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Medication Errors

Discuss about the pharmacology in Nursing.

The current assignment deals with the aspect of pharmacology in nursing.  The study here focuses upon an actual clinical scenario where the medicine administration and safety and guidelines have been violated. The assignment further divides the drug into various schedules as based upon some of these specifications the drug needs to be administered to the patient.  The medicine administration is further guided by a number of ethical principles and legislations.

The current  study is based upon the case study of Mrs. T who  was a 74 year old woman  admitted to the psychogeriatric ward  with psychotic stress or trauma. She was administered a number a wrong medication owing to the negligence of the nurse. This resulted in lethal health consequences within the patient. The patient had a past history of depression, cholecystectomy, ischaecmic heart along with recurrent urosepsis. The patient had also undergone aortic valve replacement in the year 2008 due to synocopal episodes. Since the surgery, the patient had also experienced deteriorating health conditions such as poor appetite, significant weight loss, reduced mobility and lethargy. The patient family had mentioned that much of her deteriorating health conditions could be attributed to the presence of depression in the patient and hence she required immediate intervention strategies. In the psychogeriatric ward Mrs. was commenced on mirtazapine which was increased to 15 mg after a week. The patient was to be transferred from the psychogeriatric unit to the psychiatric hospital for the treatment of her major depression. However, before the transfer the nursing professionals attending to Mrs. T had to ensure that she was provided with the required medication doses so that later she does not miss them during the transfer process. It was seen that instead of miratzapine the patient was provided with nitrazepam 15 mg, which was a sedative belonging to the benzodiazepine class of medications. The provision of the medications resulted in development of low pressure in the patient. The patient later died from septic shock and aspiration pneumonia on admission to the intensive care unit. The sedative effects of the drug caused the patient to aspirate gastric contents leading to septic shock. Hence, there was a clear negligence on the part of the nursing professionals, as they had put the medication on wrong medication. The high dosage of the sedative caused the patient to aspire her gastric contents leading to septic shock, which further triggered multiorgan failure in the patient resulting in instant death (Hanson, 2016).  The incident clearly pointed towards a   gap in communication between the nursing professionals. The nurses responsible for looking after Mrs. T had administered her wrong medicine. The incident though followed by a fellow nurse, who thought it to be the other name for the same drug and failed to consult with her colleague. Therefore, both the nurses failed to check the procedure which was followed with the patient effectively.  Hence, there clearly a breach of ethics on the part of the nurses, which further deteriorated the condition of the patient.  The nurses had also disclosed the error and documented the same in the hospital record (Brown, Edwards, Seaton & Buckley, 2017). The negligence depicted by the nurses resulted in the death of the patient. Hence, professional nursing standards and ethics had been violated over here.

Ethical Principles

The clinical negligence could be further described based upon a number of ethical principles. Some of which had been enlisted over here such as veracity and non-maleficience. Both of these could be pondered upon over here in order to understand the gaps in the nursing care and support services delivered to Mrs. T.

Veracity could be described as the condition of truth telling and is justified by the respect for persons and providing them with sufficient autonomy (Latimer, Hewitt, Stanbrough & McAndrew, 2017). For the current assignment, focus needs to be shifted to the aspect of truth telling. As mentioned by Buckley, Stasa, Cashin, Stuart & Dunn (2015), the principle of veracity is violated by omission or deliberate holding back of crucial information. This is particularly important within the healthcare context, as misleading of pivotal information can endanger the life of the patient. As supported by Birks et al. (2018), exchange of true to the fact information can prevent the occurrence of untoward incidences.  As argued by Hewitt, Tower & Latimer (2015), the veracity also refers to being honest in one’s professional interactions. The veracity also refers to maintaining the standards of documentation, effective regulatory reporting and compliance monitoring (Martiniano et al., 2016). In this respect, the nursing professionals had mismanaged the entire procedure to be followed with the patient. The lack in effective compliance monitoring further gave way to the untoward incident (Gammie, Lu & Baba, 2015). There could be a number of causes behind the negligent behaviours depicted by the nurses. It could be due to lack of training or compassionate fatigue within the nurse.


The other ethical principle which could be discussed over here is non-maleficience. The aspect of non-malefiecience in nursing means causing the least harm to the patient with a purpose  of bringing out the best possible outcome (Christensen, Craft, Wirihana & Gordon, 2015). The nursing professionals are supposed to work as per the principle of non-maleficience, where the treatments should be delivered in a way which minimizes the harm to the patient (Hayes, Jackson, Davidson & Power, 2015).  This could be discussed with respect to the current situation where both the nurses had shown negligence in taking the records and dealing with the patient. The patient here Mrs. T was suffering from acute form of depression and had to be admitted for following up her treatment. She was suggested a new medication were she was supposed to take mirtazapine instead of sertarline. However, nursing professionals who were following up the treatment of Mrs. T had put her under the wrong medication instead, where she was out on a strong sedative nitarzepam. The treatment was conducted in hasty manner which resulted in the death of the patient. Therefore, both the nursing ethical principles were clearly violated over here.

Legislation

The nursing principles were not at all followed in this case as both the nurses had shown   negligence in following the medication pattern.  The fellow nurse failed to discuss or report the error to her peer thinking that the same medication under different generic name had been provided the patient. Inefficiency was also shown in the documentation and the follow up process. Hence, there was a clear breach of the nursing ethics in the case study.

