Medication administration is an important part of nursing clinical practice.
The quality of patient care can be improved by ensuring that medication is administered safely.
Medication errors may occur in the dispensing, administration and prescribing of medications.
It is important for nurses to understand the factors involved in medication regulation, pharmacology and error producing circumstances. This will help them reduce medication errors.
Q1 Pharmaceutical companies conduct clinical tests to determine the effectiveness (effectiveness), and safety of a drug.
Here are the FOUR (4) stages of clinical trials.Q2
a) A summary of the major responsibilities of the Therapeutic Goods Administration.
b. To describe TWO (2) of the ways in which medications are controlled by Australia’s TGA
Q3: Describe the terms Pharmacokinetics (4 marks) and Pharmacodynamics (3 markers).
Q4 Explain the phenomenon referred to as the “hepatic first-pass effect” in relation oral medication.Q5
a) Briefly describe why Glyceryl trinitrate 600 microgram tablet must only be given sublingually
b.List TWO (2) specific areas you should educate the patient about Glyceryl Trinitrate.
Q6 Outline FIVE (five) different roles and/or duties of the:
A registered nurseb)Doctor
c.Pharmacists involved in safe use
Q7 Describe 5 (5) types medication errors AND the possible causesQ8
a. Explain the difference in the person-centred approach (five marks) and system-approach to human errors
b. Defences and safeguards are components in James Reason’s (1990), “Swiss Cheese Model”.
Please explain briefly how these factors can prevent medication errors from occurring
c. Holes in the defenses result from active failures or latent conditions.
Recognize medication errors
i.THREE (3) possible Conditions Latentii.THREE (3) possible Active failures
Q9 Describe 5 (5) factors that contribute medication error, and possible causes.
Answer to Question: 1807NRS Safe Administration Of Medications
Pharmaceutical companies conduct clinical trial to evaluate the efficacy and safety of a medication.
Here are the (4) phases involved in clinical trials.Answer:
The clinical trials are divided into four phases, with each phase having a clear goal.
Phase – 1.
The first step in testing the drug is to have volunteers test it.
The average number of volunteers is between 20 to 80.
This phase is designed to assess the drug’s metabolism and excretion and monitor side-effects if any.
This phase, which lasts for several months to two-years, is used to determine the drug’s effectiveness on volunteers.
This is a mostly blinded trial phase. Two groups of participants participate in the experiment. One group is given the drug, while the other receives a placebo or standard-issue medicine.
Also, the safety of the drug for patients are tested.
In this phase, additional safety and efficacy are evaluated.
The number and quality of volunteers increase to thousands.
This phase serves as a Post marketing surveillance’ of a drug to further evaluate its effectiveness, safety features, quality, and health for the patients who are given it.
Also, this stage allows for comparisons to other drugs in the market.
(Overview: Clinical trials)
2 A. A Brief Description of the Principal Responsibilities for Therapeutic Goods
Answer: TGA is the regulatory body for therapeutic goods. This includes drugs, medical equipment, and related products.
TGA has the responsibility of ensuring that all drugs available are compliant with the specifications.
TGA is responsible also for importing and exporting drugs to Australia, as well advertising for therapeutic goods.
(Australian Government Department of Health).
B) Describe (2) What Medications are Regulated By the TGA
All therapeutic products come with some risks and benefits. The TGA reviews them using scientific and clinical expertise in order to determine whether the side effects are worth the potential benefits.Accordingly, Medicines Are Tested In Two Ways:
Assessing and identifying any possible risks associated with drug usage.
To reduce or eliminate the risk, take any necessary corrective steps
You can monitor the progress of the drug after corrective measures have been taken.
After these processes are completed, the two numbers assigned to medicines depend on the type and certification of the drug.
The Australian Register of Therapeutic Goods registers all high-risk medicines. This involves evaluating the drug’s safety and effectiveness, as well as its quality.
After the clinical trial, they receive the AUSTR number.
The AUSTL number for listed medicines (vitamin and herbal medications) is used to identify pre-approved and low-risk substances. These medications can be purchased at health shops, supermarkets, and other retail outlets.
(Australian Department of Health). TGA, 2013)
3 Briefly Define Pharmacokinetics & Pharmacodynamics.The pharmacokinetics are defined as ” the study of the movement of drugs in the body, including the processes of absorption, distribution, localization, bio-transformation and excretion.” (Pharmacokinetics-Medical Dictionary)
These are the four phases of pharmacokinetics
Absorption – This is the phase which determines the course the drug takes between the time it is administered and when it enters bloodstream.
