Core Concept in Acute Care Nursing

1.Define Adverse Event

Adverse events are defined as incidents wherein harm is resulted to a person who receives health care. Adverse event usually happens because of medication errors and that also makes the health condition more critical and severe. Adverse event include infection, falls results in injuries and improper use of medical devices (Andersson and et. al., 2015). In the area of clinical practice, an unfortunate medical occurrence that may present during the event with any sort of medical error which has a causal relationship with the treatment.

Thus, in other words, adverse events is called as injury to patient that occurs due to errors in medication. This states that hospital and medical care service providers are engaged in the medical error that causes injuries and harm to the respective patient. The impact of adverse events can be highly dangerous because improper emphasis on medical aspects can bring severe challenges to the patient (D’Amour and et. al., 2014).

Apart from this, adverse event may also be called as incidents happened in the hospitals due to errors in practices and also due to changes in the medicinal doses. Adverse events directly generates medical burden and at the same time it also enhances liabilities of the hospital towards the patient.

2.Introduce the patient

The present study has been focusing on a 7 years old boy who was healthy admitted in the emergency department because of swilling in his right arm. While running, he fell down on his outstretched arm and after that he started complaining of severe pain in his wrist. The boy does not have any sort of allergies in the body. However, when he feel down, the left wrist became swollen, tender and reddish and as a result, this has developed fear in the child regarding the level of pain.

3.Brief summary of patient’s principal diagnosis, past medical history, medication and relevant results

While conducting the physical examination, it is analysed that the boy’s HR is 150, RR is 28, Sat is 100% in RA, and Temperature is 37C and weight is 30 Kg. The left wrist is swollen; hence that part has started aching. While conducting other clinical examinations, everything was normal. X-ray was also conducted and it showed Colles fracture with displacement and angulation of the distal end of the radius. After analysing the medical condition, the physician decided to do close reduction by applying the cast.

Thus, to reduce the criticality of the condition, doctors decided to prescribe 2 mg of ketamine and accordingly he wrote 60mg IV once. Prior giving any sort of medicine, the nurse informed the other nurse (who was busy) to take 20 of ketamine. After such procedure, the medication was given and the doctor started the process of reduction (Gaal and et. al., 2014). While carrying out the procedure, the monitor started to show desaturation to 90% which kept on changing. At the same time, problems were also observed in respiratory rate; hence that led the team to prepare for intubation for the purpose of maintaining the airway. Finally, after reviewing the entire situation, it is analysed that the child received 20 ml instead of 20 mg of Ketamine.

4.Describe the patient’s adverse event. What happened? How the patient’s adverse event managed by nursing and medical staff

Considering the above discussion, it is clear that there was medication error caused by the hospital which made the boy’s condition severe. The large dose of sedative medication is highly severe and dangerous too; hence it caused a deeper and prolonger sedation effect. As a result, child’s respiratory rate got depressed which generated the need of respiratory system. The nurses did not take care of the dosage and mistakenly, high dose was given to the boy. That made the condition serious (Kalisch, Xie and Dabney, 2014). At the time of observing the critical condition when the respiratory rate decreased, then during such time nurses gave bagging with self- inflating bag for 1 minute. This was done for the purpose of maintaining the airway.

5.Analyze current workplace system with best practice guidelines to manage this event

The National Safety and Quality Health Service Standards were typically developed by the Australian Commission on Safety and Quality in Health Care for the purpose of consulting and collaborating with jurisdiction regarding nursing regulation. The main aim of developing such standard is to prevent and safeguard the public from harm. Similarly, it also requires focus to improve the quality of care by the service organizations (DiCenso, Guyatt and Ciliska, 2014). Thus, in order to manage best practice in the care entity, the hospital is requisite to emphasize on a quality assurance mechanism that focuses on checking the relevancy of the system. This regulation will also assist the hospital to maintain minimum standards for safety and quality while delivering medical care services.

In order to manage adverse event, it is essential for the hospital to focus on proper dosage of medicines. While specifying the prescription, it is crucial for the nurses to read it properly so that chances of medication error can be avoided (Potter, Perry and Hall, 2016). The guidelines developed under Safety and Quality aspects needs to be maintained as they are intended to enhance the efficiency of health care services. Adverse events imposes greater responsibility on the hospitals and this also requires to adopt different tasks that can change the value of service provision. Adverse drug reaction can impact the patient’s medical condition and this can also bring other health consequences (Boltz and et. al., 2016). Thus, to manage such thing, it is essential for the hospital to make a list of all medicines so that according to the dose, medicines can be provided. Besides this, there must be continuous emphasis on controlling and monitoring aspects of the medication procedure so that to facilitate best practice in the care provision.

This also requires implementation of FMEA (Failure modes and effects analysis) which is a systematic and proactive method that evaluates a process that identify where and how might service provision has changed (LoBiondo-Wood and Haber, 2014). Thus, this is useful in analysing the relative impact of different failures for the purpose of ascertaining the processes that requires changes and modifications. However, at the same time, medicines that have a high risk of causing serious injuries and death to a patient needs to be properly stored. Apparently, errors with these products are not common; however the effects can be severely dangerous. A few examples include blocking agents in the body and concentrated anticoagulants. Further, in this area, hospital should also focus on Drug and therapeutics committee which is typically regarded as a group that is assigned several responsibilities for governance of medication management system (Thomas, Phillips and Coventry, 2014). This also ensures safe and effective use of medicines that is used in health service organization.

