Assignment 2

Name: Apsara Paudel

Student ID: 220191405

Subject: HSNS206

Unit co-ordinator: Sally Bristow

Assignment title: medication administration and medication error

Due date: 27/08/2018

Word count: 1646

Administration of medication is an integral scope of nursing practice and requires

scientific knowledge to ensure the safety and effectiveness in relation to the patient

care. Irrespective of the area of care, either home, community or hospital setting

nurses admit key role in medication administration. The issue of medication error is

common in health care settings. The role of nurse is not only bound to the

administering the prescribed drug correctly but should have a sound knowledge

regarding the actions and possible side effects of the drug. Nurses must be able to

teach the patient regarding self administration and monitoring and evaluating the

possible drug reaction.

According to (Berman et al,2014) the nurses should have a good understanding

regarding pharmacokinetics and pharmaco-dynamics as well as drug to drug

interaction to ensure patient safety and reduce the incidence of medication error in

the patient. Berman et al, (2014) also suggest the three times medication check

before administration that is first check for the patient identification and medication

order, second check for the label and expiry date, while preparing medication and

third check again matching the label for confirmation of right drug. The (NMC, 2015)

Standards of UK states that patient identification is the key aspect to be taken care

before administering the medication. As per standard 4 it is also important to know

whether the patient is allergic to that specific drug before administration to ensure

patient safety. The nurses should have detailed knowledge regarding the indication,

therapeutic effect as well as contraindication and adverse reaction of the patient. The

standard 15 focuses that the adverse reactions should be reported to the prescribers

as soon as possible.

Tollefson & Hillman (2016), suggest that the nurses should be aware about their

scope of practice. The role and responsibility of student nurse and a registered nurse
is same in regards to the medication administration. However, the student nurse is

not expected to administer drug on their own. Administering any form of drug alone

is not under the scope of practice of student nurse. Student nurse is allowed to

administer the medication only under the supervision of a registered nurse. The

registered nurse supervising the student nurse during the course of medication will

be accountable for the medication errors or any accidents related to drug

administration. After a survey, Petrova, Baldacchino & Camilleri,(2018) conclude

that the fear and hospital policy is the main barriers in reporting errors by the

registered nurse. But admitting the medication error and reporting as soon as

possible is necessary by both student and registered nurse.

The nurses should be mindful regarding the legal aspect both as a nurse and policy

of institution. In Australia there is different policy regarding administration of

controlled drugs which are classified under schedule 8 Australian Poison

Classification Schedule. During the administration of controlled drugs a registered

nurse should be witnessed by another registered nurse. In case of wastage of drug

due to refusal by patient and discarding due to contamination the amount of drug

should be documented in presence of witness and signed by both. The nurse should

be very thoughtful while administering the prescribed medication.

Safe administration of drugs comes under the roles and responsibility of the nurse

which includes five rights of medication those are the right medication, right dose,

the right client, the right route and the right time (Owusu-Agyemang and While,

2010),. Brotto and Rafferty,(2010) as cited in (Crisp, Taylor, Douglas& Reberio,

2013) mention that along with the five rights of medications the right reason and right

documentation is also important to ensure safe drug administration.

Medication error can be defined as failure in administering the drug correctly as

prescribed by the patien t(Crisp, Taylor, Douglas& Reberio ,2013). ANMF (2013),

states that a registered nurses plays a role of a clinical nurse, medicine administrator

and also a consultant. The term medication error is not limited to the proper

administration of medication. Medication error can be related to various factors such

as health care professionals, health condition of patient, working environment,

hospitals protocols and policies and computerised information system. For example

lack of knowledge and experience can result in medication error. Another reason can

be the overcrowded environment of the hospital.

In the list of the contributing factors of medication error WHO, (2016) has mentioned

the heath care professional issues as the prominent cause for medication error.