Distribution – This is when the drug travels through the bloodstream and reaches its destination.
The distribution of each drug is different depending on its effect.Metabolism (bio-transformation)is a stage where the drug is metabolized and the drug becomes inactive.
It happens in your liver.
Excretionis when the drug is not used after metabolism and is eliminated by the body through the kidneys (The Free Dictionary 2017).Pharmacodynamics:
It is a branch within pharmacology that studies drug effects and the biochemical, molecular, physiological and psychological effects.
This study helps to predict the patient’s response to a specific illness and is a key determinant of drug dosage.
Any disease, age, or interaction with other drugs can alter the pharmacodynamics. (Farinde, 2016)
Q 4: In relation to oral meds, explain the phenomenon known as The
‘Hepatic First Pass Effect’
The hepatic second pass effect, or first pass metabolism, refers to a process by which some of drug’s active substance is removed from the blood stream or metabolized before it enters circulation.
The first pass effect decreases drug concentration.
The Hepatic First pass Effect is the name of this effect. This is because liver is where the drug is metabolized.
This effect occurs as drugs are being absorbed or transferred from one site to another.
If a drug is administered orally it passes through your digestive tract and enters your liver.
The drug is transported to the liver via the portal veins that run through the hepatic network.
The potential enzymes of the liver metabolize any active ingredient. Therefore, only a few of the potentially active components of the drug are allowed to escape into your circulatory system.
The hepatic first-pass effect significantly reduces the bio-availability a drug.
The active ingredients of the drug are metabolized by enzymes present in the liver.
Therefore, drugs that have a high first pass effect on the liver are generally given in higher oral doses to at least allow the active ingredients to reach the potential location(and the circulatory tract) after passage through the heart.
Diazepam and Morphine are two examples. (Encyclopedia.com (2016)
Q.5 (Full Description of Why GlycerylTrinitrate 600 Microgram Tablets Should Only Be Given Sublingually)
Below the tongue and cheek, there are many capillaries. These tiny blood vessels are located in the area.
This allows for the immediate absorption of medication into the bloodstream.
Glyceryl Trinitrate (or Glyceryl Trinitrate) is a medication that is used to improve the heart’s function.
It is sublingually administered because it needs to be absorbed immediately, in case seizures and heart attacks.
Please list TWO (2) areas of education that should be delivered to the patient. These should not relate to GlycerylTrinitrate.
Glyceryl Trinitrate is to be used with care.
Do not chew, swallow or crush the tablets.
These tablets are to be placed underneath the tongue and left to dissolve slowly.
To avoid dizziness and shakiness, you should always be seated while taking the tablet.
For heart pain, place the tablet under the tongue. If the pain continues, a second dose can be administered.
If the pain persists beyond 15 minutes, it is time to seek medical assistance.
6.Outline (5) Different Roles and/or Responsibilities Of The RNs Doctors And Pharmacists Concerned With The Safe Use Of Medications
Registered nurses, also known as RNs or registered nurses, play an important support role in clinics and hospitals.
The nurse’s duties and active participation in the diagnosis and treatment process of patients will depend on where they work.
The Roles Of A Registered Nurse Are:
Monitor, record, and register the health of patients (changes or stability).
Keep accurate records and reports detailing the conditions and changes.
Instruct patients about drug use, including the recommended dosage and timings
Assess diagnostic tests and interpret the reports for changes in medication
Prepare the patients for examination. Assist the consultants during a physical exam (Greenwood, 2017).
Clinics and hospitals need doctors or consultants.
The Doctors will vary depending on their specialization.
Diagnose, prescribe medicine and order diagnostic tests depending on the conditions of the patient.
Perform surgeries whenever necessary, including emergency surgery.
Each of the major surgeon roles in major operations is played by neurologists or cardiologists.
Doctors make crucial decisions when it comes to patient care. They instruct health care workers and nurses on how and which medications to be administered, and what instructions should be given to primary caregivers.
The authority for doctors to alter medication, increase doses, or to introduce new drugs is available to patients.c) Pharmacist
A Pharmacist Should:
Be able and able provide the proper medication for each patient.
You should have excellent computer skills and management skills to deal with emergency situations quickly.
In order to give medications, you should work with your doctors and health care workers whenever necessary.
Know the side effects of medications and how they interact with other drugs.
Supervise the pharmacy shop and offer advice and support to patients in matters of nutrition and health.
