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Patient 1: Mrs. Grace

Written a reflection on three patient safety and clinical quality activity.

As part of my patient safety and clinical quality focused activities, I had to complete the learning activity of responding to care of three patients with different health issues. The first patient was Mrs. Grace with falls and Bradycardia. She was a 70 years old lady and admitted to hospital after falling in her bathroom. She had injured her hips and had bruises on her hands and legs. The second patient was Mr. Clarke who was diagnosed with cellulitis and had swollen legs. The swelling on his leg was painful. The third patient was Mr. Donovan with congestive cardiac failure (CCF) and he was also suffering from anemia. All these three activities tested my nursing competence in the area of three specific standards mentioned in National Safety and Quality Health Service Standard (NSQHSS). These included standards on medication safety, blood and blood products and preventing falls and harm from falls (safetyandquality.gov.au 2018).

While completing the activity related to care of Mrs. Grace, I had the responsibility to assess fall risk in patient and take appropriate step to prevent falls in hospital. As Mrs. Grace was a very old patient, I was very worried regarding how I can suggest strategies to promote patient safety in aged patient. My nervousness was also because this was my first experience in taking part in activity related to care of elderly patient. In case of management of patient with cellulitis and CCF, I was even more worried because I knew they were patients with critical disease and in case of any wrong strategies taken for these patients, I will face major challenges in demonstrating the correct competence in promoting patient safety and clinical quality in these patient. However, I tried to keep calm and ensured to utilize my knowledge in the right area to avoid making mistakes. My special focus was to maintain safety of patients in all areas. I was ready to complete this activity because this experience will help me to internalize concepts related to patient safety and quality care. This is also necessary because evidence has revealed that nurses are constantly present at the bedside of patient and they play a major in monitoring patient, detecting complication and implementing the right care process to provide quality care to patient (Vaismoradi, Salsali & Marck 2011).

By completing the patient safety and clinical quality activity with three patient, I got to learn many useful information related to improving my skills as a nurse. While completing care activity for Mrs. Grace, I faced major challenges in deciding strategies to prevent fall in patients. I faced this challenge because the patients experienced memory loss and so just making patient aware about hazards around her surrounding was not effective. However, while searching for research articles related to bedside safety of patients at risk of fall, I got to opportunity to acquire useful knowledge related to care of older patients with fall risk. In addition, while completing learning activity with other two patients, I came to realize that how communication gap can led to medication safety complications. Hence, this activity has informed me about the importance of developing communication skills to delegate care and minimize errors. Effective communication between health care providers during transition of care is essential for promoting medication safety (Johnson, Guirguis & Grace 2015). Completing this activity helped me to realize my weakness in nursing skills and the areas where I need to engage in continuous professional development in the future.

Patient 2: Mr. Clarke

Among all the three activities done with patients having fall risk, cellulitis and CCF, each patient had unique complications where I needed to critically think about the best decision for the well-being of patient. For instance, in case of Mrs. Grace the major challenge that I faced was that she fell again in hospital despite raising bed rail of patient and reviewing medication of patients. At the later stage of care, I came to learn fall risk was high in patient because she had gait problem after undergoing hip surgery in the past. Although this element was mentioned in patient history, however I was not aware that I had to take extra precaution for patient while taking her to the washroom or other areas. Patient had to go through extra pain, however I learnt from this experience that it is necessary to evaluate gait and balance in patient who had fallen at least one. Evidence has also showed that if gait abnormalities are found, then it is essential to conduct additional assessment in patient (Phelan 2015). Hence, this knowledge will help in future nursing practice and enable me to fulfill standard 10 requirement of conducting proper screening and assessment for fall.


In case of Mr. Donovan, there was a need for providing blood transfusion to patient because he suffering from anemia. Anemia is common in patients with CHF and this worsens the heart disease related complications in patient (Sandhu et al. 2010). Hence, blood transfusion was necessary for patient. I was given the task of of conducting comprehensive assessment of blood and blood products to reduce risk to patient during blood transfusion. The mistake I did in this case was that due to interruptions during the procedure of collecting blood sample, I mislabeled it another patient’s name. However, this was a near-miss event as I promptly reported about the event to senior nurse. Through this experience, I developed the knowledge that negligence can increase safety risk for patient. In my future practice as a nurse, I aim to pay full concentration to correctly identify blood component at every stage of transfusion. I would also maintain register regarding it so that I do not commit error in the future (Mattia & Andrade 2016).

