Medication and Safe Administration Essay Example

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    Nursing
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    Essay
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    Undergraduate
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MEDICATION AND SAFE ADMINISTRATION 13

Medication and Safe Administration

Medical therapy has increasingly been relied upon in the contemporary medical realm as the primary intervention for most medical conditions, and patients consuming this form of medical intervention are exposed to potential risks although the benefits are tangible (White & Bradnam, 2007). The concern about medical safety and administration revolves around the benefits patients receive from medical interventions and the underlying erroneous harm. According to Courtenay and Griffiths (2009), medical interventions benefit patients through effective disease management and improved outcomes if errors are checked. Harms from medications can be precipitated by unintended consequences such as erroneous administration for instance wrong prescriptions or even wrong timing. Other concomitant risk factors may include nursing education about patient medication safety and administration, flawed dispensing system, poor drug labelling, and low staffing. Emphasis should be focused on the reduction of medication errors, improving two-way communication, ensuring adequate nursing education and continual monitoring and proper remediation.

Roles and Responsibilities: Nurse, Doctor, and Pharmacist

In a medical institutional context, the trained registered nurses, doctors, and pharmacists work under clearly partitioned responsibilities.

Registered Nurses

The registered nurse is undoubtedly the patient’s life guard in medication and administration. The nurse is often the party in the medication hierarchy that interacts more often with the patient and on whom the responsibility leans more of identifying and remediating errors in prescribing and drug distribution. Although medical doctors prescribe the medicine and the pharmacists implement the prescription, the nurse plays the final role of administering the medication (White & Bradnam, 2007). Essentially, the nurse is the final link in the administration of medication and reduction of errors.

Nurses play a big role in implementing medical orders as directed by the medical doctor in the medication administration and record (MAR). In the MAR, the physician gives nurses orders containing the information of the medication that is used in administration. For example the MAR indicates the name of the patient, drug name and the dose of medication to be administered. Additionally, the MAR shows nurses the frequency of medication and the route of drug introduction.

It is the responsibility of the nurse to ensure that patients are clearly identified before medication administration. This implies that the nurse has the onus of positively identifying a patient before medication because an event of misidentification remains a primary medication and safety administration issue (Boundy & Stockert, 2008). The nurses therefore play a critical role of maintaining the patient identification system through proper sources of identity and controls of information. For example, it is commonplace to hear nurses calling a patient’s name loudly as is inscribed in the hospital documents in order to physically verify the identity.

The nurse of often the health official that ensures observation of patient rights while in the medical facility. The patient safe treatment is ensured by nurses by administering the right drug in the doctor prescribed quantity, giving the correctly identified patient medicine at the right time via the appropriate route of administration, and implementing patient-friendly doctor instructions (Courtenay & Griffiths, 2009). In addition to documenting the patient management properly, the nurse continually monitors the expected effects of the medication and reports any adverse reactions to the treatment.

The safe medication and administration concept requires concerted team work: the nurse plays a special role here too. It is notable that the healthcare providers prescribe and administer medication procedurally as laid out in the distribution guide (Boundy & Stockert, 2008). The nurse occupies and irreplaceable role in that they aid the healthcare team to identify and remediate errors arising from the medication system. It is the nurse that checks medical calculations with team members and consult the prescribing medical doctor if they suspect any anomaly in the prescribed medication. Moreover, the nurse identifies prescription drugs, non-recommendable drugs, and adverse reactive conditions of the patients that can hinder expected treatment results from the recommended medication. This achieved through the nurse’s efforts of collecting data about the patient’s history and comparing with standardized schedules in order to identify alternative drugs for allergic clients and possibilities of incompatible drug combinations.

To ensure that the nurses continue to discharge their huge roles and responsibilities in the safe medication and administration drive, their rights have to be closely guarded. Other parties in the healthcare realm working with nurses should ensure that they render clearly instructed and written medication orders that specify the name of drug, doses and frequency and route of administration. The pharmacists should ensure that nurses get the correct form of drugs and all information touching on the particular medication is openly and easily accessible (White & Bradnam, 2007). Nurses should remain abreast with the statuses of any medical issues concerning their clients, and they should report any errors in the medication distribution system in order to minimize the possibilities of unsafe medication and administration.