6.Compare current workplace systems for managing this event. What does the Australian Commission on Safety and Quality in Health Care suggest

Australian Commission on Safety and Quality in Health Care is a government agency that was established for managing the process of medication in effectual manner. The framework has a provision of medication safety in which the commission has identified the importance of improving the safety and quality of medication usage in Australia (Sahay, Hutchinson and East, 2015). This was one of the priorities mentioned under NSQHS standard. This is significant in terms of reducing error and harm from medicines through safe and quality. This also requires coordination with national safety and quality improvements in health care. In Australian health care entities, several national indicators for quality use of medicines are being adopted which are also intended to support local monitoring of compliance with other necessary standards. This includes processes of care that are related to medication management which is highly suitable in improving health outcomes (Carter, 2016).

However, on the other hand, in the existing case, the hospital has implemented generalised care procedure in which health and safety measures are being followed. In this dimension, it is essential for the nurses to review the medication incidents and along with that, proper monitoring is also required (Brandis and et.al. 2017). At the same time, medication incidents are primarily important incidents in Australian hospital to facilitate monitoring systems. In this context, The Medication Safety Standard requires to be implemented as a major health care system because that aids in reducing medication errors and incidents. Similarly, it is also significant in terms of improving safety and quality aspects in medicinal usage. Thus, in this respect the aim of the standard is to develop safety practices in the clinics and hospitals. Moreover, appropriate medicines are also required to be adopted for the purpose of monitoring the effects of medication process (Johnson, Sanchez and Zheng, 2016).

Several tools are available in order to manage adverse events such as voluntary and mandatory reporting from internal hospital systems that requires state and federal system. In this tool, patients themselves review the medication through reviewing diverse sources (Wu and et. al., 2017). Apart from this, document review process can also be conducted that includes patient’s charts, medical- legal documents, death certificate and complaint reports. Nurses are also required to focus on automated surveillance of patient’s treatment data in the clinical record system. This is useful in anticipating the conditions that could lead to adverse events in the health care entity.

7.Identify areas for improvement in the management of adverse events

There are several areas of improvement that requires attention especially for the purpose of reducing the opportunities of adverse events and incidents. Apparently, adverse events can be occurred through any of the medication error; therefore in this realm it is vital for the hospital to adopt various preventive measures to minimize such incidents (Tarhini, 2013). While giving dosage of the medicines, it is essential for the nurses to ascertain it properly so that patient can be protected from hazardous events. In terms of improvements, it can be said that the hospital should also start the provision of medication safety so that suitable amount of medication can be given to the respective patient. It is also mandatory for the hospitals to take immediate action for adverse events and the doctors should also adopt necessary measures to administer the condition (Martinez and et. al., 2017).

Adverse events are quite uncertain; henceforth proper safeguarding measures should be adopted so that errors and mistakes can be avoided on higher extent. This also suggest that there must be suitable consideration in practice improvement so that the chances of adverse events can be reduced (Lencioni and et. al., 2015). Moreover, in this context it can also be said that along with medication process, it is also vital for the care practitioners to focus on health and safety measures so that risks and challenges can be avoided directly. In this respect, it can also be said that to improve the service delivery procedure, hospitals must have to implement several care provisions that can enhance the service delivery aspects. Moreover, in this context it is clear that according to Australian Commission on Safety and Quality in Health Care, several standards should be determined enhancing the care dimensions (Andersson and et. al., 2015).

Conclusion and Recommendations regarding changes required in the practice

The health and social care sector is quite crucial and requires keen intervention and supervision by the medical professionals. The conditions of child would not have become worse if there was proper care taken before giving the medical dose. Clinical commissioning groups have been formulated by the government for controlling and supervising the activities which take place in the health and social care sector (Transforming our health care system, 2015). Following are some of the recommendations which can be followed for making the health and social care practises more efficient and reducing the probability of adverse events:

Supporting self management is the primary step which can be taken by health care practitioners for developing healthy behavioural attributes. Individuals that are suffering from chronic diseases or long term health illness should be taught to take primary steps at their own level so that in case of emergency certain rehabilitation methods can be adapted. The overall burden of providing specific medications and treatment is reduced when self management is possible at patient's end (Lencioni and et. al., 2015).

Systematic detection of disease and providing appropriate intervention should be provided by the practitioners before development of full symptoms. This kind of practise is considered as secondary intervention and these have a significant impact over the results or outcomes of health status of the individual.

Care coordination in different health care settings helps in reducing the chances or probability of negligence towards the patients. Be it individuals with chronic diseases or the ones with complex physical and mental conditions, there has to be coordination amongst care givers so that the effectiveness of respective treatment reduces (Thomas, Phillips and Coventry, 2014).
Aforementioned recommendations can be applied in the health and social care settings in the below mentioned ways:

• Primary prevention: Advices should be provided to patients and their relatives at the time of consultation is one of the techniques for providing tips over self management. The use of a combination of interventions for a particular treatment can be introduced completely dependent on the suitability and feasibility of outcomes.
• Secondary prevention: Low technology and cost effective interventions can be provided only when there is proper screening and knowledge of the preventive measures. The health practitioner has to develop sense of responsibility towards the patient and make it a point to deliver the best service (D’Amour and et. Al., 2014).
• Care coordination: Health care plans and programmes can be developed collectively by the respective groups and communities for bringing in coordination amongst different groups and settings.

References

• Andersson, Å., and et. al., 2015. Adverse events in nursing: A retrospective study of reports of patient and relative experiences.International nursing review. 62(3).
• Boltz, M. and et. al., 2016.Evidence-based geriatric nursing protocols for best practice. Springer Publishing Company.
• Brandis, S., Brandis, S., Rice, J., Rice, J., Schleimer, S. and Schleimer, S., 2017. Dynamic workplace interactions for improving patient safety climate.Journal of Health Organization and Management.

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