Another issue for me during the activity was to deal with ways to interpret illegible writing in medication orders. This activity however went well for me because I was aware that it is necessary for nurse to ask physician to check for medications ordered (Pirinen et al. 2015). Hence, I clarified regarding the correct medication by consulting with the clinician. This helped me to fulfill the standard 4 of NSQHS which involved communicating with clinician to develop medication management plan (safetyandquality.gov.au 2018). However, I have realized that medication administration is not a simple task, it is essential for me to learn about ways to manage high risk medication. Hence, I aim to take short course regarding this in my future practice as a nurse.

Patient 3: Mr. Donovan

Conclusion:

From the activity of completing care for three patients with different care priorities, I became aware about my strength and weakness in nursing practice. Firstly, my view about fall risk assessment for elderly patient changed after I got to learn that gait problems increases risk of fall in elderly patient. After this experience, I have improved my knowledge in understanding the relation of gait and cognitive changes on fall risk. This has increased my ability to conduct comprehensive fall risk assessment for patient. However, I still need to learn about bedside protective factors to prevent risk of falling in patients. While completing activity for patient who needed blood transfusion, I realized that it is a high attention activity and there is no chance of negligence in this area. Heavy workload may disrupt my role in blood transfusion, however I plan to take advice from senior on ways  to handle such disruptions affecting patient safety.

After completing the three patient safety activities, I have identified my weakness and future areas of learning in nursing practice. My action plan for the future are as follows:

  • I need to develop my knowledge regarding how gait problem increases risk of fall. This is necessary because I underestimated gait problem in client thus leading to fall event for patient. Evidence has also showed that understanding the relationship between early gait disturbance and cognitive changes is necessary to identify older adults at high risk of fall (Montero?Odasso et al. 2012).
  • I need to develop my confidence in ensuring medication safety for patient. This is because I lack competence in understanding about the ways to handle risk medication and identify the correct dose for individual patient. Hewitt, Tower & Latimer (2015) also revealed that educational intervention can enhance confidence of nurse in promoting medication safety.
  • During blood transfusion, I was about to make error because of disruptions during blood sample collection. To prevent disruptions from comprising patient safety, I aim to learn about ways to avoid distractions from hampering my medication administration responsibility.

References

Hewitt, J., Tower, M. & Latimer, S., 2015, An education intervention to improve nursing students' understanding of medication safety, Nurse education in practice, 15(1), pp.17-21.

Johnson, A., Guirguis, E. & Grace, Y., 2015, Preventing medication errors in transitions of care: a patient case approach, Journal of the American Pharmacists Association, 55(2), pp.e264-e276.

Mattia, D.D. & Andrade, S.R.D., 2016, ‘Nursing Care in Blood Transfusion: A Tool for Patient Monitoring’ Texto & Contexto-Enfermagem, 25(2).

Montero?Odasso, M., Verghese, J., Beauchet, O. & Hausdorff, J.M., 2012, ‘Gait and cognition: a complementary approach to understanding brain function and the risk of falling’ Journal of the American Geriatrics Society, 60(11), pp.2127-2136.

Phelan, E.A. Mahoney, J.E., Voit, J.C. &Stevens, J.A., 2015, Assessment and management of fall risk in primary care settings, Medical Clinics, 99(2), pp.281-293.

Pirinen, H., Kauhanen, L., Danielsson-Ojala, R., Lilius, J., Tuominen, I., Díaz Rodríguez, N., & Salanterä, S. 2015, Registered Nurses’ experiences with the medication administration process, Advances in Nursing, 2015.

safetyandquality.gov.au (2018), National Safety and Quality Health Service Standard, . Retrieved 24 January 2018, from https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf

Sandhu, A., Soman, S., Hudson, M. & Besarab, A., 2010, Managing anemia in patients with chronic heart failure: what do we know?. Vascular health and risk management, 6, p.237.

Vaismoradi, M. Salsali, & Marck, P. 2011, Patient safety: nursing students' perspectives and the role of nursing education to provide safe care, International Nursing Review, 58(4), pp.434-442.

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