Medical Doctors

Medical doctors are considered the chief professionals as regards patient treatment and management. However, their role primarily revolves around the patient assessment and medication prescriptions. Upon assessing and deducing possible causes of the patient’s condition, the doctor makes the appropriate medication choice fit for the clinical situation, which must suit individual patient factors.

The doctor is apparently the director of the nursing actions in that they have to identify the route of medication administration, the dose, regimen, and frequency of administration (Courtenay & Griffiths, 2009). Additionally, medical doctors have the responsibility of communicating clearly to the nurse in writing about medication and administration relative to the patient’s condition. The doctor shares some responsibilities of documentation in the medical distribution system.

It is imperative that the doctor in the contemporary healthcare realm plays a major role especially in the use of medicine. The doctor occupies a core role in the prescription and administration of medicine, continual assessment for the side effects, and working as part of the treatment and disease management team to offer a leadership oversight in the quest for improvement of patient care. The incremental complexity and sophistication of medication and drug administration requires that doctors and medical trainees understand the nature of medication error and safety, which would improve the conceptualization of medication related hazard mitigation.

Pharmacists

Pharmacists’ roles and responsibilities in medication and safety administration are complex and varied. However, their primary work revolves around pharmacy practice, which comprises the safety and effective use of medicines and to some level provision of advice on the optimal use of government medicines budget (Anderson, 2005).

Pharmacists work in the team of other healthcare practitioners: doctors, practice nurses, and community pharmacists to ensure efficacy and safety areas of medicines and patient care. According to Stone and Curtis (2002), pharmacists play a tremendous role in advising doctors on the best prescriptions. Additionally, pharmacists work with community pharmacists to ensure professional development and quality of services.

It is important noting that pharmacists play a primary role in strategic commissioning in which they take lead responsibilities for issues concerned with medication and prescriptions. This implies that pharmacists have a responsibility of ensuring that the all prescriptions within their locality are evidence-based and adheres to the government prescribed practices. Moreover, the pharmacists have a responsibility in developing lists of recommended medicines. The duty of commissioning, developing plans, and delivery of pharmacy services and supplying vaccines to the community primarily falls under the stewardship of pharmacists.

Process of Medication Approval

It is legally binding that before any drug is manufactured and marketed in Australia is evaluated and endorsed by the Therapeutic Goods Administration (TGA) (Low, Hattingh & Forrester, 2009). As underlined in the Therapeutic Goods Act of 1991, the TGA is conferred with the mandate with responsibility of ensuring efficacy of medicines, their safety and timely availability in acceptable quality. In addition to being the body overseeing the safety of medical devices in Australia, the TGA is also evaluated based on the efficacy of prescription drug evaluation (Olver, 2011). The drug approval process in Australia is overseen by the TGA and related medical agencies, and comprises of four primary steps before acceptance for circulation in the pharmaceutical markets.

The initial step in the drug evaluation and registration process is the application usually by the chemical entity in concern. At the application level the Australian Drug Evaluation Committee (ADEC) agents assess the conformity of the data supplied to the Australian guidelines, and the company is required to pay 75% of the evaluation charges.

Upon application acceptance, the drug moves to the evaluation level whereby the pharmaceutical and chemical data are assessed, the animal pharmacology and toxicology data evaluated, and then further evaluation done on the clinical data (Olver, 2011). The ADEC generates ad hoc unit review reports that lead to the pre ADEC consultation with the manufacturing company. The ADEC then compiles final product approval information that is ultimately made to the TGA. Upon receipt, the TGA makes an informed decision regarding the registration of the medication.

Factors of Increased Medication Error and Mitigation

Errors during Prescription and Administration

Medication near miss or error contexts connote the failure of the administrator to implement the planned treatment action and medically intended or application of an incorrect medication procedure (Young, Koopsen, & Farb, 2005).

