In this paper, a meaningful clinical event, regarding delayed medications, is examined. The paper explores the importance of right-time administration and causative factors and preventative measures of wrong-time errors. As a final point, I describe how I would handle the scenario differently after learning strategies to reduce late medication administrations, thus reducing patient harm. Look Back/Elaborate During week five, I was assigned to two patients (A and B), one of whom is a shared client (patient B) between a colleague and I.
Strategically, my colleague and I planned out the first half of the shift, such that we would perform vital signs and head-to-toe assessments first, administer medications in accordance with the schedule, and reposition the patients every two hours. I went to patient A’s room around 9:40 a. m. to reposition the patient, and expected to perform this task quickly and efficiently in order to comply with the schedule and deliver both of my patients’ 10:00 a. m. medications on time. However, during the procedure, I noticed that the patient’s feeding tube was leaking, which was evidenced by her soiled gown and bed linens.
The nurse instructed me to wash the patient, change the bed linens, and administer her medications afterwards. To speed up the process, I asked my colleague to assist me with hygiene care and bed making. However, we spent a great amount of time carrying out these tasks because we were having difficulties mobilizing the patient. While preparing patient A’s medications (crushing and mixing the drugs with water), my nurse would occasionally converse with me during the procedure. This distraction, along with the feeding tube leakage, resulted in delayed medications (an hour late). As soon as I finished, I rushed to patient B.
The client’s nurse informed me that she had already administered all of the medications, including antibiotics, except for one drug because the unit was short on availability of that specific drug. Generally, I committed medication-time errors for patient A, and potentially for patient B if the nurse was not available to deliver the medications. In the event, I felt distressed and frustrated because I failed to perform daily tasks on time, most importantly medication administration. Furthermore, these emotions were heightened by as I felt unable to deliver the best possible care.
Thoughts of my nurses being disappointed in me because of my poor performance were additional causes to my stress. Essentially, these negative feelings arise from my values and beliefs of being punctual and providing safe and high quality care. These values are shaped by my family and profession as I was always disciplined and taught the importance of being on time and promoting patient safety, respectively. Essentially, one significant key issue from the event previously discussed, relates to my inability to deliver medications at the specified time.
It is important to administer drugs on time to maintain patient safety, since late medications may result in ineffective treatments and unstable patient conditions (Potter & Perry, 2014). Analysis As it was previously mentioned, right-time medication administration is important to prevent patient harm and future medical costs for both patients and healthcare facilities (Pape, 2013). Medications are considered late when they are delivered beyond 30 minutes of the scheduled time or depending on the hospital policy (Morris & Brown, 2017).
Certain medications, such as antibiotics and Parkinson disease drugs, follow strict schedules to provide and maintain therapeutic blood levels (S. S Chua, H. M Chua, & Omar, 2010; Kovosi & Freeman, 2011; Wanzer, Goeckner, & Hicks, 2011). In particular, antibiotics should be administered on time to prevent bacterial resistance and inhibit bacterial growth (Chua et al. , 2010; Wanzer et al. , 2011). In relation to my situation, I could have potentially altered patient B’s health because I was unable to deliver the antibiotics on time due to sudden unfortunate events and interruptions.
Fortunately, my nurse was able to give the medications. There are multiple causes that lead to delayed medications, the main ones being distractions or interruptions, high workload, and pharmacy related events. Distractions or interruptions include noises, conversation, and phone calls, whereas workload includes multiple patients and patients who require more assistance (Brady, Malone, & Fleming, 2009; Pape, 2013). Pharmacy and drug unavailability issues are suggested to result from ineffective collaboration between the members of the healthcare team (Chua et al. , 2010; Taufiq, 2015).
Specifically, one of the studies discusses the causes of medication errors pertaining to nursing students. The paper proposes that nursing students have multiple patients, insufficient knowledge regarding medication as well as patient status, poor collaboration skills, difficulties concentrating, and inexperience (Valdez, de Guzman, & Escolar-Chua, 2013). Lack of experience may result from inadequate exposure to certain clinical situations, which poses more challenge for students when handling the increasing workload, all of which may contribute to mental lapses (Valdez et al. 2013).
Furthermore, other contributing factors are limited critical thinking and prioritizing skills (Brady et al. , 2009). In relation to my own experience, the delayed medications of patient A results mainly from high workload and distractions. For instance, in addition to the feeding tube incident, the preparation and administration of the medications required more time and I did not allocate enough time for these processes. The medications needed to be crushed, mixed with the solution, and delivered slowly through the feeding tube.
