Professional Documents
Culture Documents
Introduction
Care is one of the most important thing given by a nurse to a patient. It is the giving of serious attention, consideration, and protection towards a patient. But nowadays many nurses commit errors on field. On the other hand error means mistake, or unintentional act made by a person.One of the factors is lack of presence of mind which can lead to negligence and malpractice.This research study, aims to know what are the reasons and effect of committing errors in clinical field.
Errors are not a form of dishonesty. The Institute of Medicine (2000) defined error as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.According to, Hall (2002), an error can be classified as being active, such as medication or documentation error, or latent such as lack of prevention. According to American Nurses Association (ANA), only those individuals who have demonstrated the knowledge, skills, practice experiences, commitment, and integrity essential to profession are allowed to enter into and continue to practice within the profession.Nurses have an ethical responsibility to maintain patient safety that includes minimizing and reporting the incidence of errors. Acknowledging and reporting an error is an act of moral courage (Banja, 2001) by which the nurse safeguards the patient rights while protecting his or her own. As stated by (Husted & Husted, 2001), when a nurse is truthfully acknowledging an error, the nurse is forces to accept her own humanity and the humanity of the patient.Nurses have important responsibilities including having regular communication with patients, communicating changes in patients conditions to physicians, administering medications, and monitoring vital signs during surgical procedures.
There are basic nursing care errors resulting in negligence such as assessment errors which includes failing to gather and chart client information adequately; recognize the significance of certain information (e.g. laboratory values, vital signs). Planning errors which includes failing to chart each identified problem; use language in the care plan that other care givers understand; ensure continuity of care by ignoring the care pan; give discharge instructions that the client understand. Intervention errors which includes failing to; interpret and carry out doctors order; perform nursing tasks correctly; pursue the doctor if the doctor doesnt respond to calls or notify the nurse manager if the doctor is unavailable.
Illustration Inability to monitor patient needs and progress due to inadequate staffing ratios.
Lack of agency/fiduciary concern Failure to act as patient advocate, such as not questioning an order or reporting significant changes in the patients condition.
Inappropriate judgment
Making a wrong clinical judgment because of not collecting the right data or faulty reasoning about the data collected.
Medication errors
Missed
medications,
wrong
dosages,
or
inaccurate
intravenous rates.
Lack of
intervention
on the Because of lack attentiveness, the nurse does not notice that the patient is unresponsive due to being in a hypoglemic state. Not cleaning up spilled water on the floor in a patients room, which the patient subsequently slips on while walking to the bathroom
patients behalf
Lack of prevention
Documentation errors
Recording nursing actions prior to implementation or failing to document changes in the patients condition.
. Documentation Errors
The patient record is the only permanent legal document that details the nurse interaction with the patient and is the nurses best defense if a patient or patient surrogate alleges nursing negligence. Unfortunately there are often crucial omissions in the nursing documentation, along with meaningless repetitious entries and inaccurate entries. They might seriously affect the care of the patient receives, undermine nursing credibility as a professional discipline.
Here are some guidelines for the nurses to prevent documentation errors:
CONTENT
Enter all the information in a complete, accurate, concise, current and in factual manner. Note problems as they occur in an orderly, sequential manner; record the nursing intervention and the patients response.
Document all medical visits and consultation of which other nurses should be aware. Document in a legally prudent manner. Document the nursing response to questionable medical orders or treatment. Factually record the date and time the physician was notified of the concern and the exact physician response.
TIMING
Chart in a timely manner. Follow agency policy regarding the frequency of documentation and modify this if changes in the patients status warrant more frequent documentation.
Indicate in each entry the date and both time the entry was written and the time of pertinent observations and interventions. This is crucial when a case is being reconstructed for legal purposes.
Document nursing interventions as closely as possible to the time of their execution. The more seriously ill the patient, the greater the need to keep documentation current.
FORMAT
Check to make sure you have the correct chart before writing. Print or write legibly in dark ink to ensure permanence. Dont forget write the date and time each entry. Chart nursing interventions chronologically on consecutive lines. Never skip lines. Draw a single line through blank spaces.
