Drug Administration in Objective Structured Clinical Examination - Coursework Example

?Reflections on my Drug Administration OSCE Drug administration is one of the major roles of nurses. However, as I found out in the objective structured clinical examination (OSCE) given to us, it entails much more than simply giving a patient a pill. It is an aggregate of all the principles and skills we learn as nursing students, and the application of theories into practice. In drug administration, we have to remember and practice patient safety, provide holistic and individualized patient care, have a solid foundation on knowledge about drugs and medication safety, and perform administration checks and documentation at all times. Much about the role of nurses in hospital can be learned from something as seemingly simple as a drug administration OSCE. Patient safety practices Patient safety is a crucial part of patient care. At all times, all health professionals should keep the safety of the patient in mind. Patient safety practices for drug administration begin at the first contact, from patient identification, patient education and information, patient contact, performance of procedures, to leaving the patient comfortable. One of the important principles in patient safety is infection control. Nosocomial or hospital-acquired infections are the most common complications affecting hospitalized patients today, and one of the major sources of infection is cross-infection by health care workers (Burke, 2003). Meaning, most patient obtain infection from the hands of those that are treating and caring for them. Most incidents that lead to infection can be prevented and one of the simplest ways to prevent this is by hand-washing. In the Guideline for Hand Hygiene in Health-Care Settings released by the Centres for Disease Control and Prevention (Boyce and Pittet, 2002), it is recommended that hand washing and hand antisepsis be done if hands are visibly dirty or contaminated. It should also be done before having direct contact with patients, before donning sterile gloves, after contact with a patient’s skin, after contact with body fluids or excretion and wound dressings, and before eating or after using the restroom. In all aspects of contact with the patient, hand hygiene must be done. The guideline further recommends that health care personnel should not wear artificial fingernails, should keep nail tips short, and should remove gloves after caring for a patient. Thus, before drug administration, and even before handling drugs and preparing them, hand washing must always be done. It should also be done after patient contact, and in between interaction with different patients. Verifying patient identity is another important aspect of patient safety, and not being able to do this could lead to adverse results. Omitting verbal verification of patients’ identity prior to administering medications may lead to a potential adverse event 20% of the time in worst case scenarios (Lisby, Nielsen, and Mainz, 2005). Even with the use of medication administration technologies such as bar code verification, effectiveness in preventing errors is largely dependent on how practitioners use the technology to verify patient identity and drug identity (Englebright and Franklin, 2005). Remediable causes of having the wrong patient include absent or misused protocols for patient identification and informed consent, faulty exchange of information among caregivers, and poorly functioning teams (Chassin and Becher, 2002). During my OSCE, I failed to check the identity of the patient with my mentor. I understand that failing to properly verify my patient’s identity could lead to adverse consequences, and will make sure to keep it in mind in future patient interactions. Doing a brief clinical history can also contribute to patient safety. It allows nurses and other medical personnel to be aware of the patient’s condition, comorbidities, present symptoms and level of comfort. Particularly relevant in drug administration is asking the patient about other drugs being taken and for any personal history or family history of drug allergies. Relying on charts may be inadequate and some patients may not volunteer the information, thinking that it is irrelevant. Thus, doing a brief personal history prior to drug administration is always advisable. Medication reconciliation is another way to reduce medication errors. This entails comparing medical records, allergies and home medications, and comparing findings at admission and discharge. Doing this eliminated medication errors (Pronovost et al., 2003). Thus, it is important to always document drugs administered in the chart. This is another thing that I failed to do during my OSCE but realizing now how important it is made me confident that surely, I will remember it during my practice. Another way that patient safety can be promoted is by incident reporting. Having a web-based incident reporting system, for example, improved errors in wrong choice of drug in computer prescribing, wrong administration of drugs, and poor service of the staff after hours in a Japanese hospital (Nakajima, Kurata, and Takeda, 2005). During my OSCE, I made sure to keep these patient safety practices in mind. Those that I failed to do, such as checking my patient’s identity with my mentor and documenting that I administered a drug, are definitely ones that I will remember from now on, now that I realize how important they are. Holistic Individualized Patient Care Another important aspect of nursing care that I was able to demonstrate and further practice during my drug administration OSCE was providing holistic individualized patient care. Holistic nursing is defined as a practice of nursing which has as its goal the healing of the whole person (Dossey and Keegan, 2009). It draws on nursing knowledge, theories, expertise, and intuition. The focus is on protecting, promoting, and optimizing the wellness of a patient. Holistic nurses should assist in healing, preventing illness and injury, alleviating suffering, and supporting