Issues Related to Nursing - Essay Example

Media Presented Issues Related To Nursing: Medication Errors Introduction: Medications errors in medical practice are harming millions of patients, and the extent of harm may translate into death, injury, potentially life-threatening clinical situations that lead to extended suffering and hospital stays, or permanent disabilities. While the financial and economic issues remain considerable, the professional issues are undeniable. Many healthcare professionals are involved in patient care since healthcare is essentially collaborative share of care involving physicians, nurses, pharmacists, and many other personnel. Since in the healthcare setting, especially in the hospital in-patient environment, the nurse remains in contact with the patient for the better half of the time, the nurses are the executors of care, and they are the final common pathways of transmission of the care processes. As a result, any error made in any step of the care being undetected will appear as a deficit in standards of practice on the part of the nurses. It is not true that nurses do not make any errors, but despite being very careful, there are many other factors that may be found involved in such a medication error incident. Despite not being directly committed by the nurse if an adverse event from drug happens due to error, the nurse is often implicated in such a situation. Present scenario of healthcare demands that every professional should exercise their knowledge and expertise in every step of administered healthcare to prevent such errors. Unfortunately, the blame often falls on the nurse, but it is imperative to find out the preventative solutions to this problem rather than finding the scapegoat (Strand, J.N., Ferner, R. E., Anthony, C., Teichman, P., and Bates, D.W., 2001). The First Article: Published on June 15, 2006, in The Times and written by Lisa Greene, this article carried the headline, Nurse Error Spotlight Drug's Danger: A pregnant woman died of a magnesium sulfate overdose at South Florida Baptist, despite the drug's well-known hazards. The byline adds comments that an 18-year-old patient was given magnesium sulfate to slow down premature contractions of the uterus; although, the baby son survived, the lady expired, and the hospital issued a statement that error killed the woman. The drug magnesium sulfate is useful in certain situations despite it being a known hazard in the sense that it is reported to cause fatal clinical events. In this care, reportedly, the nurse made an error in calculating the dose. This is apparent from a quotation of a scientific journal article that reports incidences of 52 adverse overdose incidents that included 7 cases of persistent vegetative state or death. In case of this specific patient, the patient attended the hospital with pre-term labor, and the nurse gave her magnesium sulfate which was administered in a larger-than necessary dose. The baby survived, but the mother expired out of respiratory failure despite attempts to revive. The hospital spokes person directly termed this situation as a single incidence of error by an expert professional, and it was accepted to be a calculation of the dose error by the nurses. Naturally, since the authority is concerned about a lawsuit, none other than this is available to analyze the information, but this overlooks another important aspect of the problem. It is well known that even the most experienced nurse may end up in a "single tragic mistake", but it is the responsibility of the hospital authority of health system to have a safety or governance system in place that would make multiple checks before the error happens, especially when the error may be fatal in nature. This throws spotlights to a system's deficiency in designing a process that can identify a person's math error before even the error can reach the patient. This was a terrible and isolated incident, but this calls for well-lubricated and functional safety systems at all levels including prescription, pharmacy, and nursing. Computerized and automated systems even if known to be dependable, need to be monitored because there are always some human factors involved in such events (Greene, L., 2006). The Second Article: The second article in this regard is written by R. E. Ferner in the British Medical Journal. It reads, Medication Errors That Have Led To Manslaughter Charges. This tells about a horrific incident where a registered nurse gave 300 mg morphine that had been prescribed for one patient with terminal cancer to another patient in an adjoining room. The patient who was administered with this very high dose or morphine was bed-bound with severe emphysema and pneumoconiosis. The physician advised careful observation. After 11 hours of this administration, the man was found comatose. The patient was given naloxone, an antidote and other supports to have revival for a short period of time, only have a seizure and death after some time. The nurse and the physician were charged with manslaughter. The judge acquitted them since there was a brief period of revival, and there was no material evidence to suggest material contribution by any act of omission on the part of the nurse to have caused death in this patient. The author suggests