causing adverse reactions, increased morbidity and mortality is major contributing factor to patient safety within health care systems globally. This paper reflects a coroners’ examination of a 74 year old female admitted to hospital for dehydration, physical decline and other health concerns associated physiological disorder, resulting lowethe mortality due to a medication error. This paper delineates medication error and the events that lead to the patient’s death, the legal and ethical values that apply to Nursing practice. Whilst taking into consideration the patient’s diagnosis, medical history of depression, ischemic heart disease, cholecystectomy, reoccurring urosepsis and cardiac surgery six months prior to this admission this review will exhibit how this critical incident could have be prevented.
Topic 1: Medication Errors
While hospitalised, a psychiatric assessment diagnosed the patient with depression, the Psychiatrist ceased her regular medication. Sertraline; commenced her on Mirtazapine and made in involuntary referral to a Psychiatric Hospital, with the family’s consent. Sertraline is a serotonin reuptake inhibitor (SSRI) drug, used mainly to treat depression, post traumatic disorder and social anxiety disorder. Common adverse effect of this medication includes drowsiness (MIMS 2018), whereas Mirtazapine is a tetracyclic antidepressant used to block serotonin receptors and central adrenergic inhibitory autoreceptors. This medication commonly causes adverse effects of sedation in patients and in rare cases postural hypertension (MIMS 2018).
Prior to the patients’ transfer to the Psychiatric Hospital, upon discharge the Registered Nurse under the direction the Nurse Unit Manager together made a critical medication error by administering Nitrazepam, the wrong medication instead of the prescribed medication, 15mg of Mirtazapine. Nitrazepam is a benzodiazepine used for the treatment of insomnia, acts by inhibiting the nerve transmitters to the brain via the central nervous system causing sedation. A common adverse effect of this medication is over sedation and infrequently severe hypotension (Australian Medicines Handbook 2017).
Although the patient was relaxed but responsive to prior to the Ambulance Officer taking hand over, on route to the Psychiatric Hospital the patients became hypotensive and reoccurred regardless of positional changes. On arrival to the Psychiatric Hospital the patient remained hypotension and unresponsive while in Emergency and died the following day post transfer to Intensive Care Unit for continued medication care. As a result of this critical medication error The coroner examination identified the Mirtazapine already in the patients system was administered instead of the prescribed medication15mg of Mirtazapine causing a sedative effect and postural hypertension on route with ambulance officers to the Psychiatric Hospital.
There was a significant medication error that occurred that led to a poor outcome for this patient in this Coronial clinical case summary.
– Describe this medication error and explain how it occurred and identify how it affected patient safety
– Propose one strategy that could have prevented this error occurring.
– Explain how this strategy you identified, could prevent the risk of such a medication error occurring again or be minimised?
The medication was then administered via the wrong route, the PICC line instead of the NGT. Additionally, the diligent nurse would have discovered that ciprofloxacin is an extended release tablet and therefore should not be crushed (MIMS Australia, 2017). This medication error occurred due to lack of independent medication safety checks (Australian Nurse and Midwife Federation, 2015), inadequate labelling of medications and poor communication between nursing staff that resulted in loss of life. Measures that could have been implemented in this scenario and would minimise the risk of such an error occurring again include, nurses adhering to the medication labelling standards. These standard were introduced to reduce the risk of patient harm by helping the healthcare professional identify correct patient, route and medication to be administered (Australian Commission on Safety and Quality in Health Care ACSQHC, 2015). Colour-coded labels identify the target tissue type for drug administration and assist in confirming the correct route and medication class (ACSQHS, 2015). As an extra safeguard, the administration lines should also be labelled to identify the route for example, intravenous or enteral (ACSQHS, 2015). The case study states the nurse was supervised through the process however while preparing the ciprofloxacin, the supervising nurse was drawing up the other patients medication frusemide. An important strategy to prevent drug errors is independent double-checking (IDC) (ACSQHS, 2013). This check is a procedure where two registered practitioners separately check medication calculations and preparations for the same drug and match the results, instead of one confirming the others results (ACSQHS, 2013). If this check was carried out in the scenario, the ciprofloxacin would have been prepared correctly, in the right syringe and administered via the right route. Furthermore, Broyles et al. (2017) stresses the importance of health professionals adhering to the five rights of medication administration, these being, the right patient, right medication, right dose, right route and right time. Nurses are the patients’ last line of defence against error (Broyles et al., 2017) and safeguards that are in place to promote safety should be abided by, however if an error does occur it should never be covered up.
