Discuss About The IIE Transactions on Healthcare Systems Engineering.
In relation to the NSQHS standards 4 and 5, I can say that I have good knowledge and understanding regarding the steps needed for medication safety and patient identification by caring for a patient with asthma during one of my clinical placement. During my clinical placement, I was given the task of taking care for a patient, Mr. X (Hypothetical name provided because of confidentiality requirement) who was admitted to the hospital following an exacerbation of his asthma symptoms. He was also a hypertensive patient. I was given all handover information regarding the patient and I had the duty to provide prescribed medication to patient and monitor patient for deterioration in signs and symptoms. Before reviewing patient’s healthcare status and providing medication to patient, I also took steps to correctly match patient and identify any risk of allergy in patient.
Responding and relating:
I was very nervous while being assigned to provide nursing care to Mr. X because it was the first time where I had to handle a patient with exacerbation of asthma. I knew that safely providing medication to Mr. X would be a challenging task because asthma exacerbation is triggered due to exposure to allergen and it would be important to carefully identify the medications for which the patient is not allergic (Kaminsky & Irvin, 2018). Use of corticosteroids can provide relief to patient, however side-effects related to hypertension and allergic reactions made my clinical experience challenging as I had to be vigilant and constantly monitor patient for any fluctuation in his sign and symptoms (Zazzali et al., 2015). As it was a busy ward, I also decided to follow the basic guidelines for patient identity matching so that any errors do not arise because of identity mismatch and patient misidentification. This is also necessary because of the similar names and admission of patients with various types of ailments.
I was able to safely administer medication to Mr. X without any major complication because I was aware regarding the need to accurately review and record patient information while engaging in documentation process. Before providing the prescribed medication to patient, I reviewed the handover chart given by the other nurse during shift change. The handover chart gave me clear idea regarding the medication history of patient and current medication for patient at the point of care. However, to further promote safety of patient, I also entered into communication process with Mr. X to confirm all the information presented in the documented records and reduce any likelihood of errors because of poor documentation of vital patient information. Armor, Wight and Carter (2016) reports that poor communication related to drug use occurs most frequently in health care setting and life threatening medication errors occurs particularly during transition of care. This mainly occurs because of incompleteness of patient information and delivery of care through multiple staffs. I also witnessed the same issue as I found that drug allergy chart was blank and the handover has not filled it. To ensure safety of patient, I took the additional step to repeat information related to medication history to patient and asked her regarding allergy to any drugs. Adhikari et al. (2014) supports the fact medication error can be prevented during transition of care by involving patient during medication administration and clarifying all information to ensure that safety of patient is maintained. I also followed the same steps to ensure that I had accurate medicine information available with me.
The next approach was to use appropriate procedure to engage in medication administration process. Before proceeding with the medication administration, I first took all the steps to assess identity of patient and match it with the clinical procedure. As per standard 5 of NSHQS, it is essential to match patient to any intended procedure or treatment. I conducted patient identity check by first looking for armband or patient label which was used by the hospital to specify identity of particular patient. This was cross checked with the identity provided in the handover report. I double checked identity by asking the name of patient and date of birth. Asking or reading out patient’s identifiers loudly engages patient and ensure proper identity matching. As per standard hospital protocol, the patient should also have yellow or red colour band because of history of allergies (Lippi et al., 2017). However, during the procedure of identity matching, I could not see any bands. Hence, allergy related information was missing and I had to clarify this by interaction with patient. According to Jo et al. (2013), matching patient identity can decrease patient’s misidentification during medication administration. Hence, using appropriate system wide protocol helped to prevent any errors due to identity mismatch.
While recollecting my clinical experience related to medication safety and use of correct procedure for patient’s identity matching, I would like to conclude that this clinical placement experience gave me the exposure to effectively implement NSQHS standard 4 and 5. I feel standard 5 is very related to standard 4 as according six rights of medication administration, identity matching is the first step towards safe administration. The hospital’s protocol and system of identity matching and safe medication administration system also supported me to provide safe and quality patient care. In accordance with the NSQHS, my clinical setting had appropriate system in place for identity matching and this helped me to effectively apply my theoretical knowledge in real practice setting. My own values of patient advocacy also helped me to overcome issues related to missing patient information during patient administration.
To conclude, the past clinical placement has provided good exposure to learn all about NSQHS standard 4 and 5 and nursing value of patient advocacy further supported me to improve my nursing performance.
Adhikari, R., Tocher, J., Smith, P., Corcoran, J., & MacArthur, J. (2014). A multi-disciplinary approach to medication safety and the implication for nursing education and practice. Nurse education today, 34(2), 185-190.
Armor, B. L., Wight, A. J., & Carter, S. M. (2016). Evaluation of adverse drug events and medication discrepancies in transitions of care between hospital discharge and primary care follow-up. Journal of pharmacy practice, 29(2), 132-137.
Australian Commission on Safety and Quality in Health Care (2012). National Safety and Quality Health Service Standards. Retrieved from:
Jo, J., Marquard, J. L., Clarke, L. A., & Henneman, P. L. (2013). Re-examining the requirements for verification of patient identifiers during medication administration: No wonder it is error-prone. IIE Transactions on Healthcare Systems Engineering, 3(4), 280-291.
Kaminsky, D. A., & Irvin, C. G. (2018). psychology of asthma, COPD, and the overlap. In Asthma, COPD, and Overlap (pp. 67-76). CRC Press.
Lippi, G., Chiozza, L., Mattiuzzi, C., & Plebani, M. (2017). Patient and sample identification. Out of the maze?. Journal of medical biochemistry, 36(2), 107-112.
Zazzali, J. L., Broder, M. S., Omachi, T. A., Chang, E., Sun, G. H., & Raimundo, K. (2015, July). Risk of corticosteroid-related adverse events in asthma patients with high oral corticosteroid use. In Allergy Asthma Proc (Vol. 36, No. 4, pp. 268-74).