Discussion On Medication Management-Free-Samples For Assessment Answer

Importance of the topic: Medication Management

Medication error is a kind of error that causes inappropriate application of medication over the patient, causing potential harm (Fatemah et al. 2013). The medication error is preventable but when it occurs in an emergency department of a hospital, the situation becomes fatal. The medication management lies solely in the hand of the health care professionals and generally deals with the norms, process and the mode of administration of the medicines. The importance of the topic lies in the fact that such management directed towards the medication will cut-short the occurrence of the manual error occurring in the emergency department and thereby reducing the rate of mortality and unwanted deterioration of the patient’s health condition. The medication management system will promote the development of the proper medication plan, or the routine protocol that needs to be undertaken while providing medication to any patient admitted in an emergency unit and will also encourage proper interaction between the nurses and the doctors (Patanwala et al. 2012; Moorhead et al. 2014).

Audit Standards Maintained

The number of nurses with respect to doctors is high along with the increase in the number of non-veterans doctors; amount of medication error is increasing vigorously. The latest data obtained from the Kings Hospital, Singapore states that, majority of the casualties in the emergency unit of the hospitals have occurred because of the medication errors. The medication error statistics shows drastic increase of medication error incidence. 3 cases are reported in 2016 and 10 cases in 2017. Moreover, there are 2 unfortunate Serious Reportable Events (SREs) that have occurred within one-month in year of 2017. Here SRE is defined as adverse event that causes negative effect leading to an unintended harmful impact on the patient, which may or may not have been prevented (MOH 2014). Emergency Department (ED) has a stressful environment with high turnover rate of patient and unpredictable critical events. Such sudden events and work pressure make ED to suffer from high frequency of medication error. The statement holds true across the nation (Vazin, Zamani and Hatam 2014). In promotion of patient safety level, medication safety had long been recognized to be important in the field of healthcare provision (MOH 2006) Based on the escalating medication error incidence in the beginning of 2017; it was predicted the same scenario will prevail for the rest of the year. Given the significance of the current report of MEs in ED, it is very important to develop an audit on the medication administration on all Registered Nurses (RN) in this ED in order to find out their performance and identify the area of improvement. This will help to combat further ME incidence and will enhance the level of patient safety. The nursing audit is an exercise to elucidate whether good nursing practices are followed in a particular health care unit where the nursing audit is being carried out. In Singapore, according to Medication Safety Practice Guide, all healthcare professionals have equal share of responsibility to ensure medication safety especially for the nurses. Nurses hold a important position which acts as a last barrier to prevent any medication error happening at the bedside. (MOH 2006) All nurses must abide by the authorized guidelines, standards and evidence based best practices (MOH 2006).

Figure: Medication Error Statistics (Kings Hospital, Singapore for the year of 2016-2017)

Each medical nurse or midwifery specialist is relied upon to create and keep up skill with respect to all parts of medicine administration, guaranteeing that her/his insight, aptitudes and clinical practice are breakthrough. The pharmaceutical administration requires the nurse/midwife to be responsible in managing the medicinal management for the patient/benefit client, the general population.  The nurses must adopt the administration of the best medicine after the authorized standards are being made.

The audit standards that the nurses/midwives can adopt are the

1. The nurses should be aware of the legal and professional responsibilities
2. The nurses must have access to the medicines in need of the patient need and there will be support of the local systems
3. The nurses must be aware of the actions and omissions of the role of the nurses in administering a prescribed medicine
4. They must actively follow the transcription as mentioned by the visiting doctor
5. They will have to follow the administration and frequently monitor the desired effect of the drug and make review
6. The nurses should have an understanding for the drug prescription and the potential side effects. They must be efficient enough to identify, intervene and report the adverse conditions
7. They should understand the purpose of the medicines that is been registered. The nurses must seek all the information in a written form prior to the audit study
8. The audit can be done if the nurses know the potential benefits and the misuse of the drugs which is being administered to the patient
9. The nurses must adhere with the requirements of the Misuse of Drugs act and regulations to follow a strict regime in the audit
10. They must be well aware of the factors that are involved in the medicinal errors like right of the patient, mode of administration of the prescribed drug, the time of cyclic administration of the medicine in a routine base and route of administration
11. Nurses must be aware of the special care regime need to be undertaken during the intravenous administration of the drugs and these include the duration of administration, the ratio of dilution, the drug compatibility and the speed to administration or transfusion through the veins (Gardner, Gardner and O'connell 2014)