ACCOUNTABILITY
Sign your first initial, last name and title to each entry. Do not sign notes describing interventions not performed by you.
Do not use erasures or correcting fluids. A single line should be drawn through an incorrect entry and words. mistaken entry or error in charting, should be printed above or beside the entry and signed.
CONFIDENTIALITY
Patients have moral and legal right to expect that the information contained in their patient health record will be kept private.
Most agencies allow students access to patient records, for educational reasons. Students using patient records are bound professionally and ethically to keep in strict confidence all the information.
Documentation must be accurate, clear, concise, complete, and timely. Speed is of the essence when working in healthcare, but accuracy and completeness are imperative when documenting. Do not let the patients health be compromised by worrying about the speed; make sure it gets done right the first time. Documentation must have meaning today, tomorrow, and in the unforeseen future. One of the difficulties with documentation is that we never know when what we document will be needed. You want to make sure the right information gets documented and that documentation is done correctly.
Nursing documentation is important and not just for legal purposes. The results and benefits of nursing documentation are greater than the sum of the tasks themselves. It isnt an easy task, but it is necessary and it is a way of giving high-quality patient care. The lack of proper documentation can negatively impact patient care and can ultimately cause other problems. . Intravenous Fluid (IVF) Monitoring Errors
Observation and monitoring the clients response to treatment is an integral part of nursing profession. Monitoring the clients progress is essential in determining the effectiveness of the plan of care and for detection of potential complication. However, typical monitoring includes IVF monitoring.
Intravenous Therapy
When fluid losses severe or the client cannot tolerate oral or tube feeding, fluid volume is replaced parenterally through the intravenous route. Intravenous therapy is the administration of fluids, electrolytes, nutrients, or medication by the venous route. The health care practitioner prescribes IV therapy to treat or prevent fluid and electrolyte or nutritional imbalances. The nurse has specific responsibilities relative to IV therapy. As stated by Intravenous Nurses Society (INS), the nurse should review the agencies protocols before gathering the equipment. Administration set, IV pole, filter, regulators to control IV flow rate, and an established venous route.
Asses the client for allergies: tape, iodine, ointment, or antibiotic preparation to be used for skin preparation of the venipuncture site.
Observe signs of infiltration (the seepage of substance into the interstitial tissue that occur as the result of accidental dislodgement of the needle from the vein. Document implementation of prescribed IV therapy in the clients medical record.
Nursing Treatments
Distribute the intravenous fluid infusion over 12-24 hours or as prescribed by the physician.
Restrict the glucose intravenous solution rate according to the weight, or as prescribed by the physician.
Do not allow foreign objects, including air, into the intravenous solution.
Nursing Observation
Check for the infiltration or solution. Measure the patients intake and output.
Health Teaching
Describe or explain those signs and symptoms which should be looked out for and reported, such as swelling on the IV site, dyspnea, or orthopnea. : Needle Stick Injury
Center for Disease Control and Prevention have indicated an alarming number of percutaneous injuries involving contaminated sharps. Needle stick injuries involving hallow-bore needle account for almost half the incidences of percutaneous injuries. The statistics of other countries of the world has shown alarming numbers and the risk for needle stick injuries has been increasing dramatically. Nurses are at particular risk because of the nature of the job that they do. The concern for needle stick injuries has become a global concern.
RECOMMENDATIONS
Measures on the prevention of needle stick injuries should be put in place as follows:
Require the use of safer devices to protect healthcare workers from sharp injuries.
Solicit the input of frontline patient care employees about selection, identification, and evaluation of effective engineering and work practice control.
Require employees to maintain a sharp injury log to document each incident and the work area in which the exposure occurred. Logged data will help determine the effectiveness and safety of currently used devices for future product development.
Evaluate occupational health and safety program and make the changes necessary to minimize injuries. Adopt the World Health Organizations safety standards.
In the absence of needle stick legislation, it is imperative to impress upon health care providers and health care administrators the following concerns:
Hospitals and other facilities that employ nurses and healthcare workers have an obligation to apply the same standard prevention to caregivers as they do patients.
Needle stick injury changes the life of victims. Contracting HIV and Hepatitis C from needle stick injury is a risk nurses take every moment of their work.
