MILESTONE 3 FINAL BASED ON WEEK 1 AND WEEK 2 FINAL PAPERS ( ALL ATTACHED)SHOULD READ THE LATEST FEEDBACK FROM PROFESSOR IN WEEK 3 JOURNAL FEEDBACK.text boook readingChapter 6: pages 185–196, 199–2

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Identify the nursing care issue and state the desired outcome

Nursing Care Issue: One of the issues in the current state of medication is the medication error which is defined by NIH as failure that might lead to harm on the patient (NIH.gov).

In the current sector of healthcare this issue has become a great challenge. Mistakes involving medication are among the most common healthcare issues. Web have different kind of medication errors which include failure to perform any of 6 rights in medical administration, cross sensitivity, wrong diagnosis etc. Medication error can result from those involved in the chain such as prescriber, manufacturer, blood level monitoring, administering and lack of education to patients. The nurses should do safety check before administering medication as they are the last in the chain. We have areas where nurses are not in position of identifying errors where the doctors and pharmacists can pin point out the error. An example is where a pharmacist forgets to identify problem of cross sensitivity and misdiagnosing medication to patient. For the nurses they have got direct contact with patients and in acute setting they are ones who spend time with patient hence this result to medication error in most instances which make it a big issue.

Desired Outcome: From NIH they have estimated that medication error results to 1 of 131 patient deaths and 1 of 854 inpatient death according to report by institute of medicine (Nih.gov).In case of medical error most people are held accountable especially nurses who are supposed to do last check before administration. The medication errors range from nothing happening to as far as death of patients. Even though there are steps which have been taken to avoid the medication error we still have serious errors being made by members of the care team. For the acute care facilities they have taken steps to prevent errors from arising where they have adapted the electronic medical record connected with pharmacy, wrist scanning bands before administering medication, having nurses to do verification and pharmacy reviewing PT. The nurses are trained to review the lab results, diagnostic results and patient’s diagnosis and understanding why certain medication are prescribed to patients before administering. At times the nurses might fail to do this which could result to an error. There was a situation where the patient INR was at 3.1 and patient was on 5mg of Coumadin where the goal was 2-3.Pharmacists made a mistake and ordered 3mg of Coumadin but it fails discontinuing 5mg making total of 8mg.Nurse failed to question order and administered 8mg and next INR which was 4.8.Though there was an error from pharmacy the nurse who administered was held accountable. This example indicates that though we have measures in place the 6 steps have to be followed where lab results have to be reviewed before medication.

From the facility we have got several measures taken to avoid medical errors. We have got access to medical records for community pharmacy. This enables us to view the medication records of the patient. Compare it with home list the patient came with and ask question where we had any doubts. This eliminates problem of missed dosses and wrong prescription by the provider. Hospitals discourage use of home medication. The relatives have to take back medication bottles after comparing. In case the patient is taking medication which is not in pharmacy formulary then it has to verify the medication, label with barcode and nurses should lock it up in medication drawer and administer it to patients as directed until they are discharged. For insulin two nurses have to verify it prior to administration as well as heparin drip. Medications which are not scanned are reported to the manager at the end of the month where each nurse should have 98% of scanning rate. All medications entered should be verified by the pharmacists before administering them.

Reporting error as early as possible leads to a better outcome to the patient. An example is where you mistakenly administer 60 units of short acting insulin instead of long acting insulin has to be reported immediately otherwise it could be detrimental to patient life. I encourage colleagues to talk with patients about home medication regimen on admission and question orders they have doubts with. In case of any error they should report in timely manner. Create a non-punitive environment for the staff which can encourage staff to report the issue without fear of being punished.

Ask at least one question of your instructor that could help you do your best on Milestone 1

Question: Why do you think medical error should be taken with a lot of seriousness?