Topic 2. Ethical Principles
Ethical principles relate to medications just as they do to any other nursing practice. Therefore ethical principles apply to the nurses’ practice in the administering of medication to Mrs T.
After reading the Coronial clinical case summary;
Describe each of the following ethical principles and discuss how each apply to this clinical case summary:
• Were these ethical principles upheld by these nurses? Yes or no. Explain your response.
NB: It is expected that you write in third person (no ‘I’ or ‘we’ statements).
Negligence is defined as an individual act that causes another person foreseeable harm by not forfilling their obligations. It must be established that a total, reckless or disregard for the life and safety of the individual. An example: A nurse isn’t paying attention and gives someone a harmful dose of a medication and the client suffers avoidable harm could be considered criminally negligent.
Duty of care is defined as legal and professional requirement within the skills of profession to exercise reasonable care for an individual and to avoid acts or omissions of negligence which can be reasonably foreseen to cause harm to an individual. An example: A nurse responds to a buzzer and advise the client that they will return to assist them, does not return and the client attempts to stands, to toilet themself and falls causing an injury.
Vicarious Liability is defined as the assignment of financial responsibility or compensation to an employer or agent for harm caused to an individual due to the employees’ negligent practices. An example: A nurse neglects constrains a client and leaves the client unattended for an hour and half, the client passes away. The employee or agent is sued for the nurses negligent and becomes responsible for financial compensation for the damages they have cause to the client and their family. to someone other than the employee or agent for
Topic 3. Legislation
Medicines are a therapeutic method for the treatment of disease, managing illness and easing discomfort with the intent foster and maintaining good health. According to the World Health Organisation medication errors is a major contributing factor causing harm to millions of people annually and the minimum of one death daily (WHO, 2018). Medication legislation is employed to safeguard the administration of drugs for individuals under the care of regulated health professionals. The intent of medication legislation and its related standards and polices is to prevent major harm or adverse reactions to individuals and improve the health and wellbeing of individuals. Nurses have a duty of care to practice within their scope to manage polypharmacy, minimise misuse, solve medication issues, educate individuals, prevent over use and under-use and to reduce discomfort for individuals and promote holistic wellbeing individuals. In accordance with the drugs and/or poisons legislation (Queensland Legislation, 1996.), competent nurses have responsibility and accountability to administered and manage medications safely, therefore, require strong understanding of pharmacology, the individual; their health; risks and benefits; dosage and length of treatment; and co-morbidities or diseases with the aim to effectively prevent the potential to cause adverse drug reactions and causing fatal medication interactions. The Australian Government, Therapeutic Good Administration regulates how medicines and chemicals are made available to the community through the implementation of Australian schedules for medicines and poisons, to safeguard public health. The medicines and chemicals associated with these Schedules are categorised into different levels of regulatory control from one to ten. The schedules This paper will provide a brief description of the main schedules associated with administration and management of medication by nurses, Schedules 2 to 4 and Schedule 8 as outlined. Schedule 2 Pharmacy Medication
Include a brief description of the listed below:
– Schedule 2,
– Schedule 3,
– Schedule 4 and
– Schedule 8.
Scheduling of medicines and poisons
There is a national classification system that controls how substances such as medicines and chemicals are made available to the public. Medicines and chemicals are classified in schedules according to the level of control over their availability needed to protect public health and safety.
The schedules are published in the Standard for the Uniform Scheduling of Medicines and Poisons (opens in a new window). The schedules are adopted under the Controlled Substances (Poisons) Regulations 2011 (opens in a new window).
Pharmacy Medicines – substances available from a pharmacy or if a pharmacy is not available, from a licensed person
Pharmacist Only Medicines – substances available from a pharmacist without a prescription
Prescription Only Medicines – substances that should only be used or supplied on the order of a prescriber (eg a medical practitioner) and available from a pharmacist on prescription
Controlled drugs (drugs of dependence) – substances that need to be available for use but manufacture, supply, possession and use need to be restricted to reduce abuse, misuse and dependence.
– After Mrs T aortic valve replacement operation, she was taking Panadol Osteo and Endone for a short while for on-going post-op pain. Identify the generic names of each of these medication and what schedules they belong.