The main components of medical therapy treatment comprise of prescription in which the appropriate medication for particular condition is deduced, the administration in which medicine is obtained and prepared for the ultimate use, and monitoring whereby the healthcare professional monitor the effect of the medication and document the outcomes. It is imperative that there is potential for error through the medication process.

According to Young, Koopsen and Farb (2005), factors influencing occurrence of errors in medication can occur during prescription, administration, or a misreporting during performance monitory phase. During prescription, inadequate knowledge about the pharmacokinetics and pharmaco-dymanics and the contraindications (Light, 2010) of a drug can result in errors, and the problem has been exacerbated by the increment of the medicines in use. Additionally, miscommunication during prescription, failure to individualize medication to suit a patient’s condition, and the cases of prescriptions to the wrong patients form part of the erroneous medication statistics.

The errors associated with administration of drugs include giving medicines to the wrong patient especially due to wrong patient identification, administration through a wrong route, and use of wrong drug or giving the drugs at the wrong time. Inadequate documentation is another source of medication errors during administration that is orchestrated the failure of health professionals to ensuring adequate communication and procedural discipline in drug administration.

Mitigation of Erroneous Prescription and Administration

Use of Generic Names

In the highly liberalized drug manufacturing market, there are innumerable trade names for drugs that are often inscribed on packages in large letters that easily obscure recognition of the generic name (Aspden, Wolcott, Bootman & Cronenwett, 2006). To mitigate the error margin especially at the point of administration, it is recommendable that the health officers to encourage use of generic names only in the place of work in order to establish drug identification and simplified communication culture. In order to make medication safer for outpatients that purchase the medicines from chemists, it is recommendable that the patients are made aware of both the brand and generic names of each drug that has been prescribed for them.

Individualized Prescription

In order to make medication and administration safer for patients, it is worthwhile for the prescribing doctors to tailor drug choices to individual patients based on their health conditions. This approach would make it possible to reduce unwanted drug use outcomes for patients with special health cases such as pregnancies, diabetic complications, or allergies.

According to Aspden et al. (2006), a safe prescription should clearly consider the clarity in name and communication of the medication of choice, the route of administration, frequency, and the span of time that the patient will take each drug. It is important for the doctor to mine history about recently used drugs, the drugs purchased over the counter before the intended prescription, and any concerns the patient may have with the prescribed medicines (Helmchen, Kaestner, Lo Sasso, 2008).

Nursing Principles

Emphasis of core nursing principles concerning medication can help mitigate errors especially during administration. It is recommended across the world that before administering drugs the nurse should ensure that it is the correct medication, for the right patient, and in the right dose (Talbot & Aronson, 2011). Additionally, the administering health professional should make sure that the medicine is administered at the right time, and given via the right route. Correct documentation during administration is as important as the drugs because that would help reduce double, untimely or wrongful drug administration.

Patient Education

In the contemporary health provision realm it is important to educate patients about medication and administration safety, which would comprise teaching them the benefits and associated hazards. This is achievable through effective and purposive communication between healthcare professionals and the patients.

As suggested by Aspden et al. (2006), patient education should comprise the understanding of the difference between trade and generic names for drugs and the inherent benefits. Efforts should be spared to make the patients know the purpose of medication, meaning of dose in treating their conditions, the reason for choice of routes of administration, and the importance of reporting full history regarding side effects and dislike for certain medicines. Medication and administration will become safer if patients are involved actively to a level where they understand the importance of maintaining written records of medicines that they take and their historical complications such as allergies, terminal conditions, and even previous problems with certain medicines (Falvo, 2010).

Summarily, to reduce errors and improve safety in medication and administration, prescriptions should ensure clarity in communicating the name of the drug, dosage, underlying side effects, period medicine must be taken, and important patient factors. Documentation at every level of patient management should be clear, legible and unambiguous.

