Medication Practice Improvement, Medication Support Mechanisms, Medication Orders and their Communication, Medication Safety Standards - Essay Example

Medication Practice Improvement Episode Student’s name Institution Instructor Intercepts Intercepts are an important part of clinical nursing practice as it is only through intercepts that practice may be enhanced for client safety. In my professional nursing practice I have encountered a range of scenarios which put people receiving medication at risk. I have identified three scenarios which I deemed critical towards the enhancement of medication management safety. I came up with three intercepts which I believe will be useful in enhancing professional practice in medication management safety. The intercepts are in medication administration, medication support systems, and in medication orders and their communication. Medication Administration Having been at my duty station for about three years I have become familiar with the systems of medication administration. According to Aronson (2009) this presents one of the highest risk areas in medication management. While the five rights of medication management are common for all nursing students in Australian universities I established that their application in practice was deficient thereby increasing risk of errors. Learners are normally well versed with procedures but in practice do not apply the clinical principles they have learnt in college to enhance clinical outcomes. I found that the ineffective application of these resulted in ineffective interception of errors in packaging storage, prescription and prescribing. I established that dosage calculations were never checked independently by another nurse and cross checking of the patient and the medication was not done. I came up with an intercept which was procedural in that the issuing of medication by the pharmacy was to be done only after independent verification and signing off by two nursing professionals. Medication Support Mechanisms Medication support mechanisms at my professional practice were in error in both clinical and individual support. Medication safety calls for a high level of support in terms of assisting the patient acquire instruction on administration techniques, information, and instruction on self monitoring equipment (Kohn et al, 2000). Clinicians need to be offered support in the performance of their duties such as information on new developments, appropriate equipment, in service training and education and adequate staffing. All of these are critical aspects in most of the service organizations which always have changing standards but most of all in clinical nursing practice. In my professional practice I established that while some of the supports were provided to patients and the clinical officers, the practitioners did not make the most of them. In this regard I came up with an intercept aimed at enhancing the utilization of supports. An intercept I deemed most important was in service refresher courses on the importance of utilizing medication support mechanisms in enhancing medication practice. Medication Orders and their Communication Communication between clinical practitioners regarding aspects such as client history, their records and what had been previously prescribed is critical in ensuring medication safety. I had to come up with an intercept with regards to medication orders and their communication. Prescription and prescribing of medication at my place of work did not follow the laid down guidelines. Prescriptions were found to be ineligible which resulted in wrong medications being issued to patients. The policy and procedure at my workplace was deficient in that due to the inadequate numbers of clinical personnel errors in prescribing and prescription happened more often than not. The heavy workload resulted in ineffective prescribing, wrong medical decisions and inappropriate prescribing. The heavy workload meant that guidelines in which clinicians had to have another clinician double check could not be enforced resulting into lapses (Greenwald & Halasyamani, 2010). I came up with an intercept that set fixed working hours for every clinician. While this increased waiting times for patients, there were lesser errors. Intrinsic Factors Medication administration was weighed down by a lack of knowledge and skills of the systems and procedures of operation. Many of the clinical practitioners did not have knowledge or competence with regard to current legislation on medication management such as ANMC competencies and documentation requirements (Cohen & Smetzer, 2007). The highly complicated nature of systems and the workload meant graduates do not have the opportunity to work with an RN in a facilitator role which means that systems are ignored for the most part. The lack of knowledge and competencies in medication resulted in the clinicians operating on outdated systems which were not as effective. Medication support mechanisms were impacted by a lack of skills of the clinical staff. Many of the staff lacked the prerequisite skills to offers support to the patients. Even as the hospital offered equipment, there was a lack of training on the use of such equipment. New equipment and new workspaces are being introduced everyday yet there was no clear procedure in place to offer support to the staff on their proper usage. The refresher courses and in-service trainings which were meant to enhance skills were not implemented. As such personnel considered themselves competent yet were deficient in communication skills, medical delivery systems and offering of support and information to patients. Medication orders and their communication were hampered by the instance of lack of adequate staff. This resulted in fatigue which is the cause of prescription errors experienced. Due to the insufficient numbers clinicians are forced to work long hours which negatively impacts medication safety. The low numbers also result into a lack of motivation and stress particularly for the graduate clinicians who did not have RNs guiding and motivating them in the transition phase (Mayo & Duncan 2004). Extrinsic Factors The work environment is a critical component of medication safety which impacted practice in terms of medication orders and their communication. The workload at my place of work is related to the instance of ineffective prescribing and prescription. Double shifts and solo mode of practice result in frustration and fatigue which results in errors particularly since the RNs and the graduate clinicians do not have the same level of competence. The nursing and resident ration being low makes it hard to respond to emergencies making medication practice ineffective (Wolf et al, 2008). Support systems are important in any care setting and hence they have to be clearly set out. The system of support at the organization was deficient since there was an organizational culture which was detrimental to such objectives. The support systems at the organization were geared towards punitive rather than supportive recovery oriented culture. RNs were not encouraged or did not have time to engage with new nurses due to a culture that emphasized output over quality service. This creates an organizational culture of solo mode practice which tends to make medication practice disjointed (Grol et al, 2005). Evaluation audit and feedback processes are deficient in medication administration processes and hence the errors at the organization have become endemic. The evaluation and audit processes at the organization were deficient since processes, systems and the efficiency of the systems and staffs were conducted on a yearly basis. The administration did not seem particularly concerned with the auditing of personnel competencies for task assigned which resulted in complacency and lack of motivation. For the most part medication administration aspects of packaging storage and writing of dosage were laissez faire. Given that feedback was once a year, it was ineffective in arresting situations of immediate concern. Medication Safety Standards Medication Orders and their Communication It is critically important to offer support to patients regarding where they may find access to