Everything possible must be done to protect healthcare workers from unnecessary and preventable exposure to injury and disease.
V: Medication Errors
Safe administration of medicines is of paramount importance to ensure patient/client safety. All medicines are potentially harmful and nurses must be fully aware of the importance of safe storage, ordering and prescribing of drugs. Much has been done to make drug administration safe and yet errors do still sometimes occur. The extent of drug errors has been the subject of much attention from the government, hospital management, pharmacist, and health care professionals, all of whom consider the safe administration of medicines to be an essential nursing skill.
Nursing errors include failing to read the medication label, misreading or incorrectly calculating the dosage, failing to identify the client correctly, preparing the wrong concentration, or administering a medication by the wrong route (e.g. intravenously instead of intramuscularly, some medication errors are very serious and can result to death.
If medication error occurs, it must be reported as soon as it is discovered so that any necessary actions can be taken immediately. In most cases, an unusual incident or quality assurance form is completed by the nurse who makes or discovers the error. The physician is notified of the error, and plans are instituted for assessing the patients for adverse effect.
The nurse must realize the seriousness and magnitude of her responsibility in the administration of medications. VIGILANCE is the keyword in the prevention of medication errors.
Medication ordered by the physician but taken in an incorrect dose at the wrong time or with total lack of understanding of its purpose.
As stated by Mumme (1977), a medication error may very well lead to a malpractice suit. The leading cause of claims against nurses is carelessness, forgetfulness, and insufficient communication with the patients or with the doctor.
Smetzer (2001) suggested a model to safeguard the recipient, the nurse (administrator), the pharmacist (dispenser), and the doctor (prescriber). She maintains that all involved should know:
The patient/client.
The drugs.
Contributing factors identified in nurses and nursing practices that have been implicated in drug errors include:
High workload.
Error in transcription.
Do find time to know more about the drug your patient is receiving.
Do keep the medication card with you as you prepare and administer a medication.
Do concentrate on what you are doing when you are preparing a patient medication.
Do ask another nurse or your superior to check your computation before you prepare the drug.
Do shake the bottle containing liquid medications (especially if it is a suspension) thoroughly before pouring out the patients dose. Do ask the patients name, dont rely on his room or bed number.
Do observe the patient for any reactions to the drug he has received. Do record patients refusal to take his/her medication.
Do chart a medication only after you have administered it. Do ask question. Your question may save a patients life. Donts Dont accept verbal orders except in emergencies. Dont prepare medications way ahead of the time they are to be administered. Dont use medication which are not clearly labeled or solutions which show signs of deterioration. Dont administer medication which somebody else has prepared. Dont ask someone else to administer medication which you have prepared. Dont leave the drug on the table when the patient says I will just take it later.
A conscientious nurse takes every precaution to avoid errors when administering therapeutic agents. However, humans are subject to occasional poor judgment and errors unfortunately may occur. Acknowledgement of errors can often minimize their possible detrimental effects.
The following steps are recommended when a medication error occurs: Check the patients condition immediately when the error is noted. Notify the physician to discuss possible courses of action which depend on the patients condition. Write a description of the error on the patients permanent record, including remedial steps that were taken.
Complete a special form for reporting errors, as dictated by agency policy. This forms, frequently called incident, or unusual occurrence report, require a full explanation of the
situation and the steps that were taken following its commission. For legal reasons, it is essential that errors be described fully and accurately.
Each health care agency has its own policy regarding the handling of medication errors but one rule holds true for all: the immediate superior and the doctor who ordered the medication should be immediately notified. If the latter cannot be contacted immediately, incident should be reported to the resident physician on duty so that necessary measures can be undertaken. Students and staff nurses are usually ask to write an incident report after all necessary measures to safeguard the patient have been instituted
Enter all the information in a complete, accurate, concise, current and in factual manner.
Note problems as they occur in an orderly, sequential manner; record the nursing intervention and the patients response.
Document all medical visits and consultation of which other nurses should be aware.
Document the nursing response to questionable medical orders or treatment. Factually record the date and time the physician was notified of the concern and the exact physician response.