Reflection
1. In this scenario the nursing student did every task she
had been asked to do. Should anything else be expected of students?
2. What interpersonal and situational factors influenced how
this scenario transpired?
3. How might the outcome of Mr Esposito have been different
had Maddie had a requisite level of clinical reasoning skills?
4. What aspects of this adverse drug event were preventable?
5. Should this adverse drug event be documented and reported?
If so, where, by whom, to whom and why?
6. The medical officer and nurse discussed whether Mr
Esposito and his daughter should be told that he had experienced an
adverse drug event. The nurse thought they should be told, but the
doctor disagreed saying that telling Mr Esposito and his daughter
would make them worry needlessly. What do you think and why?
7. Reflect on the scenario and outline some of the errors
that occurred and that led to Mr Epsositos adverse drug event.
Mr Guiseppe Esposito, 81 years, was admitted to the medical ward
of Griffith Community Hospital with dehydration as a result of
suspect gastroenteritis. He had been vomiting and had diarrhoea for
two days prior to admission. Intravenous fluids were commenced and
his diarrhoea began to improve the following day, although some
nausea persisted. Mr Espositos IV was not resited when it ‘tissued
later that evening.
At 000 the next day (Guiseppes second day following
admission) Maddie was asked to administer Guiseppes usual oral
medications (frusemide 80 mg, digoxin 125 micrograms and enalapril
20 mg). It was a busy shift and the registered nurse (RN)
supervising Maddie was interrupted and asked to attend to another r
patient. She said, ‘Keep going – Ill watch what you are doing from
over here. Maddie, although new to the ward and feeling quite
intimidated, was conscious that this was outside of her scope of
practice. She said, Im sorry but I am not allowed to administer
medications without direct supervision by a registered nurse. The
RUN looked surprised but said, ‘Oh … Okay, Ill be there in a tick.
While she waited, Maddie checked that there was a valid order for
the medications and reviewed the ‘Australian Medicines Handbook,
(Rossi 2011) to find out more about the medications following the
‘six rights (right patient, right drug, right dose, right time,
right route, right documentation); she also checked to see if
Giuseppe had any allergies. Maddie asked him to check his
medications as she gave them to him, saying, ‘Im giving you your
Lanoxin, Lasix and Renitec, is that right? Do you know what theyre
for, Giuseppe? He nodded and replied, ‘Yes, yes, theyre for my
ticker and my water.
Read the above continuation of the scenario about Mr Esposito
and answer these questions about medication safety and
administering medications.
What other ‘rights are essential to medication safety?
1. What does a valid medication order require?
2. What three checks are required when administering
medications?
3. Should Maddie have taken Giuseppes vital signs prior to
administering his medications?
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