Audit Questions

The 5 specific audit questions, solely directed towards the concept of the medication management which the nurses are requirement to fill at the time of medicine administration are

• Does the hospital have a medicines policy that is practiced in the hospital?
• Are the medicines kept safe in the hospital?
• Are medicines requiring refrigeration stored in a separate refrigerator?
• Are refrigerated medicines properly labeled to indicate storage requirements?
• Are dosage instructions clear and is the medication administration record completed correctly?

Audit Setup

The audit was done at emergency department of the Kings hospital Singapore. It is a multidisciplinary hospital.

Population and Sampling

All the nurses of the emergency unit of the Kings hospital in Singapore will be involved in the audit. The exact population who will be examined are the 150 registered nurses. The number of samples who are actually being audited are 150 veteran nurses of the emergency unit

Introduction

Medication management can be regarded as the principal responsibility of a nurse in any health care setting (Health Information and Quality Authority (HIQA) 2009). It is a complex process, which involves several steps like prescribing proper medicines, ordering the medicines, dispensing the used vials and syringes, supplying the medicines to the wards, then finally administering the drug, and storing via proper refrigeration (Dilles et al. 2012). Research suggests that error in any phase of the medication cycle, adversely effects the patients’ physical safety, which is comes under the highest priority in the nursing practice (Weaver et al. 20013). Moreover, adverse drug events are common in the emergency unit of the hospitals and hospital residents are more susceptible to such threats because of high occurrence of polypharmacy and change in pharmacokinetics and pharmacodynamics. The pharmacokinetic and pharmacodynamics varies with age and have a huge influence over the durg interactions and associated side-effects (Dilles et al. 2012, p.172).

In the nursing practice, the nurses are religiously trained to preach the five basic rights of medication administration. The 5 rights are include, the right of medication, right dose, right route, right time and right patient. However, evidence indicates that majority of the nurse fail to preach these five basic rights. Therefore, additional strategies are required to be implemented in order to negate the chances of the medication errors. This additional strategy comes in the form of nursing audit.

The objectives of this audit were:

The aim of this project is to implement best practices prevalent in medication management in the emergency unit of the hospital. The principal objectives are to reduce the overall rate of occurrence of the medication errors or the chances of adverse drug events through incident reporting and adherence to the medication administration via following safety guidelines. The additional objectives of this dissertation are to promote the overall safety quotient of the residents via complying the professional and national standards of nursing on the medication management.

Rationale

Medical Audits Technology Systems have designed an audit system to promote the improvement of the operation of the medication safety in the clinical areas. It also ensures compliance with legislation and thereby improves medication management to prevent patient harm (McBane et al. 2015).

The importance of the medication management lies in the fact that it promotes proper monitoring of the medicines that are going to be administered to the patients. It also evade the chances of the unsafe medication communications with over-the-counter medications or different cross-reactivity of the pharmaceuticals. This is particularly imperative for those taking extensive quantities of drugs to address interminable ailments and different maladies, which is more predominant among seniors (Wager, Lee and Glaser 2017).

The Health (Nursing Homes) (Amendment) Act (Health Act) (2007) states that all the suppliers and the social care administrations (private and government hospitals), need to enlist with HIQA and need to claim that they attempt to observe controlled exercises as characterized in the Act. Numerous proposals were made to guarantee that the supplier/individual in control (nurture director/pioneer) conform to the Health Act 2007 and National Quality Standards for Residential Care Settings for Older People before they get officially enrolled. These suggestions can only be implemented by the change in structure and frameworks of the association (Smith, Bates and Bodenheimer 2013).

