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Assignment on safety medication administration
Assignment on safety medication administration
Medication safety reflection
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INTRODUCTION This is the case study of Ms Lynette Maree Young, 46 years old women who died on 29 April 2012 because of shock following Interferon alpha treatment. During the treatment of her in the hospital, failure to early diagnosis of pericarditis and failure to prompt management of side effects of interferon therapy led the situation for death of Ms. Young. The main reason behind the death of Ms Young has happened due to the lack of assessment and inappropriate care provided by the health team including doctors and nurses. This assignment will discuss the cause of Ms Lynette Maree Young death in the context of Coroner’s case, patient safety, tort of negligence and ethical issues that has been identified during the period of treatment SECTION
Liability Issues Primarily, Caring Memorial Hospital will be held liable in this malpractice case under the premise of respondeat superior. “Under respondeat superior an employer is liable for the negligent act or omission of any employee acting within the course and scope of his employment” (Thornton, 2010, para. 2). The risk manager Susan Post, JD and the quality assurance director Amy Green were both aware of the potential for increased risk on the Oncology unit. They had been making observations several months prior to incident that related to deficiencies in staffing and safety standards. Per, ASCO and ONS (2012) new staff are required to demonstrate competency and receive comprehensive chemotherapy education.
1.Match each cultural group with its corresponding cultural practice. 1 c Asian 2. a Hispanic 3. d Native American 4. b
It is important to follow any guidelines and leaflets in medication, as this helps the safe administration of all medicines. It is also important to find out if a person has already taken medication prior to the care support worker giving them any. This is to ensure that you do not overdose the individual. A service user usually has a MARS sheet where the medication that is administered in signed off by the care worker that last administered it to them, so that the care support worker can clearly see that last time the medication was administered to service user, and when they are next due to have the medicine.
The Medicines act 1968 governs the manufacture and supply of medicines it divides medical drugs into three categories which are, prescribed Medicines, Pharmacy Sales and general Sales. All professionals who are involved in medicines management are governed by a legal and professional accountability to follow best practice when prescribing and administering medication. This is essential in the provision of safe and effective patient care. Prescription only medicines can only be given in accordance with the directions of an appropriate practitioner. Unless instructed, there is no scope to alter the dose or change the form of a prescription only medicine, for example, by crushing or opening a capsule would be a breach of the 1968 Act.
The Victoria Government Department of Human Services (2012) stated “the freedom to make decisions which affect our lives is a fundamental right that each of us should enjoy”. The decisions we make in our lives represent who we are and how we want to be perceived by the world – whilst taking into consideration our own morals, beliefs and goals. Supported decision-making (SDM) is a process by which “a third-party assists or helps and individual with an intellectual or cognitive disability to make a legally enforceable decision for oneself” (Kohn & Blumenthal, 2013). May & Rea (2014) stated that “supported decision-making assumes that all people, regardless of their ability or disability, have some capacity to be involved in decision making”.
Review with nurse Gilbert why valium and morphine are contraindicated in shock and her duty to identify this and speak up 5. Review with nurse Gilbert her duty to speak up regarding a need for a transfer of patient to Dr. Dick 1. Complete a root cause analysis identifying breakdowns in processes that directly resulted in the negligent acts by nursing, if any. Implement action plans to correct any process issues identified. Complete any additional individual nurse follow up identified, as needed, outside of short-term action
In care settings the currently legislations, guidelines policies and protocols relevant to the administration of medication would be: - The misuse of drugs act 1971 - The Medicines Act 1968 - Care Standards Act 2000 - The Health and Social Care Act 2001 The Control of Substances Hazardous to Health Regulations 1999 - The RPS Handling Medicines in Social Care Guidelines The recording, storage, administration and disposal of medication must be adhered by employees in accordance with the current policies and procedures. The policies are in place to protect everyone - training must be undertaken or up-to-date before support workers can administrate any medication.
Current Legislation relevant to the administration of medication falls into three categories which are listed below. The legal management of medication is covered by the acts listed below and various amendments made to them, such as: • The Medicines Act 1968 – (amended in 1998) • The Misuse of Drugs Act 1971 • The Misuse of Drugs (Safe Custody) Regulations 2001 • Data Protection Act 1998 • Health and Social Care Act (CQC) (Regulated Activities) and the Essential Standards 2001 – (amended in 2008 and 2012) • The Nursing Midwifery Guidelines for the management of medicine administration Some legislation has a direct impact on the handling of medication in social care settings. These are: • The access to health records act 1990 • Mental
Recognizing, acknowledging, and understanding medication safety is important when administering medications. Understanding which medications are high-risk ones, being familiar with the medications being given, remembering the five most important rights when administering medications, communicating clearly, developing checking habits, and reporting the medication errors will lead to safe outcomes for the residents. However, errors do occur from a lack of experience, rushing, distractions, fatigue, doing too many things at once, not double checking, poor communication, and lack of team work. It is not only the staff that commit errors, but also the work environment that contributes to the medication error. Two examples are poor reporting systems
The Health and Safety at Work Act etc 1974 aims to ensure the health, safety and welfare to all individuals in the workplace and reducing the risk of accidents, illness, injuries and malpractice. This can include the administration, handling, storage and record of dangerous substances and the training of staff in these areas as well as in handling safety equipment to ensure health and safety. In the Health and Safety at Work Act etc 1974, policies can alter depending on the requirements in different areas in different settings. In Hospitals, one of the areas that requires policies following the health and safety at work act include the administration, handling, storage and recording of medication prescribed to service
To create an environment where these errors are a rare occurrence, all healthcare professionals must dedicate themselves to implementing QSEN's six core competencies each and every day. These professionals must also speak up when they see room for improvement in their workplace. Regardless of the healthcare setting or demographic of patients, safe outcomes are the purpose of providing patient-centered care. Since nurses are the largest subgroup of healthcare professionals, their ability to make strides towards improved medication administration is undeniable. As the nursing code of ethics states, nurses have the duty to protect the health and safety of those in their care (Winland-Brown, Lachman, O'Connor Swanson, 2015).
There were specific situations that led to the cause of Julie Thao's actions of medication error and the death of Jasmine. The situation could have completely been avoided had Julie followed the code of ethics and avoided shorts to provide proper care for the patient. The state claimed that Thao's mistake was caused by actions, omissions and unapproved shortcuts, however, there were other factors that played a role in her carelessness as well. While failure to comply with procedure has been a factor in the medication administration error, other factors contributed as well. For example, failure to properly use the information system, or to ignore alerts or warnings have also resulted in preventable errors (Nelson, Evan, & Gardener, 2005).
Medication use is potentially dangerous. Polypharmacy is increasing, and makes it harder to keep track of side effects and interactions and of potentially inappropriate drug combinations. “The risk of serious consequences, hospitalization, and death due to medication errors increases with patients’ age and number of medications (Scand J Prim Health Care, 2012)”. For example, the GP is supposed to monitor the patient's regular medication, but does not always do so. Lack of monitoring and keeping track of patients’ medication use is a main cause when a patient is given inappropriate drugs.
Husband and family are a bit upset about this.” Immediately when the nurse left, I reviewed the patient’s medical record and to my surprise, she had Phenergan, an anti-nausea medication, prescribed but it was never given at this point! Not once. I did note the morphine was
