C33 : Nursing

Reflection on understanding of two of the NSQHS standards based on patient care experiences

Based on my past clinical experience in nursing practice, I can say that I have good understanding regarding the NSQHS nursing standards 4 and 6 as I have experience in building therapeutic relationship with patient, working collaboratively with the nursing team and linking theory to practice during medication administration. I can give an idea regarding my knowledge in the two standards based on two occasions when I worked with two patients in an acute care clinical placement and a mothers and baby unit (MBU). The experience of providing care to two patients in two different clinical setting will be discussed to define my knowledge regarding medication safety standards and the communication for patient safety standard.

Description:

During my placement at the MBU unit of a hospital, I was assigned under the care of Mrs. Williams (hypothetical name because of confidentiality criteria) who was admitted in the psychiatric ward because of symptom of post natal depression. As per the patient’s handover report given to me, I was supposed to assess mental status of the patient and administer anti-depressants to the patient under the supervision of my mentor.  I fulfilled the standards required for medication safety by following the rights of medication administration and engaging in positive interpersonal interaction with patient. Furthermore, my experience of providing care to Mr. X (hypothetical name), a patient with asthma at an acute care clinical placement, developed my understanding regarding communicating for patient safety and working collaboratively with the nursing team.

Feelings:

While being assigned for the care of Mrs. William, I was very nervous because it was the first time that I was administering medication myself. Safely administering medication is a challenging task in a psychiatric ward because of challenges in interpersonal interaction and the need to adjust dose of medication to prevent psychiatric symptoms. However, following basic principles of medication administration helped me to effectively deliver medications (Hemingway et al., 2015). I was also reflecting on the mentor’s advice that was given during previous simulation experience for medication administration. In case of the placement at acute care hospital, it was a busy ward and I was anxious because everything was going at a fast pace. I was afraid that communication errors might arise in such busy ward.

Evaluation:

According to NSQHS medication safety standard, it is essential to have a protocol and organization wide system in place for medication safety (Australian Commission on Safety and Quality in Health Care, 2012).  I used the six right of safe medication administration protocol to safely administer medication. I started with confirming patient identity and matching it with the patient order. Right medication for the right patient was judged by matching the medication level with the order. I also carefully review the medication order to match the dosage criteria while providing the medication to patient. I was also aware regarding the interval at which the medication needs to be provided and inquired from the patient too regarding time when she took the last medication. The route of administration was followed and I also recorded the administration of medication along with the timing on the medication chart. During my end of shift, I gave the document to handover nurse and also informed them regarding observation of any side effects and the next timing of medication too. According to Smeulers et al. (2015), practicing 7 rights of medication administration is important for nurses as these are quality indicators for safe medication administration.

During my experience of working at the acute care clinical placement, the positive aspects of care giving was that the hospital had a structured handover protocol in place that continuity of care as an easy job for me. Although the nurse who was about to leave gave me the handover report, I was anxious because I could communicate regarding patient’s health status as she was in a rush. However, after reviewing the handover chart, I found the shift handover protocol of the hospital to be very useful as it answered all questions that I had about patient. I could easily implement all action along with therapeutic communication with patient. I actively involved patient during the care and clarified each action before implementing so that any errors due to miscommunication could be avoided (Hada, Coyer & Jack, 2018).

Analysis:

While reflecting on the experience of safely administering medication, I found that accurate documentation system to review medication order and update medication administration was an effective strategy to promote medication safety. Secondly, my application of theoretical knowledge related to medication safety helped me to minimise possibility of medication errors. Extensive collaboration and communication with health care team also helped to decrease medication errors and promote patient safety (Kitson et al., 2013).  Documentation of patient information and involving patients during the communication process is also a part of NSHQS standard 4. In addition, my experience of working at a busy ward gave me the understanding that use of structured handover protocol can help in effective transfer of care responsibility and accountability in care (Malekzadeh et al., 2013).

Conclusion:

To concluded, I would like to say that my past clinical experience has enhanced my competency and skills related to NSQHS standard 4 and 6. I understand the importance of organization wide protocols for medication safety and safe handover process and I also have the exposure to effective deliver care by communication with patients and the nursing care team.

Action plan:

My plan for the future is to learn about ways to safely administer high risk medication as my past clinical encounters did not gave me the opportunity to learn about ways to identify high risk medication and this knowledge will be essential when I transition to professional nursing practice.

References:

Australian Commission on Safety and Quality in Health Care (2012). National Safety and Quality Health Service Standards. Retrieved from: https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-Standards-Sept-2012.pdf

Hada, A., Coyer, F., & Jack, L. (2018). Nursing bedside clinical handover: a pilot study testing a ward-based education intervention to improve patient outcomes. Journal of the Australasian Rehabilitation Nurses’ Association (JARNA), 21(1).

Hemingway, S., McCann, T., Baxter, H., Smith, G., Burgess?Dawson, R., & Dewhirst, K. (2015). The perceptions of nurses towards barriers to the safe administration of medicines in mental health settings. International journal of nursing practice, 21(6), 733-740.

Kitson, N. A., Price, M., Lau, F. Y., & Showler, G. (2013). Developing a medication communication framework across continuums of care using the Circle of Care Modeling approach. BMC health services research, 13(1), 418.

Malekzadeh, J., Mazluom, S. R., Etezadi, T., & Tasseri, A. (2013). A standardized shift handover protocol: Improving nurses’ safe practice in intensive care units. Journal of caring sciences, 2(3), 177.

Smeulers, M., Verweij, L., Maaskant, J. M., de Boer, M., Krediet, C. P., van Dijkum, E. J. N., & Vermeulen, H. (2015). Quality indicators for safe medication preparation and administration: a systematic review. PLoS One, 10(4), e0122695.