Example of Medicine: Paracetamol

The paracetamol is a generic name referring to medicine in the class of analgesics or pain killers (World Health Oeganization, 2005). The medicine is used for relief from headaches, toothache, or even the symptoms of cold. In many countries, paracetamol is used without necessarily seeking a doctor’s approval.

Paracetamol is dispensed in brands of a range of manufacturers and can be made from a combination of ingredients such as decongestants. Differences in paracetamol types reflect from differing packaging: tablets, liquids, or even capsules based on the target population if it is adults or children. In some countries the medicine is called Acetaminephen.

Paracetamol can be used by both children and adults (World Health Oeganization, 2005) but is highly discouraged for people with liver, alcoholism, or kidney complications. The side effects are rare and not highly documented by for mention of rashes or low blood pressure.

Mr Drago Davic

As aforementioned, paracetamol is a pain relieving medicine that has few if any documented side effects safe for rashes and low blood pressure. At his age of seventy years, Drago may potentially have some alcoholic, liver or even kidney complications, which i would include in the questionnaire to understand his history. Additionally, i would be concerned to assess whether there are any other medicines that he may be using that can be problematic with paracetamol.

Once i have documented Drago’s medical history, I would plan to:

  1. Teach him the importance of medication and safe administration whereby I would talk to him about taking the right number of paracetamol tablets as recommended by the pharmacist.

  2. I would teach him about the benefits of completing the recommended dose of the drug and its storage.

  3. I would instruct and show Drago how to maintain a written record of drugs they are taking indicating the date and the reaction to the drug.

Upon teaching Drago i would evaluate the effectiveness of the session through observation and a short interview.

  1. I would ask Drago to explain about his condition after taking paracetamol,

  2. I would observe his physical appearance to note any changes in self expression that may reflect relief from pain or its exacerbation.

  3. Finally i would seek to see his recording of the type of drug taken and any effects as felt

References

Anderson, S. (2005). Making medicines: A brief history of pharmacy and pharmaceuticals. London, UK: Pharmaceutical Press.

Aspden, P., Wolcott, J., Bootman, J.L., & Cronenwett, L.R. (eds.) (2006). Preventing medication errors: Quality chasm series. New York, NY: National Academies Press.

Boundy, J.F., & Stockert, P.A. (2008). Calculation of medication dosages: Practical strategies to ensure safety and accuracy. New York, NY: Lippincott Williams & Wilkins.

Courtnay, M., & Griffiths, M. (2009). Medication safety: An essential guide. Cambridge, UK: Cambridge University Press.

Falvo, D. (2010). Effective patient education: A guide to increased adherence. London, UK: Jones & Bartlett Publishers.

Helmchen, L., Kaestner, R., Lo Sasso, A.T. (2008). Beyond health insurance: Public policy to improve health. Melbourne, Australia: Emerald Group Publishing.

Light, D. (2010). The risks of prescription drugs. Columbia: Columbia University Press.

Low, J., Hattingh, L., & Forrester, K. (2009). Australian pharmacy law and practice. Melbourne: Elservier Australia.

Olver, I.N. (2011). Perspective on contemporary and alternative medicines. Sydney, Australia: World Scientific.

Rey, J., & Birmaher, B. (2009). Treating child and adolescent depression. New York, NY: Lippincott Williams & Wilkins.

Stone, P., & Curtis, S.J. (2002). Pharmacy practice. London, UK: Pharmaceutical Press.

Talbot, J., & Aronson, J.K. (2011).Stephen’s detection and evaluation of adverse drug reactions: Principles and practice. (6th ed.). Hoboken, NJ: John Wiley & Sons.

White, R., & Bradnam, V. (2007). Handbook of drug administration via enteral feeding tubes. London, UK: Pharmaceutical Press.

World Health Organization. (2005). Pocket book of hospital care for children: Guidelines for the management of common illnesses with limited resources. New York, NY: World Health Organization.

Young, C., Koopsen, C., & Farb, D. (2005). Medication errors guidebook. New York, NY: University of Healthcare.