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Write Reflection Essay on :

- Safe Administration of medication : Flucloxacillin by IV (intravenous)

Personal Experience Administering IV Medication

One of the greatest challenges for the nursing professionals to overcome while providing care to the patients is the safe and effective administration of medication. As mentioned by Roughead, Semple and Rosenfeld (2016), the medical errors have been recognized as the leading public health issue which is attributed to add 25% of health care associated accidents in the Australian health care system. However, among the various different types of medication errors that are prevalent in the health care scenario, by far the most prevalent one can be considered administering the intravenous (IV) medication (Maaskant et al., 2015). Administering IV medications require advanced skill set and competencies due to the complicated and meticulous procedure associated with the entire procedure of administering intravenous medication to the patients (Parry, Barriball & While, 2015). Hence, it is very important for the nurses to develop skill set sufficient for adequate intravenous medication administration. This essay will attempt to explore my personal experience of administering IV Flucloxacillin to a patient taking the aid of Gibbs reflection cycle.

I had been given the opportunity to administer Flucloxacillin via the IV route to a patient and my course of action for this activity began with introducing myself to the patient. Then, as per the standard guidelines, I carried out the five moments of hand hygiene all the while engaging in small talk with the patient in to develop a therapeutic connection and build an easy rapport. Followed by which I carried out identification check for the drug, by matching the drug name with the prescription chart and the label of the container and also its expiry date (Kemh.health.wa.gov.au, 2018). Then I ensured the patient is right for this administration matching the name and medical record number prior to administration, along with any possibilities allergy or hypersensitivity to the drug components. The next three rights to be checked is right time, right dose and right route which I completed next, although I also confirmed with the buddy nurse before commencing with anything. I commenced with safely preparing the medication dosage following the ANTT technique and reconstituted the medication safely. Although, in the excitement of the entire experience I overlooked the aspect of checking the probability of phlebitis the need for checking of the cannula site which is very important to avoid the risk of the patient obtaining phlebitis or any pertinent infections. However, the buddy nurse reminded me immediately carried it out effectively. The last task for me had been to discard the sharps safely and adequately which I carried out and then educated the patient regarding the medicine administered and what can be expected as adverse reactions and how to communicate if experiencing and adverse reaction out of the norm before leaving the room.

Evaluation of the Experience

First and foremost, I would like to add in this context that this had been an extremely helpful experience for me to administer intravenous medication, which is the one of the most challenging role of a practicing registered nurse. This had been my first experience of administering intravenous medication on my own to a patient in the real clinical setting and I had been extremely nervous while administering the medication and even my hands had been shaking a little. Although, I tried my best to not let my nervousness and excitement cloud my clinical decision making and medication administering skills and I attempted to invest complete attention and dedication to the tasks I had to complete as per the basic standards of administering intravenous medication safely. Although I did commit two unintentional errors while completing the entire activity. First and foremost, I completely forgot to check the cannula site for competency and possibility of phlebitis about which I was reminded by my buddy nurse. Another mistake I committed due to my nervousness and the hurriedness to complete the activity within the given time had been missing out explaining the patient the need for administering the medication and taking verbal consent to the process.

The evaluation section of the Gibbs reflective framework allows the nursing professional to revisit the entire experience in acute details and explore all the positive and negative aspects of the experience, recognizing what worked and did not work in the activity (Husebø, O'Regan & Nestel, 2015). I believe that although I have made certain errors while engaging in this extremely helpful activity, I had been correct in the majority of the tasks that are needed to be completed by the nurse administering IV medication. Hence, there are a lot of aspects that worked and had been correctly carried out with respect to the present standards and guidelines of administering IV medication to the patients (Lenz et al., 2017). For instance, patient introduction and engaging with patient before actually carrying out any care activity is a very important aspect of care delivery which I had correctly demonstrated, it not only helps in developing an adequate therapeutic connection with the patient but also helps in calming and comforting a patient (Safetyandquality.gov.au, 2018).  The five rights of medication administration is another integral element of safe medication administration guidelines which I have also carried out effectively and efficiently. The timely administration of five moments of hand hygiene along with infection control is one of basic requirements which is needed to be followed by all health care professionals across the globe, which I believe I carried out effectively as well.

Factors Contributing to Errors

 However, there are certain errors made by me as well, which could have led to considerable negative outcomes for the patient. First and foremost, I missed out on taking verbal consent from the patient by explaining the need for administering the medication and along with that I missed out on checking the cannula site for phlebitis as well. Another mistake which can be considered as a mistake on my part is missing out on documenting the experience adequately and spontaneously where my buddy nurse had to remind me more than once to document certain details of the activity. Hence, these represent certain incompetence with respect to my professional skills and there is need for improvement in certain skills to be able to carry out professional growth and be able to provide safe, effective and patient centred care to the patients.