a interprofessional check list system that goes through several steps of checking and cross-checking to stop the process of drug administration at any step right from the prescription spanning over to dispensing, then to preparation, and then to administration. It will operate like a feedback snake-ladder system where any error detected will intimate all the personnel involved and will tend to start the process and its review anew. The problem is not bad, inefficient, or careless people, the problem is that the medical care system needs to be made safer. It also proposes that it is erroneous to blame the nurses since in great majority of cases, the causes of serious failures stretch far beyond the actions of the individuals immediately involved, although they must be accountable in such incidences (Ferner, R.E., 2000). The Third Article: This article published in TenetNurse.com covers an entirely different angle of nursing medication errors. This analyzes the clinical situations in medicinal errors committed by the nurses and finds different reasons that are entirely unrelated to nurses personal factors in such errors. Verbal orders are implicated in such situations, and sounds are not at all dependable guides for drug administration. These are sound-alike drug names, misinterpreted numbers, verbal communication of multiple drugs at the same time, and break down of communications while giving and taking orders in a noisy environment of the hospitals. As a result, the safe measures are directed toward these pertinent factors, rather than improving nurses' capabilities (Grissinger, M. and Munn, J., 2007). As far as the nurses are concerned, they may as well start refusing verbal orders or start writing down orders and make computer entries that may be corroborated by the prescriber. Another way to prevent events is to write the indications of any particular drug beside their names. A second person may verify the orders. The nurses can ensure and enforce physical presence of pharmacy personnel to take the orders, never ever over telephonic communications. They must raise awareness that errors may happens, and they should be able to identify areas where potential errors creep in. Cross verification with the physician, habits of checking the dose in terms of body weight, knowledge about problematic drug names, information to handle and analyze an order, knowledge to point out discrepancy, and most importantly of all, a zeal to perform a good work with feelings for the patient may avoid such errors and would definitely add to the accountability of the nursing profession (FDA, 2003). The system of medical care must be safe only when human error is taken to be granted as inevitable, and system can minimize them even if it includes personal failures, such as, gross negligence, recklessness, or criminal behavior, incompetence apart. As such, error may be defined as failure, personal or institutional, to perform an intended and ideal action. They most commonly arise out of faulty planning and execution of action. Errors in planning action or executing them may happen when the nurse is ordered to perform unfamiliar tasks or where there is insufficient information to formulate an analytical solution. To avert such human factors, there have been increasing use of computerized automated prescription, dispensing, and delivery systems, but it is to be remembered that there would be human factors always involved. To achieve that, the best prescribed tools are alertness and knowledge. The automated habit of experience should not be allowed to take its toll on drug administration process that should be pristine and precise. To be able to do that knowledge will create the background, but proper education, supervision, and alertness to prevent personal slips and lapses (errors in executing tasks and errors due to failure of memory). It is also to be mentioned that such lapses and slips occur most commonly in presence of tiredness, interruptions, and distraction by competing tasks. All of these are inevitable in current medical practice with heavy work load, but this can never serve as an excuse to commit an error (Mayor, S., 2004). A good professional should be able to convert an automatic task to an error-free precision maneuver. It is not just convicting the professional who has caused an iatrogenic error, it is all about performing a correctional maneuver on the whole system so that at least preventative efforts are perceived, and that would generate the greatest accountability of the profession. Reference List FDA, Strategies to Reduce Medication Errors, (2003). Accessed on July 20, 2007. http://www.fda.gov/fdac/features/2003/303_meds.html Ferner, R.E., (2000). Medication errors that have led to manslaughter charges. British Medical Journal; 321: 1212. Greene, L., (2006). Nurse Error Sotlights Drug's Danger. St. Petersburg Times, Tampa Bay . Grissinger, M. and Munn, J. (2007). Verbal Orders Can Communicate Trouble. Accessed on July 20, 2007. http://news.nurse.com/apps/pbcs.dll/article. Mayor, S. (2004). Report Calls for Strategies to Reduce Medication Errors. British Medical Journal; 328:248. Strand, J.N., Ferner, R. E., Anthony, C., Teichman, P., and Bates, D.W., (2001). Reducing Medication Errors. JAMA; 286: 2091. Read More