patients. The principle of holistic nursing is centred on relationships with patients and is healing oriented, as opposed to the traditional approach which focuses on diseases and cures. Holistic nursing puts emphasis on self-care, mindfulness, and facilitation of healing in others. Concern for the patient is central to this holistic approach. Elements included in patient concern are: the subjective experience of the patient and the meaning he or she ascribes to health and illness; the cultural values, beliefs, and folk practices related to health; spirituality; the evaluation of complementary and alternative modalities; comprehensive health promotion and disease prevention; self-care processes; physical, mental, emotional, and spiritual comfort; empowerment, decision-making, and making informed choices; social and economic policies and their effects on individuals and communities; healthcare systems and their accessibility and quality; and the environment (Dossey and Keegan, 2009). While these may seem daunting, when I reflected on it, it made sense that I should adopt such a view on nursing care. While I may just be doing something as simple as drug administration, every interaction with a patient is a chance for me to contribute to his or her wellness. The use of interpersonal skills could lead to health promotion, enabling the patient to benefit from every encounter with his or her nurse, even in the long-term, which is the benefit of holistic patient care (Benson and Latter, 1998). Also, nursing care which looks beyond just accomplishing the usual duties have been found to lead to better patient satisfaction, now an important indicator of quality care. Patient satisfaction particularly increased when nurses anticipated patients’ needs and responded to their requests, both elements of patient concern (Dingman et al., 1999). In the initial contact with the patient, one of the ways that a holistic care could be initiated is by taking time to build rapport. This entails introducing self as the nurse in charge, taking time to know the patient, communicating and providing information. Fosbinder (1994) breaks down this process into four parts: translating; getting to know you; establishing trust; and going the extra mile. Translating entails informing, explaining, and instructing on the specific aspects of treatment and general principles of care. Getting to know you consists of nurses’ personal sharing and having rapport with the patient. Trust was found to be established when patients saw that the nurses took charge and liked what they were doing. Going the extra mile included friendship and providing care beyond what is expected. Interpersonal skills and qualities such as kindness, warmth, compassion, and genuineness were found to be important in building therapeutic relationships and in controlling patients’ pain and distressing symptoms (Johnston and Smith, 2006). In another study, humour was also found to have a positive impact on the patient-nurse relationship and the patient’s well-being (Astedt-Kurki et al., 2001). Keeping these processes in mind and later on expressing them innately will help me in interacting with my patients and making sure they get the care they expect and more. Informed consent Obtaining informed consent is done to protect patient autonomy and to promote meaningful decision-making. It is especially relevant when providing nursing care as nursing care procedures can potentially invade patient autonomy. Furthermore, obtaining informed consent makes procedures less mechanistic and more attuned to the needs of individual patients (Aveyard, 2002). Prior to drug administration, nurses should obtain informed consent. This ensures that patients or their representatives are aware of what is being done for the patient, and are also informed of the possible side effects. The patient can be an ally to the health professionals in caring for him or herself. In medication safety, the patient can anticipate possible side effects and monitor them, if he or she is informed beforehand. Medication safety I think one of the more important principles that I learned in my drug administration OSCE was medication safety. I think the reason why such a seemingly simple task as drug administration must be subjected to a long complex process of checks is because errors in administering drugs could lead to potentially undesirable, and even fatal, effects. Medication safety entails a lot of knowledge and steps. First and foremost, all nurses must have adequate knowledge about drugs. The drugs being administered must concur with the patient’s condition and medical history. Also, nurses must apply knowledge and theory so as to give the patient the drug via the right route, during the right time and date, and with the right dose. Many factors contribute to medication errors, which can be divided into system issues and personnel issues. System issues are those related to the environment and the setting that contributes to errors. These include lack of adequate staffing, inadequate access to policy and medication information, faults in the physical environment such as poor lighting and inadequate drug preparation facilities, and organizational culture. Incident reporting and evaluation could pinpoint the exact system issues involved and work towards eliminating these problematic issues (McBride-Henry and Foureur, 2006). Personnel issues are those that contribute to errors because of an individual’s oversight. As nursing students, these are the issues that we are trained to avoid. These include a lack of understanding of how errors occur, which could lead to perpetuation of errors committed. This can also be due to failure to adhere to policy and procedure documents, presence of distractions, and lack of knowledge about medications. Other issues include the number of hours on shift and the workload. Along with personal conviction to do better, these issues must be addressed by the hospital and the professional body to ensure that all practicing nurses exhibit competence at all times (McBride-Henry and Foureur, 2006). Smith (2004) released a set of guidelines on medication safety. Medication errors can occur in all health care systems and can involve any health professional. This of course includes nurses performing drug administration. The guideline provides recommendations on all aspects of drug administration, from safe prescribing, to safe dispensing, to safe administration. Particularly relevant to my field is the safe administration of drugs. The recommendations state that there should be procedures that will ensure that the right patient receives the right drug, in the right dose, by the right route, at the right time. Staff should have access to reference sources that supports safe drug administration and should be well-trained and assessed as competent before being required to administer drugs. The patient’s treatment plan should also include information for drug administering and monitoring the foreseen effects of the medicines. Nurses should also discuss the drugs being administered with the patients or their representatives at time of administration, not only to ensure that the appropriate drug is being given, but also to promote health and understanding of the patient regarding their conditions. Care and order must also be put in storing the drugs so that errors in drug selection are reduced. Lastly, there should be a system of reporting drug administration errors and near misses. These should be recorded and reviewed regularly to raise staff awareness of the risks of drug administration errors. There are still other ways to reduce drug administration errors. Protocols should be carefully followed, especially with high-risk drugs. Close monitoring of patients must be done, and when appropriate, infusion pumps must be used. The place where drugs are prepared should be kept clean and orderly to minimize distractions. Nurses must be vigilant in checking calculations. Lastly, patients must be informed regarding the medications they are given and its possible side effects (Copping, 2005). Patient comfort and satisfaction Patient satisfaction is one way to know that quality care is being provided. In a literature study by Johansson, Oleni, and Fridlund (2002), they were able to describe eight domains in nursing care that had an impact on patients’ satisfaction: the socio-demographic background of the patients, their expectations on nursing care, the physical environment, the communication and information they received, their level of participation and involvement, their interpersonal relations with their nurses, the nurses’ medical and technical competence, and the influence of the health care organization on patients and nurses. Ensuring patient comfort at every interaction is central to being a good nurse. Providing comfort assures patients that their safety is being ensured, and this makes a significant contribution to the perceived quality of care, the control of costs, and even the health outcomes of the patients (Curley, 1998). Showing concern and ensuring comfort may be as simple and basic as introducing one’s self at the beginning of the interaction, asking the patient how he or she feels, and informing the patient if a procedure is to be done. Specifically in drug administration, care and concern may be translated by making sure that the patient’s position is appropriate, that is, he or she should be upright or head is elevated when taking medications so as to avoid aspiration. One should also provide water to make it easier for the patient to take the medications. At the end of each interaction, the nurse should conclude it by asking if the patient has any questions or concerns and helping the patient into a relaxed position. Clinical Judgment I think the main goal of activities such as the drug administration OSCE is to hone our clinical judgment. Our clinical judgment consists of all our knowledge and theories and how we practice it as we interact with our patients. Tanner (2006) presents the results of her review of studies on clinical judgment. She found that nurses’ clinical judgments are more influenced by what they bring to the situation rather than the objective data at hand. Also, sound clinical judgment depends more on knowing the patient, especially his or her typical pattern of response and concerns. Judgments can also be influenced by the context in which the situation occurs and by the culture and prevailing systems in the nursing unit. Based on these, we can see how important the nurse’s background is, the context of the situation, and the nurse’s relationship with patients. All of these contextual details play a role in how nurses interpret findings and respond to it. However, clinical judgment should be checked by medication management protocols. Medication management activities of nurses consisted of these six themes: use of medication protocols, scrutinizing patients’ identity before medication administration, double-checking certain medications before administration, writing incident reports, following specific policies, and timing the administration of medications (Manias, Aitken, and Dunning, 2005). These are all helpful checks to avoid errors in drug administration. Overall, I learned a lot during my drug administration OSCE. I was able to practice and apply the nursing theories that I know and was able to see areas where I needed improvement. Detecting my oversights made me remember them more vividly, especially since a practical exam such as an OSCE made me feel all the more how important proper nursing care is. References Astedt-Kurki, P., Isola, A., Tammentie, T., and Kervinen, U., 2001. Importance of humour to client-nurse relationships and clients’ well-being. 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Medication reconciliation: a practical tool to reduce the risk of medication errors. Journal of Critical Care, 18(4), pp. 201-205. Smith, J., 2004. Building a safer NHS for patients: improving medication safety. London: Department of Health. Tanner, C. A., 2006. Thinking like a nurse: a research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), pp. 204-211. Read More