– State the legislative schedule of the 2 (two) medications involved in the medication error discussed in the clinical case summary. State the legal requirements in storage and administering of these scheduled medications to Mrs T, which the nurse has a responsibility in abiding by.
This education activity engages and educates, Aboriginal and Torres Strait Island people
American Association of Critical-Care Nurses (2012). Prevention of Aspiration. Critical Care Nurse Journal, 32(3), 71-73. doi:http://ccn.aacnjournals.org/Australian Commission on Safety and Quality in Health Care (2013), Literature Review: Medication Safety in Australia. ACSQHC, Sydney. doi:https://safetyandquality.gov.au/wp-content/uploads/2014/02/Literature-Review-Medication-Safety-in-Australia-2013.pdfAustralian Commission on Safety and Quality in Health Care (ACSQHC). (2017). National Safety and Quality Health Service Standards (2nd ed.). Medication Safety Standards. s(4), 29-36. doi:https://www.safetyandquality.gov.au/publications/national-safety-and-quality-health-service-standards-second-edition/
Australian Commission on Safety and Quality in Health Care. (2013). Evidence Briefing on Interventions to Improve Medication Safety: Interventions to reduce interruptions during medication preparation and administration. 1(4). doi:https://www.aihi.unsw.edu.au/chsEvidence briefings on interventions to improve medication safety: Double checking medication administration. doi:https://www.safetyandquality.gov.auAustralian Medicines Handbook Pty Ltd (2018). Australian Medicines Handbook. doi:https://amhonline.amh.net.au/Australian Nurse and Midwife Federation. (2015). Quality use of medicines. doi:http://anmf.org.au/documents/policies/PS_Quality_Use_Of_Medications.pdfBryant, B., ; Knights, K. (2014). Pharmacology for health professionals ebook (4th ed.). doi:https://ebookcentral.proquest.comBullock, S., ; Manias, E. (2016). Fundamentals of pharmacology (8th ed.). Melbourne: Pearson Australia.
Hu, X., Yi, E. S., ; Ryu, J. H. (2014). Aspiration-related deaths in 57 consecutive patients: Autopsy study. PLoS One, 9(7). doi:http://dx.doi.org.ezproxy.cqu.edu.au/10.1371/journal.pone.0103795MIMS Australia. (2018, April). MIMS Australia. doi:http://www.mims.com.au/
Queensland Legislation (2018, March). Health (Drugs and Poisons) Regulation 1996. doi: https://www.legislation.qld.gov.au/view/html/inforce/current/sl-1996-0414
Roberts, D. J., Haroon, B., ; Hall, R. I. (2012). Sedation for critically ill or injured adults in the intensive care unit. Drugs, 72(14), 1881-916. doi:http://dx.doi.org.ezproxy.cqu.edu.au/10.2165/11636220-000000000-00000Roughead, E. E., Semple, S. J., ; Rosenfeld, E. (2016). The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia. International Journal of Evidence-Based Healthcare, 14(3). 113-122. doi:doi:10.1097/xeb.0000000000000075
Therapeutic Good Administration, Department of Health (2016, July.) doi: https://www.tga.gov.au/scheduling-medicines-poisons
Wheeler, H. (2013). Law, ethics and professional issues for nursing. doi:https://www.routledge.comWorld Health Organization. (2018). Medication Errors World Health Organization. doi http://www.who.int/iris/handle/10665/252274
World Health Organization. (2018). WHO launches global effort to halve medication-related errors in 5 years. doi:http://www.who.int/en/news-room/detail/29-03-2017-who-launches-global-effort-to-halve-medication-related-errors-in-5-yearsStaunton, P.J., Chiarella, M. (2013). Law for Nurses and Midwives (7th ed). Ch 6. 218-219. The administration of drugs Midwifery Board of Australia (NMBA) for National Registration
Accountability means that nurses answer to the people in their care, the nursing regulatory authority, their employers and the public. Nurses are accountable for their decisions, actions, behaviours and the responsibilities that are inherent in their nursing roles including documentation. Accountability cannot be delegated. The registered nurse who delegates activities to be undertaken by another person remains accountable for the decision to delegate, for monitoring the level of performance by the other person, and for evaluating the outcomes of what has been delegated (Nursing and Midwifery Board of Australia 2013). See below for the related definition of ‘Delegation’.