As a nursing student I know that all health care workers have a top priority, patient safety. Patient safety, is an umbrella term that encompasses many aspects of care; privacy or confidentially, skin care, fall prevention, prevention of hospital acquired infection, proper teaching and implementation of self care or help the patient stay safe from further illness and proper medication administration.
There are a few fundamental guidelines within the registered nurses practice that are designed to keep the patient free of injury. One is the nursing process, which is a five-step process that includes assessment, nursing diagnosis, planning, implementation and evaluation. These steps were designed to ensure the delivery of quality care, but that also means safety. Within each step of the nursing process the nurse is using the data to best care for the patient.
For example, during the evaluation the nurse is obtaining information that could indicate that the patient may be in danger, either from there own choices, they’re ignorance to proper self-care or at the hands of another person. During the nursing diagnosis and planning phase the nurse must be competent enough to identify possible harms to the patient in order to implement appropriate measures to treat manifestations and derail any possible problems that may occur. Implementation phase the nurses interventions include everything from addressing the specific problems that the patient is experiencing to organizing collaborative activities with other specialties. Finally, evaluation is another point that the nurse must assess that the patient’s safety is being maintained in terms of the therapy and interventions that were used are proving the goals for the patient are being met.
Another nursing process that is used to keep patients safe is the, six rights of medication administration” (Lilley, 2009): right drug, dose, time, route, patient and right documentation.
Unlike the previous method discussed where patient safety was folded into the process, this nation-wide mandate of proper drug administration’s soul purpose is for patient safety.
With drug dispensation, the registered nurse should never assume anything. The administration of the right drug needs to start when the physician writes the order and the nurses first job is to make sure it is a legitimate order by verifying the order has been signed by the provider and if a verbal order is given that nurse is responsible to have it signed within 24hours. Also, when the nurse is confirming that the patient is to receive the right drug, they will be sure that the medication makes sense for the patient and they’re particular disease process and not interacting with other medications.
Prescribers indicate the dose for any medication, but the nurse must always confirm that the indicated dose is appropriate with the patient age and weight. When the nurse is to do calculations, s/he is to double-check those mathematical equations with special attention given to where the decimals are placed.
The nurse must always check their institutions policy when it comes to time of medication administration, but the nurse must also take into consideration of the pharmacodymanics and pharmacokinetics properties of each medication. Other considerations to take are the patients planned activities, tests, meals, infections, baseline and current vital sign.
With any medication, the nurse must also know the correct route that a medication can be given and should be given depending on the physicians orders, hospital policy and the indications for specific route of each medication. An incorrect route distribution could, at worst, be detrimental to the patient, but at least it would cause absorption variances than that of the desired and therapeutic amount.
Double and sometimes triple checking that any particular medication is going to the right patient is crucial. This should be done at least one in the medication room while pulling the drugs and a few times while in the patients room. Identifying the client with their armband with both the clients’ own verbal statement of who they are along with matching it to the name on the medication list with the given drugs that were pulled.
Lastly, a nurse can protect the client from harm by completing the correct documentation within a reasonable time frame not only of medication administration, but also with any changes with the client; ambulation, turning, voiding, physical assessment and general disposition. This action helps oncoming nurses and professionals of other modalities give appropriate care based on where the client’s needs are, currently.
Another element to safe care for the client that the nurse must consider is the scope of practice that s/he works within and the scope of practice that any persons under they’re delegation. Scope of practice is solidified by the National Council of State Board of Nursing (NCSBN) and American Nurses Association (ANA) by means of a blueprint to keep clients safe, but is based on the specific skills and knowledge that each modality has been trained for.
For example, a nursing student who is not yet licensed and depending on their level of completion and achievement within a nursing program are not permitted to give care like an already licensed RN. According to one of our text, when it become essential to act immediately to stabilize a patient, the student can classify a patient in three categories; High priority, intermediate priority and low priority (Potter, 2009). The student should be able to identify a patient’s status in each of these levels of priority and get help for each one.
A nursing student can give CPR in the immediate situation where the patient has an airway obstruction, but outside of that must step back from the situation and get an experienced RN. According to the National Student Nurse Association (NANA) regarding the student nurse scope of practice, the nursing student had a right to advocate of clients, maintain confidentiality, identify appropriate action to ensure safety of clients, timely care, compassionate care, professional care, truthful, accurate and timely communication, maintain the highest moral and ethical principles, accept responsibility for our actions, provide excellence in nursing, be a life long learner, treat others with respect, promote an environment that respects human rights, respect all cultural and spiritual beliefs, collaborate in every possible manner, use every opportunity to improve faculty and the list goes on and on (NSNA, 2009).
Patient safety is a top priority, and when it comes to a situation where the patient is not in immediate danger or the airway is obstructed, proper guidelines and procedures need to be followed to protect the patient from additional or escalating problems.
Just as a reminder, the best way to retain this information and test well on the ICLEX is to practice, practice and practice! So far, may favorite book is, Prioritization, Delegation and Assessment.
This book is a great first semester tool that you can refrence to the other semesters too! Its inexpensive and provides an easy format, a must buy!
Lewis, S.L., Dirksen, R.S., Heitkemper, M., Bucher, L. and Camera, M.I.(2011). Medical-Surgical Nursing (8th Ed.). MO: Elsevier
Lilly, L., Collins, S., Harrington, S. and Snyder, S.J. (2011). Pharmacology and the Nursing Process (6th Ed.). MO: Elsevier
National Student Nurses Association, Inc. (n.d.) Code of Ethics: Part II Code of Academic and Clinical Conduct and Interpretive Statements. Retrieved May 8, 2012 from http://www.nsna.org
Potter, A.P. and Griffin, A., (2009). Fundamentals of Nursing (7th Ed.). MO: Elsevier