A specialty in the dispensing of medications for a specific purpose like heart condition or cancer.Describe (5) Different Types Of Medication Error AND A Possible Cause For Each
Here are some possible errors and causes:
The following errors in prescribing include incorrect dosage, incorrect route of administering, wrong frequency, and wrong time.
Dispensing errors can include insufficient preparation of an IV solution, incorrect dispensing of expired drugs, equipment problems (syringe defect), IV liquid leak or line strike, dispensing too late and so forth.
Infusion pump failure – forgetting to set an infusion line, no communication by written or non-compliance (Allard, et al. (2008)
Fragmented errors in care, such as poor communication between the doctor or health care professional.
Error in drug preparation, where intravenously administered medicine is given orally instead of intravenously.Causes Of Errors:
A loss of memory. For example, a nurse might forget that a patient is allergic.
This is often caused by distraction.
Memory lapse can also be caused by forgetting to take the recommended daily dose or administering too much or too little.
There are many problems with the systems. For example, not labeling drugs categorically; medicines of the same name placed near one another or lacking bar coding could lead to the errors.
A lack of knowledge or understanding in the part of health workers can lead mistakes in remembering and administering generic drugs.
An error can occur if there is not enough information about the patient, or it could be due to omissions such as allergies or previous history.
Exhaustion can lead to errors in the work of a nurse or other health care worker.
8. Explane the Difference Between The Person Centred Approach and System Approach to Human Error
The whole system is centered around the person (the patient).
The patient is at the center of the system and is educated to administer prescribed doses.
Problem here is that the patient may be not sufficiently informed to ensure the correct dosage.
A system-centered approach puts the system in the center and includes all health care workers, doctors, nurses, and other staff members.
These errors are caused by many factors, including poor communication, overworked staff and inadequate lighting.
B) James has components such as defences, safeguards, and barriers
Reason’s (1990), “Swiss Cheese Model”.
These factors can be used to prevent medication error (4 marks).
In Swiss cheese, the defence layer is described as an error prevention system.
Many hospitals have high-tech systems that prevent errors from happening.
Sometimes, the barriers may appear as ‘holes’ that aren’t aligned with each others. In these cases, a healthcare worker might have to report to the nurse about the drug administered. They might then pinpoint the issue.
A failure at one point might not be fatal. However, there are several layers of’safeguards.
Doctors- nurses- patients- This entire sequence can become incomprehensible, as ‘holes’ and ‘errors” can be reversed, according to the Swiss cheese model.
As the model predicts having one system above the other or having ‘defenses (in line), can prevent errors.
The nurse who is watching can quickly correct any errors made in the line, such as a mislaid health care worker.
According to Duke University School of Medicine (2016), Swiss Cheese model can aid in error defection.
c. Active failures and latent disorders can lead to holes in the defenses.
You can identify medication errors by:
In some cases, dormant or latent conditions can exist within the system.
Nursing and health workers under great pressure
Overworking, poor staffing conditions, and inadequate equipment
There are no alarms or effective indicators, there are no standard procedures and the equipments have no design problems.
Latent failures could cause an error. But, the other person responsible for monitoring the system or taking charge might prevent the error.
But, persistent latent conditions can create long-lasting holes in a system (Reason2000).
Three (3) Possible Active Failed
Violations by nurses and other health care workers (who have direct contact with the patient), including slips in care, errors in drug administration, violations of procedure.
Instructions not understood, or not properly read
Mistakes made while administering IV fluids, potent drugs or infusions.
9 Describe FIVE(5) Factors Which Contribute To Medication Failure AND APossible Cause For Each
There are errors in every system. The medical field is no exception.
There are many factors that can lead to medication errors.
Incorrect drug administration: giving the wrong dosage, incorrect drug or not noticing allergy symptoms.
Causes: A lack of a system to transmit information, a lack of knowledge and skills to administer drugs or follow instructions can cause confusion for health care workers.
Professionals may use medical abbreviations which can cause confusion.
Errors by nurses or doctors in prescribing drugs. Patients were not properly monitored, and thus the doctor made the error of giving incorrect medication.
Causes: Poor Communication – Poor communication within the system – Between nurses and health care workers and between doctors and patients.
Not clearly identifying allergic symptoms.
The method of administering the drug is: IV fluids administered orally or by infusion can result in serious errors.
Inaccurate, incomplete or incorrect diagnosis of a condition or disease
Causes: Lack of knowledge about the disease, or the cause thereof, communication errors between the doctor and patients, problems with the patient’s understanding, errors in the diagnosis report.
Nursing care errors caused by negligence
Causes include overworked employees, low knowledge of conditions and patients who are not cooperative.References:
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