Read the below scenario and reflect on what really happened. Answer the questions following the scenario:
(Levett-Jones & Newby 2012)
1. In this scenario the nursing student did every task she had been asked to do. Should anything else be expected of students?
2. What interpersonal and situational factors influenced how this scenario transpired?
3. How might the outcome of Mr Esposito have been different had Maddie had a requisite level of clinical reasoning skills?
4. What aspects of this adverse drug event were preventable?
5. Should this adverse drug event be documented and reported? If so, where, by whom, to whom and why?
6. The medical officer and nurse discussed whether Mr Esposito and his daughter should be told that he had experienced an adverse drug event. The nurse thought they should be told, but the doctor disagreed saying that telling Mr Esposito and his daughter would make them worry needlessly. What do you think and why?
7. Reflect on the scenario and outline some of the errors that occurred and that led to Mr Epsosito’s adverse drug event.
Mr Guiseppe Esposito, 81 years, was admitted to the medical ward of Griffith Community Hospital with dehydration as a result of suspect gastroenteritis. He had been vomiting and had diarrhoea for two days prior to admission. Intravenous fluids were commenced and his diarrhoea began to improve the following day, although some nausea persisted. Mr Esposito’s IV was not resited when it ‘tissued’ later that evening.
At 000 the next day (Guiseppe’s second day following admission) Maddie was asked to administer Guiseppe’s usual oral medications (frusemide 80 mg, digoxin 125 micrograms and enalapril 20 mg). It was a busy shift and the registered nurse (RN) supervising Maddie was interrupted and asked to attend to another r patient. She said, ‘Keep going – I’ll watch what you are doing from over here’. Maddie, although new to the ward and feeling quite intimidated, was conscious that this was outside of her scope of practice. She said, I’m sorry but I am not allowed to administer medications without direct supervision by a registered nurse’. The RUN looked surprised but said, ‘Oh … Okay, I’ll be there in a tick’. While she waited, Maddie checked that there was a valid order for the medications and reviewed the ‘Australian Medicines Handbook’, (Rossi 2011) to find out more about the medications following the ‘six rights’ (right patient, right drug, right dose, right time, right route, right documentation); she also checked to see if Giuseppe had any allergies. Maddie asked him to check his medications as she gave them to him, saying, ‘I’m giving you your Lanoxin, Lasix and Renitec, is that right? Do you know what they’re for, Giuseppe?’ He nodded and replied, ‘Yes, yes, they’re for my ticker and my water’.
Read the above continuation of the scenario about Mr Esposito and answer these questions about medication safety and administering medications.
What other ‘rights’ are essential to medication safety?
1. What does a valid medication order require?
2. What three checks are required when administering medications?
3. Should Maddie have taken Giuseppe’s vital signs prior to administering his medications?
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