Case study with guided questions
The medication error examined occurred during a medical-surgical clinical rotation. Within the clinical group of junior nursing, the medication administration policy required junior nurses to check with the clinical instructor/educator that the dose, medication, patient, time, and route were correct prior to administration. On the day of the error, the clinical group completed the morning preclinical conference, and the Junior nurse was approached by her assigned unit nurse. The nurse requested that the Junior nurse draw up and administer two units of regular insulin with respect to protocol delineated using the physicianordered sliding scale. The unit nurse checked the medication administration records for the patient and noted that a blood sugar reading was obtained at 0600. Despite the need for insulin coverage as ordered using the sliding scale, there was no record that the insulin was administered to the patient by the night shift nurse. The floor was busy and appeared chaotic. In addition, the unit nurses were under added pressure because of a new policy to administer medications in compliance to physician ordered scheduled times. The the Junior nurse searched for the clinical instructor (educator) without success in an attempt to communicate about the opportunity to administer an injection of the medication. After reporting to the unit nurse that the clinical instructor was not available, the unit nurse reinforced the importance of administering the insulin as soon as possible because it was already past the medication's administration scheduled time. The unit nurse stated that she would watch the Junior nurse because the clinical instructor (educator) was not available. The Junior nurse reviewed the glucose level with the sliding scale on the order, verified the correct type and quantity of insulin, drew up the medication, and had the assigned unit nurse confirm the insulin type and dose. The medication was administered under the supervision of the unit nurse at 0730. While electronically charting the administration of insulin, The Junior nurse noticed that the night shift nurse had retroactively charted the medication administration of two units of regular insulin for 0700. The Junior nurse notified the clinical instructor and the unit nurse immediately. The patient was informed of the situation, was given orange juice and breakfast, and was monitored for signs and symptoms of hypoglycemia. The patient's blood sugar was checked 30 and 60 minutes after the insulin was administered. The blood glucose levels were found to be within normal limits. Although the unit staff did not feel an incident report was necessary, The Junior nurse and clinical instructor (educator) completed an incident report under the supervision of the unit nurse manager. If traditional handling of the medication error had occurred, the Junior nurse would have been reprimanded and received remediation. In addition, if the clinical instructor (educator) had followed the staff nurse's suggestion, nothing would have been done and the opportunity to improve the process lost.
Questions:
Q1. Discuss and explain the pharmacokinetics and pharmacodynamics of the drugs in the case study.
- Discuss the nursing implications related to the administration of insulin
- What is the complication of the insulin overdose
Q2. Analyze and discuss the factors which might have contributed to the errors in the case study. Perform a detailed (root cause) analysis - critical evaluation of the incidents and a review of the literature. Suggested word limit 500
- Evaluate the process of clinical decision making to show how chains of errors can combine to cause harm to patients
Q3. Identify the relevant legislation and professional regulation related to safe administration of insulin in the case study. Suggested word limit 250
- Evaluate the philosophical underpinnings of the safe administration of medication and the relevant competencies about medication safety
- Identify institution's medication administration policies, regulations, and guidelines
Q4. What type of professional development/strategies would you recommend for these nurses to undertake to prevent such incidents from occurring in the future and why? Suggested word limit 250.
- Consider ways in which healthcare professionals develop knowledge and skills specific to the safe administration of medication and patient safety
- Apply best practices for preventing common complications of healthcare