While analysing the errors made by me, I believe the nervousness and excitement of carrying out the entire activity had been the primary contributor to my errors. As mentioned by the Shahrokhi, Ebrahimpour and Ghodousi (2013), nervousness stemmed from the insufficient work experience of the nurses and the huge gap in the theoretical learning and knowledge with respect to practical application in the correct manner is a considerable contributing factors leading to errors in practice, especially the medical errors. Although, it is inevitable for the nurses that are transitioning into practice to be nervous, there is need for skill advancement to be able to overcome the impact of nervousness and excitement leading to considerable errors. The lack of applicative educational experience is another reason behind the extent of errors of the transitioning nurses, hence the need for more application based education setting rather than focusing mostly on theory is conspicuous (Parry, Barriball & While, 2015).

However, the errors that I had made can also been attributed to being distracted by the chaotic activity and noise in the background which is also a prominent factor that leads t medication errors in clinical settings. In such case, there is need for effort and skill enhancement to enhance focus and attention of nurses while in practice so that they are not easily distracted by the noise or any other form of distractive activities going on in the clinical setting. Lastly, not properly documenting the medication administration and not checking the cannula site for phlebitis are errors that not only hint at incompetency but can potentially harm the patient. Furthermore, phlebitis is a concern which leads to even pulmonary embolism in certain cases and can be life threatening if adequate care is not taken (Dunda et al., 2015). Hence, needless to say, it is very important for nurses to employ utmost dedication and follow a set protocol effectively while administering the IV medication to ensure not harming the patient. Hence, I will require to invest efforts to rectify my lack of skills that led me to commit to the unsafe practice.

Skills and Competencies Required for Safe IV Medication Administration

Conclusion:

On a concluding note, administering intravenous medication is indisputably the sector of professional responsibilities where the nurses commit the most mistakes, and unfortunately I also committed certain mistakes which could have potentially harmed or disrespected the patient. This had been an excellent opportunity for me to understand my strengths and weaknesses with respect to this professional practice and I will be taking adequate efforts based on this knowledge to improve my skills and competency as a practicing nurse.

First and foremost, attention, dedication, focus and being able to conquer nervousness had been one of the greatest challenges and weaknesses that I discovered from my practice. Hence I will be enrolling in different professional practice workshops to build on the mentioned skills to strengthen my professional competencies. Along with that, I will also reach out to my supervisor for feedback and suggestions so as to how I can improve my skills and be able to attain the competencies that I am lacking. I will also take the aid of online courses and webinars to enhance my knowledge or documentation and patient consent. I discovered compassion, empathy and patient engagement to be my strengths, I will be taking additional efforts to further improve these skills as well to build on to my strength (Bengtsson & Carlson, 2015). 

References:

Bengtsson, M., & Carlson, E. (2015). Knowledge and skills needed to improve as preceptor: development of a continuous professional development course–a qualitative study part I. BMC nursing, 14(1), 51.

Dunda, S. E., Demir, E., Mefful, O. J., Grieb, G., Bozkurt, A., & Pallua, N. (2015). Management, clinical outcomes, and complications of acute cannula-related peripheral vein phlebitis of the upper extremity: A retrospective study. Phlebology, 30(6), 381-388.

Husebø, S. E., O'Regan, S., & Nestel, D. (2015). Reflective practice and its role in simulation. Clinical Simulation in Nursing, 11(8), 368-375.

Kemh.health.wa.gov.au. (2018). Intravenous Medicines – Checking and the Administration. [online] Available at: https://www.kemh.health.wa.gov.au/~/media/Files/Hospitals/WNHS/For%20health%20professionals/Clinical%20guidelines/Pharmacy/guidelines/Checking%20and%20Administration%20of%20Intravenous%20Medications.pdf [Accessed 12 Sep. 2018].

Lenz, J. R., Degnan, D. D., Hertig, J. B., & Stevenson, J. G. (2017). A Review of Best Practices for Intravenous Push Medication Administration. Journal of Infusion Nursing, 40(6), 354-358.

Maaskant, J. M., Vermeulen, H., Apampa, B., Fernando, B., Ghaleb, M. A., Neubert, A., ... & Soe, A. (2015). Interventions for reducing medication errors in children in hospital. Cochrane Database of Systematic Reviews, (3).

Orbæk, J., Gaard, M., Fabricius, P., Lefevre, R. S., & Møller, T. (2015). Patient safety and technology-driven medication–A qualitative study on how graduate nursing students navigate through complex medication administration. Nurse education in practice, 15(3), 203-211.

Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse medication administration error: A narrative review. International journal of nursing studies, 52(1), 403-420.

Pendleton, D. (2018). Australia joins international push to halve medication errors | Safety and Quality. [online] Safetyandquality.gov.au. Available at: https://www.safetyandquality.gov.au/media_releases/australia-joins-international-push-to-halve-medication-errors/ [Accessed 12 Sep. 2018].

Roughead, 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(3-4), 113-122.

Shahrokhi, A., Ebrahimpour, F., & Ghodousi, A. (2013). Factors effective on medication errors: A nursing view. Journal of research in pharmacy practice, 2(1), 18.

Standard 4: Medication Safety. (2018). Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard4_Oct_2012_WEB.pdf

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