Mrs Nguyen has been on the ward for 5 days. After being admitted with falls for investigation. You cared for her on her first day and then had 4 days off. Today she is allocated to you again. You read her notes and check her charts and recall that her blood pressure has been unstable and that her antihypertensive medication was ceased on the chart by the medical officer on her admission day. You check the vital signs and note BP has varied between 80/60 and 130/86. You note on the drug chart that despite the diltiazem being ceased on day 1 it has been given every day since. Two ANUMs have signed for this medication as well as 2 other RNs who work on the ward. One of the ANUMs is in charge today. What will you do to manage all aspects of this situation? (600 words)
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As a nurse, my first priority is the safety and wellbeing of my patient, Mrs. Nguyen. In this situation, there are several concerns that need to be addressed. Firstly, her blood pressure has been unstable, which requires close monitoring and assessment. Secondly, there is a discrepancy between the medication chart and the administration of antihypertensive medication, which could potentially harm the patient. Lastly, there is evidence of inconsistent medication administration by several staff members, which requires investigation.
To manage this situation, I would take the following steps:
Assess and stabilize Mrs. Nguyen’s blood pressure: As Mrs. Nguyen’s blood pressure has been unstable, it is important to assess her current status and provide appropriate interventions to stabilize her blood pressure. This may include positioning her correctly, providing oxygen therapy, or administering medication as per her doctor’s orders.
Review the medication chart and administration record: It is essential to review the medication chart and administration record to ensure that all medications are being administered correctly and as per the doctor’s orders. In this case, I would investigate why Diltiazem has been given despite being ceased on the first day of admission. I would also review the medication chart for other potential errors or discrepancies.
Speak to the ANUM in charge: As one of the ANUMs has signed for the medication and is in charge of the shift, I would speak to them first to understand why the medication was given despite being ceased on the chart. I would also ask them to review the medication administration record to identify any other inconsistencies.
Address any discrepancies or errors: If any discrepancies or errors are identified, I would take immediate action to correct them. This may include contacting the prescribing doctor to clarify the medication order or contacting the pharmacy to verify the medication supply. I would also ensure that any missed doses are documented and reported to the medical team.
Document the incident: Any discrepancies or errors identified, as well as any actions taken to address them, should be clearly documented in Mrs. Nguyen’s medical record. This is important for ongoing patient care and for any potential investigations or audits in the future.
Report the incident: Depending on the severity of the incident, it may be necessary to report it to the hospital’s incident reporting system or to the relevant authorities. This would ensure that any potential risks to patient safety are identified and addressed appropriately.
Ensure ongoing monitoring and follow-up: Finally, I would ensure that Mrs. Nguyen’s blood pressure is closely monitored and that any further medication administration is checked against the medication chart. I would also ensure that the incident is followed up with the relevant staff members to prevent any potential errors in the future.
In conclusion, managing a situation like this requires a thorough assessment of the patient, a review of the medication chart and administration record, and clear communication with the relevant staff members. Any discrepancies or errors must be addressed immediately to ensure patient safety, and the incident should be clearly documented and reported as required. Ongoing monitoring and follow-up are also essential to prevent any potential errors in the future.