Also, because the nurse conversed with me during the preparation, it led to further delays such that I had to pause what I was doing when I gave my response. This behaviour or value of mine is shaped by my family because I was always taught to be respectful and give my full attention when people converse with me. As for the wrong-time errors associated with patient B, the contributing factors include the delays that occurred with patient A, pharmacy-related issues, and limited drug knowledge. Since one of the patient’s drugs was not on the unit, the nurse had to place an order.
Simply, the order placement, drug transport, and medication preparation would result in late administration. Also, my lack of knowledge regarding drugs may be associated with inadequate prioritizing skills, such that I did not take into account that some medications are more crucial than others to be delivered at the specified time. In addition, my inexperience plays a huge role in this clinical scenario. Considering that it was my first time handling more than one client, it made me feel overwhelmed, and thus rendered my coping strategies ineffective.
These negative feelings could have affected my concentration when preparing medications. Overall, all of these factors led to wrong-time medication administration. I am fully aware that this type of medication error can occur countless times in clinical settings, and I may not always have another nurse available to give or order the medications on my behalf. That being said, I need to learn and develop strategies to tackle similar situations in the future. These strategies include collaboration, adequate knowledge, and interventions to prevent distractions.
In general, collaboration is an important factor in reducing medication errors, but primarily, timely and effective collaboration with the pharmacy can prevent late deliveries (Chua et al. , 2010). Also, enhancing one’s knowledge regarding drugs aid in prioritizing one’s tasks regarding medication administration (Brady et al. , 2009; Chua et al. , 2010). Since nurses are unable to deliver all of their patients’ medications at that specific time, nurses need effective judgement and prioritizing skills, such that crucial medications are administered before other medications (Brady et al. 2009; Chua et al. , 2010).
To decrease time-related medication errors from distractions, Pape (2013) proposes the use of the “no interruption zone” (Pape, 2013, p. 219) when preparing medications, which is marked on the floor with tape. In addition, nurses may wear a sash during medication preparation and administration, which serves to warn individuals not to interrupt the healthcare provider during the process (Pape, 2013). Furthermore, when nurses are disturbed by other individuals, they should verbally inform them to stop their distracting acts (Pape, 2013).
For instance, one might respond with, “no talking please. I am giving medications now” (Pape, 2013, p. 221). However, in relation to my situation, I failed to adhere to these strategies because I did not check the drug’s availability beforehand, and thus did not communicate and collaborate with the nurse and pharmacy in a timely manner. Also, I failed to review the patients’ medications which resulted in inappropriate prioritization of tasks. Furthermore, I did not stop the nurse when she talked to me during the medication processes, allowing myself to be distracted and delay the delivery of medications.
Revision/New Perspective After reading through several articles, I learned that delayed medications can cause harm to patients, especially when a patient is scheduled to receive critical medications (e. g. Parkinson disease drugs and antibiotics) (Chua et al. , 2010; Kovoski & Freeman, 2011). Fortunately, this medication error is preventable. For instance, preventative measures include, timely collaboration with the healthcare team, adequate drug knowledge, and prevention of interruptions or distractions (Brady et al. 2009; Chua et al. , 2010; Pape, 2013).
If I were to relive this experience, I would first view and learn both of my patients’ 10:00 a. m. medications and check their availability. By doing so, I would be aware that patient B has critical drugs to receive, whereas patient A does not. Thus, I would know to administer patient B’s medications first. By checking drug availability prior to administration, I would know that patient B is missing a medication and immediately inform the nurse about this.
The order would then be placed and the drug would arrive on the unit on time or within the 30 minute margin. Also, knowing that patient B has crucial medications, I would have handled the leakage incident differently. For instance, I would inform my nurse that I can just clean the affected body part and place a blue pad on the soiled linens for now, and return later to provide proper hygiene care and bed making after delivering both of my patients’ medications.
Furthermore, when I was interrupted by the nurse, I would kindly say, “if you don’t mind, I will just prepare and give the medications and then we can talk afterwards. Please and thank you. ” Generally, if I handle the situation this way, I would have delivered patient B’s medications at the specified time and patient A’s medications within the allowed time-margin, which would avoid medication errors. Conclusion Right-time administrations is important to promote patients’ health and safety, as it maintains therapeutic blood levels (Potter & Perry, 2014).
The cause of this type of medication error may be associated with patients, nurses, pharmacists, and the remaining healthcare system. Fortunately, effective collaboration, up to date education, and strategies to prevent distractions can reduce time-related medication errors (Brady et al. , 2009; Chua et al. , 2010; Pape, 2013). Overall, adherence to these suggestions are important to provide effective treatments.