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    MEDICATION ERROR…………..Bella Richard

    I am reflecting about an incidence which was occurred during my clinical placement. I was working in a ward when I have seen that a student nurse took vital signs of all patients in ward and present the register to in charge nurse to inform the vital signs of all patients. In charge nurse notice that one of the ward patients had fever and informed it to duty doctor. Doctor told the nurse to give tablet panadol to patient, and nurse follow the doctor order and given tablet panadol to patient. After half an hour after given medication patient develop allergic reaction. Patient had history of allergy to panadol but neither doctor asked about it nor nurse. One more thing doctor did not write this medication order on treatment sheet of the patient and nurse followed doctor’s verbal order. Even nurse did not document this event in nursing notes. She only told to the next shift nurse verbally that the patient had fever and I have given her tablet panadol.

     

    As per “The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) reported that roughly 0.1 million individuals die every year from medicinal error that happen in hospitals and the subsequent passing/year because of pharmaceutical mistakes is higher than that of work put wounds in Pakistan. (Riaz M.K, Hashmi. M.K, Bukhari. N.I, Hussain. M. R, 2014). Other than deaths, such mistakes can bring about undesirable results, loss of trust in the medicinal services framework, increment in treatment cost and longer stay in hospital. In developed nations like the US, such mistakes are accounted for to be accountable of 7000 deaths for each year (Lehne, A.R. Moore,L. Crosby,L. & Hamilton, D, 2013).

     

    This incident made me feel worried because medication errors is a one of the most common cause amongst the most widely recognized reasons for unintended damage to patients. They add to adverse events that swap patient security and result in a vast financial burden to the health services. The anticipation of drug mistakes, which can occur at each phase of the medication preparation and distribution process, is basic to keep up a protected medicinal services framework. One third of the medication error happens in the nurse administration phase. Providing medications to patients is therefore a high risk activity (Samarawickrama, A.A. Suraweera R. K. Sivayoganathan, C. & Sakeena, M.H. 2014).

     

    Panadol is frequently used over the counter drug and usually used for the relief of fever, headache and minor pains. Adverse effects of panadol are rare but allergic reaction includes skin rash, and blood disorders such as thrombocytopenia, neutropenia, pancytopenia and agranulocytosis (Han, S. et.al. 2014)

     

    The most genuine concern with Paracetamol is the impact it has on the liver, and subsequently certain things must be gone to instantly. Yellow eyes or skin can be an indication that the liver is harmed because of the ingestion of Paracetamol (Vidhya Malar, H. L. Mary Mettilda Bai S. 2012).

     

    I evaluated this incident and learned an important of checking the medication chart thoroughly following five rights of medication administration. Giving medication is not just the prescribed medications administration to patients. It is the safe routine with regards to regulating medications to patients following rule of five rights, for example, the correct patient, the correct medication, right dose, the right time and the right route (Medication Handling in NSW Public Health Facilities, 2013). I also experienced that nurses should carefully check the medication orders to prevent medication error and unintended harm to patients.

     

    By analyzing the episode, I discovered that as a nurse we should know the obligation of care and in addition the patient well being. Nurses are accountable of patient safety while giving medications to the patients. To prevent the same issue and show signs of improvement result, the nurse ought to have completely checked the drug chart for medication orders and most extreme ask patient for any allergies before administrating medication.

     

    Because of this scenario, I understood that nurses ought to go to an education session to be a competent and confident nurse to perform safe medication administration practice for patient safety. Moreover nurses should follow the safe medication practice such as five rights of medications as well as they should know the pharmacokinetics of drugs like dose, route frequency, and side effects of drugs.

     

    Nurses must know importance of the written orders of the medication even though they are in the busy working situations and should not rush to give drugs to patients without written orders to prevent medication errors. Nurses should also double check any drug allergies of the patient to give no harm to the patient and to provide quality care to the patient.

     

     

    Bella Richard
    MScN Student
    Ziauddin University College of Nursing

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