support groups, medications, and information on options available for their ailments. One critical component of the intercept process is communication to patients and carers. This may be achieved through provision of information during consultation, identification of written sources of information suitable for consumers, referring clients to programs offering support and information such as rehabilitation centers or any other centers which attend to specific needs (Australian Commission on Safety and Quality in Health Care). There needs to be a resource center wherein the details of the patients and recent medicines may be kept in order to ease access to clinical officers that may need to provide the information to patients from time to time. Support ought to include a medication management plan which involves the carers, patient sand the clinicians in order to avoid errors in prescribing or prescription which for the most part are brought about through lack of proper communication channels among the parties (World Health Organization, 2011). Through a standardized plan the issues of medication orders and issues of communication may be avoided for instance through electronic records or following a template action plan detailed for a range of scenarios. Medication Administration Medication administration as an important element of health care and safety calls for a system to be put in place which ensures that errors are minimized. In order to do this there needs to be implemented a system of up to date decision support tools and clinical information that aid in the administration of medication (Aronson, 2009). A range of decision support tools such as newsletters, in service education, desk top icons and awareness campaigns would serve to ease the health and legal issues of prescription. There should be clear guidelines put in place aimed at placing responsibility on a person to undertake regular review of the decision support systems effectiveness and whether they are aligned to organizational objectives (Hughes, 2008). There ought to be regular review and audit of systems in order to ensure that protocols and procedures which are set are being followed by the clinical personnel in the administration of medication. Through a review of electronic reports and records the effectiveness of procedures and protocols will be determined. In accordance with legislative requirements the organization ought to review policies and procedures to ensure they are in line with professional and legislative protocol. Such policies ought to cover prescription, storage, packaging and management of medication. Medication Support Mechanisms An intervention in medication support system is through the implementation of governance systems which are aimed at constant reviewing of support systems for effectiveness. It has been established that a lack of support mechanisms are among the highest predictors of ineffective medication. Interventions in medication through procedural means are one of the means through which this may be rectified. The process of offering support mechanisms is not a cheap one and hence it has been overlooked or ignored by many health institutions as unsustainable. However it has been established that having better support systems made the medication and safety framework 40 percent more effective in reducing erroneous prescription (Kohn et al, 2000). Clinical officers with access to a range of decision making tools such as electronic records, better designed workspaces and equipment are more likely to make fewer errors in their work. Patients that are offered access to sources of information are also likely to be more interested in their treatment and have more confidence in their practitioner. Such patients will also be less likely to make errors in taking their medication and will be healthier in the long run thus making medication safety management more effective for the health institution (Greenwald & Halasyamani, 2010). How Involvement has Impacted my Practice My involvement in the three incidents has made me have a different perspective on the need for clinical nursing practice to be made more procedural. Through my involvement in the making of the making of important intercepts I believe I have come to acknowledge the role of the clinical nursing professional in enhancing practice regardless of their level of practice. Medication Administration This being one of the most high risk areas in medication management the fact that it had not been taken very seriously is a cause for concern. The incidence of issues in medication administration has led me to develop interesting perspectives on certain aspects of medication safety. The episode of patients receiving the wrong prescription as a result of lack of proper procedural measures has made me understand the importance of such procedures. My practice has been informed by this session in that I have come to the realization that what is taught in college to nursing professionals is important for professional practice. This episode has made me take what I had studied very seriously such that I now revise what I had studied and attend refresher and in-service trainings in order to be more effective in medication safety. Given the success of my intervention in the prevention of errors at the workplace I have come to believe that it is the role of every clinical nursing professional to ensure that there are proper procedures in place to enhance professional practice. Medication Support Systems The experience with medication support systems have made me acknowledge the importance of medication support systems. Prior to my experience in which clients reported being dissatisfied with the support system, I did not have an appreciation of medication support systems. I find that I am more inclined to offer the most information and access to information available to me to the patients in order to enhance medication safety. On the other hand my professional practice hs been enhanced through my experience in that I have come to appreciate the role of proper administration techniques, instruction and self monitoring which clients need in order to be safe with medications. The need for support for clinicians has also become an important part of my professional practice and thus I am actively involved in advocating for better working conditions, equipment and training at my place of work. Through my experience I have come to see my professional practice calling for more involvement with patients which I had previously deemed to be only theoretical. Medication Orders and their Communication I believe communication to be one of the most critical aspects in enhancing the performance of a clinical nursing professional. Having knowledge on client history, communicating with carers and other professionals is critical. My professional practice has been greatly enhanced through my experience in medication orders and communications intercept. Through this I have come to acknowledge the role played by communicating and sharing of information and knowledge with other practitioners thus enhancing each other’s knowledge. My prescriptions have been highly effective and I have had lesser errors through consultation with other RNs, getting information from the client records, the clients, and their carers. I have come to appreciate the need for set times of rest and procedures which allow for clinicians to rest and recuperate thus reducing stress from the workload. Through this experience I do believe my professional practice has been enriched. 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Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 37. Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human: Building a safer health system. Washington, D.C: National Academy Press. Mayo A.M. & Duncan D. (2004). Nurse perceptions of medication errors: what we need to know for patient safety. J Nurs Care Qual. 19 (3): 209-217. Wolf Z.R. & Hughes R.G. in Hughes RG, editor, (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 35. World Health Organization. (2011). Improving Medication Safety. WHO Patient Safety Curriculum Guide: Multiprofessional Edition. whqlibdoc.who.int/publications/2011/9789241501958_eng.pdf Read More