These include inadequacy of training to health care professional, ineffective way of

communication among the health care professionals, work overload and lack of

knowledge and experience. WHO also states that one of the factors resulting

medication error is inability to perceive the risk. This applies in case of Mrs. Melissa

Mendez where the nurse was unaware about the possible drug interaction between

Methotextrate and Trimethoprim. In relation to the case another reason of medication

error can be the poor communication between the nurse and doctor where the doctor

was unknown about the regular doses of Methotextrate that was being taken by the

patient. The pharmacist came to know about the medication error at the time of

discharge of the patient. This whole case can be taken as inappropriate

communication among health care professionals. The policy of hospital can also be

viewed as a factor here as the pharmacist was unavailable to review the drug chart

of Melissa Mendez who was on methotextrate which is a high risk medication as

classified in NSW health guidelines.

 According to WHO (2016), medication error can be in many forms such as wrong

patient, wrong medication, wrong route, wrong dose or wrong frequency. Medication

error can happen during prescribing, dispensing, administration or during

documentation. Medication error is taken as a serious issue in almost every country

of the world. There are various factors that contribute in medication error in hospital

settings. According to the survey conducted by Biron et al, (2009) the primary

factors contributing in medication error is the interruption in work and distraction at

the time of medication. For example, in cases like the nurses are too busy and work

is overload, the nurses cannot concentrate well in every patient which can lead to

medication error. Medication error are the most common errors in the field of nursing

errors. Likic, R. & Maxwell, SRJ. (2009) mention that poor prescribing of drugs is one

of the preventable and most common causes of medication error. As per the survey

done in Malta hospital in 2009, the most frequent causes identified were the illegible

handwriting of the prescriber and the tiredness due to workload among nurses as

well as the interruption at the time of medication administration. The National

Coordinating Council for Medication Error Reporting and Prevention in 2013 as cited

in (AORN 2009), describes that the improper identification of the patient is risk factor

of medication error. This includes the acts like negligence in viewing the medication

profile before prescribing, dispensing or administering the medication.

The Australian government health and policy and guidelines follows own criteria in

medication. A group of drugs known as A-PINCH (Antibiotics, Potassium, Narcotics,

Chemo-therapeutic drugs and Heparin including other anti-coagulant drugs) is

classified as High Alert Medication. According to NSW Health Policy (2013), the

patient receiving these drugs in any form should be monitored and supervised

closely as there drugs have higher possibility of adverse reaction to the patient. The
progression and deterioration in health conditioned should be clearly noted. In case

of Mrs. Mendez she is on treatment of rheumatoid arthritis with drug Methotrexate,

one of the chemotherapeutic drugs. The doctor prescribed Trimethoprim for the

treatment of UTI and the same was administered by RN. In this case both doctor and

RN are unaware about the possible drug interaction between Methotrexate and

Trimethoprim which can be life threatening as it can lead to pancytopenia in the

patient. As per the policy NSW (2013), both the prescriber and the RN should have

knowledge about the drugs that can react with Metotrexate. Another guideline is

monitoring the patient which is done by the RN and she was able to identify the

adverse reaction as nausea and confusion to Mrs.Mendez and reported the doctor

immediately which was reviewed by the doctor and changed the drug to another

antibiotics. The early detection of the adverse drug effect prevented from worsening

the condition of the patient. The nursing practice should follow the nursing standard

as per Nurses and Midwifery Board of Australia. The work done by RN in the given

case is based on standard 1, standard 3 and standard 7 as per the Registered Nurse

Standards for Practice. Standard 1 is critical thinking and analysis which is covered

in nursing practice by RN in case of Mrs. Mendez where she analysed the condition

of patient and able to make decision of calling the doctor for review of the patient

which is safe practices. Standard 3 is about maintaining the capability of practice.

The RN was concerned about the deteriorating health condition of the patient and

responded in time in regards to calling the doctor. The last standard 7 is evaluating

outcomes. In case of Mrs. Mendez nurse was evaluating and monitoring her

condition which was prime responsibility of nurse and meanwhile she communicates

to doctor to inform about the condition of patient. Despite all of the policies and

standard related to nursing care the nurse was not able to acknowledge the
possibility of drug interactions between Methotrexate and Trimethoprim and

medication error occurred.

To sum up, medication administration is one of the significant roles of the nurses.

The student nurses and registered nurses are responsible for ensuring safety of

client during medication administration. A student nurses should never administer

any drugs without guidance of patient. Medication error is one of the serious issues

in hospital round the globe as it can cause devastating effect in the health of patient.

The medication error can be prevented by following policies and standards of

nursing practice.

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