2NUR112.MED Errors - MED ERROR assignment, hope it\'s helpful PDF

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MED ERROR assignment, hope it's helpful...

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Alternate Clinical Assignment- Med Errors 1.Pre-clinical preparation- Make a maxi-learn card on the following medications/IV solutionsMorphine- opioid- pain reliever Dilaudid- opioid, schedule II orazepam (Ativan)- Benzodiazepine, reduces anxiety ketorolac (Toradol)- NSAID hypertonic saline- Hypertonic solution pulls fluid from the cells into the vasculature Sleep apnea: If a patient has sleep apnea, they have difficulty breathing while they are sleeping. Their airway gets completely obstructed at times and don’t breathe at all. This can wake them up because they are so short of breath. People use a C-PAP machine Pectus carinatum: is a rare chest wall deformity that causes the breastbone to push outward instead of being flush against the chest. It is also known as pigeon chest or keel chest. Pectus exacuvatum: is a structural deformity of the anterior thoracic wall in which the sternum and rib cage are shaped abnormally. This produces a caved-in or sunken appearance of the chest Yolk sac tumor: is a rare, malignant tumor of cells that line the yolk sac of the embryo. These cells normally become ovaries or testes; however, the cause of a yolk sac tumor is unknown. It is most often found in children before the ages of 1 to 2, can occur throughout life. 2. Log onto www.gnsh.org On the top bar click 30-minute weekly Click team engagements Click case studies on medication errors and view- John LaChance, Leah Coufal, Lewis Blackman, and Emily Jerry. 3. Access the article, Nursing Assessment of Continuous Vital Sign Surveillance to Improve Patient Safety on the Medical/Surgical Unit in the Journal of Clinical Nursing Volume 25 Issue 1-2 January 2016. ncbi.nlm.nih.gov/pmc/articles/PMC4738424/ 4. At the Zoom meeting be prepared to discuss: What factors contributed to the medication errors being made?  Medication dose should be double checked by the RN, especially when administering analgesics to pediatric patients.  High doses should be questioned by the RN before administration  Patients were not on a cardiac monitor and that was a major cause of the patient’s death. Could a continuous VS monitor have prevented negative outcomes? A continuous VS monitor could have prevented all of these deaths. The VS monitor would have alerted the RN and of staff of any changes that occur in the patient’s vital signs. This is especially helpful in post op patients who are receiving pain medications that can suppress the respiratory system and decrease the blood pressure.

Is alarm fatigue preventable? Alarm fatigue is preventable. The nurse has to set the VS monitor parameters appropriately for the patient -This will reduce the number of false alarms that occur When parameters are set appropriately, the monitor will only alarm when there is a potential issue that needs to be addressed. How can a hypertonic solution of saline contribute to a client’s death? Hypertonic solution pulls fluid from the cells into the vasculatureàcan cause fluid overloadà can lead to death. Risk for hypernatremia & hyperkalemiaàcan cause seizures & cardiac dysrhythmiasàcan lead to death. How do the 7 rights of medication administration prevent medication errors? The seven rights of medication administration prevent medication errors by ensuring: RN is administering the right doseàright medicationàright routeà right patientà right time.  Makes the nurse question order before administration if it is correct, which can be a fatal mistake if missed. 7 rights allow safe, effective care. Working collaboratively in interdisciplinary teams is a nursing competency. Give an example as to when nurses may need to collaborate with pharmacists. An RN may need to collaborate with the pharmacist if they want to be sure that an ordered medication is compatible with other medications that a patient is receiving. John LaChance had a history of sleep apnea. What is the association of this diagnosis and opioids? What assessments/interventions could the nurse have done to prevent John’s death? Why is the hand-off report with the SBAR so important? If a patient who has sleep apnea is given opioids, their risk for respiratory complications increase while they are asleep. The nurse should have had John on a continuous vital sign’s monitor. This would alert the nurse of the patient’s respiratory rate and oxygen saturation, which are crucial vital signs to monitor when a patient is on opioids. The handoff report with the SBAR is so important because it advises the on-coming nurse what was done for the patient that night. It gives the on-coming nurse crucial information needed to continue quality patient centered care to the patient. What was the dosage of Ativan prescribed for Leah Coufal? What is a pediatric dose? Is the prescriber at fault for the order, the pharmacist for filling it, or the nurse administering it? The dosage of Ativan prescribed to Leah was 2mg q 2 hr. Pediatric dose for Ativan is 0.05mg/kg/dose (Medscape.com, 2019). In this case the nurse is at fault for administering the medication. The RN is the last line of defense when it comes to medication errors. The RN should question orders that seem excessive.

What assessments could have been done on Lewis Blackman after receiving ketorolac (Toradol)? Lewis should have been on a continuous cardiac monitor. Vital signs should have been consistently monitored throughout the night. Mrs. Blackman stated that the nurse kept setting the parameters on the VS machine lower and lower. ***This could be due to alarm fatigue and the nurse not believing/ignoring what she was seeing on the machine. ***When Lewis started complaining of abdominal pain, the nurse should have done a focused assessment on his abdomenànotified the MD about this new issue. This simple step could have saved Lewis’s life.   

What strategies could be used to make nurses more vigilant when assessing clients after medication administration/to feel comfortable questioning a prescriber’s drug order/to question a pharmacist’s med preparation/to link current diagnoses and co-morbidities with possible drug side effects? Before administering the medication, the nurse should really ask himself/herself “what is this medication going to do in the body and what are the possible adverse effects associated with this medication?” If the nurse asks themselves this question, they will know what to look out for and what to assess the patient for. The nurse should always advocate for their patient. If the nurse suspects that the dosage of the medication is not appropriate, she should contact the doctor and question the order. For new nurses, this may be intimidating. The nurse should always approach the doctor in a confidant but approachable manner. If the nurse gets pushback from the patient, he or she should state that they are concerned about the safety for this patient. The nurse should always double check the dose preparation from the pharmacy. If the nurse suspects that an error has been made, he or she should contact the pharmacy and question the medication. This should be done in a respectable, non-confrontational manner and as stated earlier, state that this is a patient safety concern. Patients with co-morbidities should be taken into consideration when administering medications. If a known side-effect of a medication is hypertension, you would not administer it to a patient who has hypertension, because this could worsen their pre-existing condition. The nurse should assess the patients past medical history and always monitor vital signs before administering medications that have significant adverse reactions....