Medication

Question 1

Registered nurses are responsible for ensuring patients’ rights. Numerous risks are involved in drug administration. Therefore, registered nurses have the responsibility of informing the patients of the name, purpose, action, and possible side effects of drugs. In addition, registered nurses have to ensure that patients receive labeled medications and inform them adequately about any experimental nature of drugs. It is the responsibility of the nurse to guarantee that patients do not receive unnecessary drugs. Simply put, registered nurses have the responsibility of ensuring that patients are adequately informed and have knowledge about drug administration, including legal issues, pharmacology, physiology, and anatomy. Registered nurses are also responsible for reading medication charts, which must be completed accurately and unmistakably so that patients receive safe and optimal medication therapy.

Any registered nurse is also responsible for the five rights of administration, namely right patient, right drug, right dose, right route, and right time. Right patient means that the nurse has to check the name of the sick and the number given at the health care facility, as well as compare it to the chart and the band used in identification. The nurse is required to inquire from patients about their names and the information regarding their place of birth. Right drug implies that it is the responsibility of the registered nurse to check drugs before removing them from the trolley or container and to check expiry. Right dose presupposes that the nurse has to check the dosage and read container label. Right route means that the registered nurse has to ensure that the drug is given only through the designated route.

Medical doctors place medication orders. They assess the patient and place an order for a given medication. On the other hand, a pharmacist reviews medical orders to ensure that the appropriate drug is selected, the dosage is identified, and frequency is determined to meet patient’s needs. Pharmacists dispense medication based on the doctor’s prescription. The medical doctor and pharmacist monitor drug administration to guarantee that the drug administered is not causing adverse effects.

Question 2

Prior to marketing a drug in Australia, it must first undergo evaluation by the Australian Drug Evaluation Committee (ADEC). The committee reviews drugs, which are then listed by the Therapeutic Goods Administration (TGA). Companies sponsoring clinical trials are required to submit the data for the evaluation to the TGA and give it a notification that the proposed trial has received approval by an institutional review board. The TGA evaluates quality, safety, and the efficacy of drugs. It also considers the availability of drugs.

All new chemicals or applications requiring expertise’s advice have to pass through the ADEC. Though the committee can recommend what needs to be done, the TGA makes the last decision on whether a new drug is registered in Australia. Apart from evaluating prescription drugs, the TGA is charged with the responsibility of evaluating other medications, such as alternative medicines, over-the-counter medications, and medical devices.

Pharmaceutical companies, also known as sponsors, are required to provide information for drug evaluation and then seek subsidization by the government through the Pharmaceutical Benefits Scheme (PBS). Through such subsidizations, drugs become affordable for patients and increase market share.

However, first, drugs should be assessed by the Pharmaceutical Benefits Advisory Committee. The assessment is necessary to ensure effectiveness or cost effectiveness, and the government should be willing to fund it. The cost of submission has been one of the reasons companies may never want to apply for listing. For instance, since 2010, the PBS has been charging a cost-recovery commission of $19500. Submission requires the collection of thorough data on cost effectiveness, which requires significant time and resources. If companies choose not to apply for PBS listing, they can sell their drugs directly or seek funding through hospitals, charitable organizations, or private insurance companies.

Question 3a

The ward environment is major contributor to medication errors. The first aspect of ward environment is ward ethos. Matrons or senior sisters who are concerned with the safety and speed of care delivery predetermine the atmosphere in the ward. On the one hand, experienced nurse managers are more likely to persuade other nurses to deliver safe care irrespective of how long it takes. On the other hand, inexperienced or over-burdened nurses may focus on speed administration of medication over safety, which can lead to the violation of safe practices (Shahrokhi, Ebrahimpour, & Ghodousi, 2013).

In addition, the aspect of over-dependence on senior nurses has been cited as a major contributor to medication errors. In some health care settings, there is the tendency of routing all queries to the senior nurses on shift regardless of the nature of the problem or the task that the senior nurse is undertaking at the moment. Some senior nurses have claimed that they were over-used because though their role is to coordinate ward activities, and they cannot perform this role effectively due to nurse shortages. Some junior nurses have also claimed that senior nurses were not willing to allow them to take responsibility. Therefore, poor task delegation can lead to nursing personnel with low self-esteem and unwillingness to take responsibility for medication errors (Shahrokhi et al., 2013).

Similarly, there is the problem of unwillingness to challenge or be challenged. Some nurses lack the ability or confidence to challenge the decisions of their colleagues even when they believe that the decisions are not correct. It is disempowering when nurses are not willing to question the position of someone considered to be in power, for example, the doctor. The unwillingness to question doctors is hampered by nurses’ cultures where the status differences between nurses and physicians are considered an important factor. The deliberate distancing by nurses from their responsibilities has been among the major causes of medication errors (Shahrokhi et al., 2013).

Finally, negative attitudes towards reporting mistakes have been considered a major cause of medication errors. Reporting at ward may be reduced because of the uncertainty of the need to define and report the error, the lack of clear guidelines for reporting, the time it takes to complete reporting forms, and the lack of confidentiality. Moreover, the lack of feedback or presence of blame culture is a factor that can hinder reporting, leading to medication errors (Shahrokhi et al., 2013).

Question 3b

The first preventive strategy to address negative attitudes towards reporting and promoting the environmental ethos is education on medication. In addition, nurses with unsatisfactory knowledge about the need to enhance safety need education. Staff education is necessary for the nurses to be aware of basic errors. Through education, nurses can prioritize safety over speed (Blank et al., 2011). Similarly, through education, nurses will realize the need and strategies to report medication errors. Medication education for the nurses can help them to learn the process of reporting, what can be reported, and how to report it. Therefore, attending educational programs, which have topics in pharmacology and procedures involving the use of medication, is necessary for reducing medication errors (Athanasakis, 2012).