The significance of drug legislation has been discussed over here. The drug legislations consist of the effective guidelines regarding the medication patterns and the exact doses based on which the medicines need to be administered to the patient.  As mentioned by Hewitt, Tower & Latimer (2015), under no circumstances unsupervised medication could be suggested to the patient. The storage, supply of medicines is governed by drug and medicines legislation (Birks et al., 2018). Some of the legislations which could be highlighted over here are -Poisons and therapeutic goods act, 1966, Poisons therapeutic goods regulation, 2002. With regards to the current scenario, some of the effective drugs regulations could be discussed over here which are health regulation, 1966, which sets out requirements for endorsements holders concerning storage, record keeping and sales of schedules drugs and poisons. As per the health regulation, the record keeping should be done effectively regarding the administration of the drugs. This helps in the prevention of administration of wrong medicines or wrong medication doses to the patient.

In this respect, some of the regulations mentioned in the Australian schedule of medicines have been listed over here. Some of these are schedule 2, 3, 4, 8 and so on. The schedule 2 covers pharmacy medicine, under which psychological drugs with high potential for abuse have been reported such as    hydromoprohone, nethadone, meperidine etc. The schedule 4 covers prescription only medicine such as diazepam, mizadolam etc and has low potential for abuse compared to schedule 3 drugs which include Ephedrine, Apomorphine etc. The schedule 8 covers controlled drug which have high potential for abuse and addiction. Some of the examples are – Buprenorphine, Alprazolam, Amfetamine etc. The schedule 3 covers the highly addictive medicines and could only be prescribed under the consent of a pharmacist only. The professional attending to the care concern of Mrs. T needed to ensure that proper doses of the right medication were provided to the patient. As mentioned by Gammie, Lu & Babar (2015), following the six right of nursing can prevent the occurrence of the untoward accidents in an acute clinical setup. The six rights could be mentioned as follows- right medication, right dose, right time, right patient, and right route. Additionally, the nursing ethics had not been followed over here which led to a further worsening of the situation.


The patient Mrs, T was also provided with a number of medicines such as panadol osteo and enbdone. Endone consist of the generic name oxycodone and was listed under schedule 8 of the drugs and medicines. Panadol osteo contained the generic name osteovan and belonged to schedule 2 as per the Australian drugs and medicine.

The patient Mrs. T was provided nitrezepam which belonged to schedule 4 of the Australian medicines and drugs and was a prescription drug only. Therefore, unsupervised doses of the medication could lead to further heath risks in the patient. The mitrazapine belonged to the schedule 1 of the Australian medicines and drugs and is considered to be low risk drugs (Hibbert & Sutton, 2017). They belong to the paracetamol class of drugs and could be stored under normal conditions. On the other hand, before administration of a schedule 2 drug the nurse should have checked the proper disclaimers alongside consulting a physician attending to the patient, as it would have helped in the prevention of untoward health risk to the patient.

Conclusion

Therefore, focusing upon the clinical scenario and the nursing ethics one could say that effective documentation along with provision of sufficient training to the nursing professionals could have helped in the occurrence of such untoward incident. Additionally, the provision of nursing continuing education can also help in ensuring that the nursing standards and ethics are maintained in right place.

References

Birks, M., Ralph, N., Cant, R., Tie, Y. C., & Hillman, E. (2018). Science knowledge needed for nursing practice: A cross-sectional survey of Australian Registered Nurses. Collegian, 25(2), 209-215.

Brown, D., Edwards, H., Seaton, L., & Buckley, T. (2017). Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.

Buckley, T., Stasa, H., Cashin, A., Stuart, M., & Dunn, S. V. (2015). Sources of information used to support quality use of medicines: findings from a national survey of nurse practitioners in Australia. Journal of the American Association of Nurse Practitioners, 27(2), 87-94.

Christensen, M., Craft, J. A., Wirihana, L., & Gordon, C. J. (2015). Pathophysiology team teaching: bioscientist contribution to knowledge integration in a nursing subject. Journal of clinical nursing, 24(23-24), 3739-3741.

Gammie, T., Lu, C. Y., & Babar, Z. U. D. (2015). Access to orphan drugs: a comprehensive review of legislations, regulations and policies in 35 countries. PloS one, 10(10), e0140002.

Hanson, J. (2016). Surveying the experiences and perceptions of undergraduate nursing students of a flipped classroom approach to increase understanding of drug science and its application to clinical practice. Nurse education in practice, 16(1), 79-85.

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076.

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

Hibbert, D. B., & Sutton, J. (2017). A chemical view of analogue drug laws in Australia: what is structural similarity?. Australian journal of forensic sciences, 49(6), 605-625.a

Latimer, S., Hewitt, J., Stanbrough, R., & McAndrew, R. (2017). Reducing medication errors: Teaching strategies that increase nursing students' awareness of medication errors and their prevention. Nurse education today, 52, 7-9.

Martiniano, C. S., de Castro Marcolino, E., de Souza, M. B., Coelho, A. A., Arcêncio, R. A., Fronteira, I., & da Costa Uchôa, S. A. (2016). The gap between training and practice of prescribing of drugs by nurses in the primary health care: a case study in Brazil. Nurse education today, 36, 304-309.

Pauly, N. J., Slavova, S., Delcher, C., Freeman, P. R., & Talbert, J. (2018). Features of prescription drug monitoring programs associated with reduced rates of prescription opioid-related poisonings. Drug and Alcohol Dependence

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