Background

Drug administration in nursing is extensively characterized. It deals with the protected and successful utilization of the remedy and over-the-counter restorative items. The nurses and midwives are the most important members in solution administration and add to persistent/benefit client mind. Pharmaceutical administration is a complete mediation, which includes the learning of trained nurses and the exercises that are performed to help the patient/benefit client in accomplishing the best advantage and best results including drugs. The duties of pharmaceutical administration fuse the appraisal, arranging, execution and assessment of the nurses (Sousa et al. 2017).

The Medication Management Plan (MMP) of Singapore furnishes wellbeing specialist co-ops with a standard frame that can be utilized by nurses and the associated wellbeing staff to enhance the exactness of data recorded on confirmation and accessible to the clinician in charge of restorative basic leadership (Westbrook et al. 2015).

Standard recording of the prescriptions taken preceding introduction at the hospital and accommodating of patients' pharmaceuticals on affirmation, intra-doctor's facility exchange and at release is viewed as fundamental for the medicine compromise process. The MMP gives an appropriate paper frame to this reason. The MMP shape was intended for use in minor and grown-up patients (Walker and Colledge 2013).

Audit purpose

1. Assessing and monitoring the quality of service provisions
2. To provide the evidence of competence
3. Preventing and reducing errors
4. Demonstrating accountability
5. Developing and training staffs

Methods

Standards

The audit standards will be created on the basis of the emergency department of the organization. The audit survey will be conducted at the emergency department of the multidisciplinary hospital in Singapore, Kings Hospital.

Setting

The audit will be done in the emergency ward of the department of multidisciplinary hospital, Kings hospital Singapore.

Population

The population required in this will be 150 registered nurses in the emergency unit out of 150 total nurses.

Data collection

The data was collected by distributing the questionnaire among the nurses who are attending patients in the emergency unit. The nurses only after having the proper knowledge about the patient and the medicines are asked to fill the questionnaire in Yes or No format while administering the medicine to the patient.

A planned investigation includes the accumulation of the information related to pharmaceutical information. Audit examination is finished utilizing graph audits or other information sources to survey pharmaceutical use as indicated by pointers and criteria arranged ahead of time (Billingham, Whitehead and Julious 2013). The benefit of a forthcoming survey is that the drug specialist (or other commentator) can mediate at the time the solution is apportioned to counteract blunders in, for instance, dose, signs, or cooperation. Audit assessment, may include a greater amount of the analyst's opportunity or expect access to medicinal records, is best expert when the commentator has time far from the patient care zones and diversions. Commonly, solution related criteria that are explored in these sorts of assessments are as per the following—

Prospective studies (obtained from prescription records) (Herrett et al. 2015)

• Indication of the dosage
• Dose of the drug per body mass and age
• Duration of therapy and degree of toxicity
• Dosage form and route of administration
• Potential medicine interactions or drug cross-reactivity
• Appropriate therapy and medicine selection
• Therapeutic duplication
• Contraindications in medication with drug allergy and age
• Quantity dispensed
• Retrospective studies (obtained from prescription, medical records, and laboratory records) (Aiken et al. 2014)
• Proper Laboratory monitoring
• Monitoring of the therapeutic use of high-cost medicines
• ADRs to medications
• Correct use of generic or therapeutic equivalents
• Patient outcomes from pharmaceutical therapy

Collection of the information is performed by auditing an appropriate example of outlines or solution records from the human services office, for the most part by chose drug store faculty. At any rate, 50 to 75 records ought to be explored at every human services office. The bigger the office and the more experts, who are accessible, the bigger the level of records that would should be looked into and broke down (Bronzino 2014).