Furthermore, senior nurses have complained of being over-burdened with work, causing tiredness. Apparently, tiredness can be minimized if nurses only work during prescribed hours. Extended hours hinder the ability of nurses to make appropriate medical decisions. Nurse shift managers need to ensure strict adherence to a specified duration of the work. Similarly, interruption and distraction, which are endemic in health care settings, can be prevented if special zones are created and given special markings such as no interruption. With large signs posted over medication carts, nurses who read the signs will not bother to distract (Mahajan, 2011).

Interdisciplinary collaboration is necessary between nurses, doctors, and pharmacists because nurses have let the responsibility of choosing the dosage be the work of doctors. In most cases, nurses do not challenge the prescription of doctors even when they are wrong. There is, therefore, a need to establish policies, strategies, and systems that can help to reduce medication errors. The collaboration between different disciplines can assist in developing a comprehensive view regarding the issue of medication errors, causes of the errors, and ways different health care professionals should face the problem of medication errors (Blank et al., 2011).

Head nurses strongly influence the conduct of other nurses and can enhance reporting medication errors. The cooperation between head nurses and other nurses who perceive that they have minor roles to play in their health care settings can help to minimize cases of medication errors. The head nurse should cooperate with all the nurses to understand their beliefs in how to create safer healthcare environments. For instance, the nurse in charge can motivate other nurses to remain vigilant and promote conditions that contribute to the minimization of medication errors (Athanasakis, 2012).

Nurses’ reluctance to report medical errors can be minimized if there is a system of reporting anonymously. Promoting anonymous reporting without mentioning names can make nurses feel comfortable and increase their ability to report. In addition, nurses’ feedback coupled with information regarding medication errors is also essential (Athanasakis, 2012).

Question 4

a. Brand Name, Dosage, and Route of Administration

The brand name of the drug administered to the patient is Tramadol. The drug is indicated to relieve moderate and severe pain. In the case of the patient at hand, the medication was administered for joint pain, which was a result of fracture injury that the patient had a few days ago. In adults, oral administration is recommended at the dosage of between 50 to 100 mg taken after 4 to 6 hours. The maximum dosage per day should be 400 mg. For patients over 75 years, the maximum oral dosage should not be more than 300mg per day divided into doses.

b. Pharmacokinetics and Pharmacodynamics of Tramadol

Pharmacodynamics. Tramadol is a centrally acting synthetic analgesic from the aminocyclohexanol group that is often accompanied by opioid-like effects. Its action is hypothesized to include binding to µ-opioid receptors and the inhibition of re-uptake of serotonin and noradrenalin. The opioid-like action is due to the low affinity for binding to the receptors and increased affinity for binding with the main active metabolite known as 0-desmethyltramadol to µ-opioid receptors. The metabolite is more potent in producing analgesia than tramadol. Serum concentration required for effective post-operative effect is 300ng/Ml.

Pharmacokinetics. The drug is absorbed after oral administration of 50mg capsules with the bioavailability of between 68-72 percent. Peak serum is attained after two hours after drug administration. Peak plasma concentration is approximately 280ng per milliliter. Administration of the drug with food does not affect absorption. The drug is administered rapidly in the body with the volume of distribution in adults being between 2-3L/kg. The drug is metabolized in the liver. Excretion is by the kidneys; cumulative renal excretion is about 95 percent.

c. Potential Adverse Effects, Interactions, and Nursing Considerations

The use of the drug can lead to somnolence, dizziness, constipation, constipation, nausea, pruritus, and sweating. The drug should be used cautiously in reduced dosage with depressants, particularly in patients receiving central nervous system depressants, such as tranquilizers, sedative-hypnotics, alcohol opioids, or phenothiazine. Therefore, nursing caregivers should be cautious before prescribing the drug to patients who are taking depressants. Using tramadol with serotonergic agents can cause serotonin syndrome. Caregivers should ensure that when an overdose occurs, then emergency measures, such as keeping respiratory airways open and circulation, are mandatory.

Question 5

Assessing Learning Needs

The patient who received the medication was a 70-year-old man who lives with his wife in one of the city suburbs. The patient said that he was not suffering from any other medical condition, apart from a viral infection that occurred about a month ago. The patient says that he does not drink, but he has been smoking for the past 20 years. He also does not take make physical exercises. After taking the medication, the first side effect he developed was dizziness. The proposed medication dosage is 100mg administered twice a day. Before tramadol is administered to an adult, it is important to determine the severity of the pain. It is also crucial to know whether the patient consumes alcohol and takes alcohol opioids.

Furthermore, it is important to consider psychosocial needs and detailed history. There is also the need to include a family member during the assessment. Finally, it is critical to assess the patient’s level of education because it can help to determine whether the patient can read the instructions to ensure the correct medicine administration.

Planning Education with the Patient

1. Presenting information

1. Speaking in a low voice
2. Allowing the patient time to assimilate and integrate information
3. Reducing environmental distractions
4. Promoting group teaching where necessary

2. Suggesting lifestyle changes

1. Being aware that elderly patients are cautious about changes
2. Explaining the implication of the changes

3. Checking whether the objectives of the teaching are met

1. Identifying what is mutually acceptable
2. Ensuring patient’s taking part in goal setting
3. Checking whether the patient is complying with expected behavioral changes

Evaluating the Effectiveness of the Session

An assessment will be made to determine whether the patient has complied with the expected behavior changes. If patients consider the teachings necessary, they adopt them into their lifestyles or change it to embrace the teachings.

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