Data collection Table

Response	Res	Res	Res	Res	Res	Res	Res	Res	Res	Res
	Y/N	Y/N	Y/N	Y/N	Y/N	Y/N	Y/N	Y/N	Y/N	Y/N
1. Is the patient’s name in the medication chart legible?
2. Has the Date of Birth of the patient been enlisted in the medication chart?
3. Is the ‘Allergy’ status clearly marked on the medication chart?
4. Is the authorised doctor’s signature present on all medication orders?
5. Is the ‘date of order’ written by the nurses on all medications orders provided the doctor?
6. Are all the medication orders clear and legible?
7. Are the medication orders has the clear indication of the patient name?
8. Are the medications orders clearly stating the route of administration of the drug?
9. Are the medications orders clearly stating the tenure or the time of medicine administration 9in case of intravenous or intramuscular or subcutaneous?
10. Are there any medicines for which the administrations have been ceased in the last 7 days?
If ‘yes’ has the chart been signed and dated to indicate the cessation date?
Are the unused medicines returned to the pharmacy for repacking? Are the bottles or the packs of the ceased medicines removed from the patient’s drug trolley?
11. Are the required authorised signatures present on all the medication charts?
12. If medication refused or withheld has been recorded appropriately with proper reasons?
13. Have all the refused or withheld medicines (more than 7 consecutive doses) been referred back to the doctors for proper audit?
14. Has the pharmacy dispensed adequate stock of medicines prescribed in order to ensure that the doses are never missed under any circumstances?
15. Is the patient’s current photo attached at the front of the medication chart for instant identification?
16. Is the temperature of the drug storage refrigerator been strictly monitored or maintained?
17. Have all the opened eye drops or nose drops been marked with the date of seal opening date?

Key Elements	Standards	Audit questions
Patient Information Easily accessible and readily available demographics and clinical data (age, diagnosis, allergies status) via electronic system. This will ensure that the correct drug is administered to the correct patient	Demographic data and medication profile such as patient identity and allergy status must be updated regularly	1.      Do nurses apply barcode name bracelets and coloured allergy bracelets to every patient? (YES/NO) 1.      Do nurses identify the correct patient and IC number before serving medication? (YES/NO)
Drug Information To maintain an up-to-date drug knowledge among the nurses through readily accessible online references, protocols, and computerized drug information systems.	·         All nurses must know where to look for the online up-to-date drug information resources	1.      Do nurses know where to access online drug information resources? (YES/NO)
Drug labeling, packing, and nomenclature To facilitate proper identification of drugs and to prevent medication error from sound alike or look alike drugs name	·         All post filled syringes medication must be labeled with the name and strength of the medication	1.      Do nurses label all post-filled syringes medication with the name and strength? (YES/NO)
Staff competency and Education Staff education plays a vital role in the medication error prevention such as baseline competencies and knowledge about medications, non-formulary medication and High Alert Medication (HAM).	·         All nurses must know the safe use and proper storage of the medications within the hospital.	1.      Do nurses know the safe use and storage of medications within the hospital? (YES/NO)

Table: The table represents the basis of the audit question framed

(Source: Created by author)

Ethical consideration

In case of conducting a research, the researcher is required to strictly follow the ethical guidelines that comes under the Data Protection Act. The ethical principles along with the guidance help the researcher to conduct the research successfully. In order to carry forward the research, the researcher is required to take consent from the participants. The participants who are not interested in survey shall never be forced or compelled. Apart from taking the consent, the research needs to be quite aware about the biased factor, which is quite common in survey. Proper screening of the biasness will help in generation of the standard data, minus the false positive results. However, manipulation is not the way out for standard results and must be avoided on highest priority. Moreover, the collected data must be protected as per the privacy guidelines. The data collected was primary data and hence again privacy comes into consideration and should not be used or cited in other related works.

While designing the survey questionnaire, it was kept in mind that the it does not contain any personal questions that can hurt the emotion and feelings of the participants. Furthermore, for successful completion of the survey, the researcher needs to collect information from some of the most authentic resources while conveying the purpose of the survey to the participants. Now this will subsequently will make the participants more cautious and to deliver their views properly.

In order to conduct this nursing audit, the researcher obtained an ethical approval. It was collected from the Institutional Review Committee along with a signed consent collected from the hospitals higher authority before data collection. The completed audit questionnaires were retrieved only after their completion in the emergency ward of the Kings hospital

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