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Assessment And Management Of Clinical Problems

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Assessment And Management Of Clinical Problems

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Assessment And Management Of Clinical Problems

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Question:
Discuss about the Assessment and Management of Clinical Problems.
 
 
Answer:
Introduction:

Nepean hospital is a biggest hospital in blue mountain region with 520 bed  and covers various specialties such as medical, surgical, mental , pediatric and palliative care. I will be working Ambulatory procedure centre (APC) ward. The majority of the patient in this ward is admitted with common emergency surgical condition such as appendicitis, cholecystitis, diverticulitis and bowel obstruction and most of them are self caring.  It is very fast paced ward and we have to deal with IV antibiotics and pain medication. The focus of my med-sla project is proper documentation of known allergy and patient;s adverse drug reaction in the medication chart. I will propose my project by preparing poster presentation and showing it to other health workers in the ward. Clinical evidence suggests that adverse drug reaction is one of the leading factor to increase mortality rate and increase patients length of stay in hospital. Furthermore, there has been evidence where patients allergy documentation is missed, and their health deteriorate by giving the drug which they are allergic to. Therefore, the outcome of SLA is to prevent such allergic and adverse drug reaction by proper documentation in medication chart.
The purpose and aims of the Med-SLA
Some recent cases had been reported in the ward, which had raised a large number of concerns among the higher authorities regarding the safety of the patients in the hands of the new graduate nurses. Recently a patient had been given decongestants due to allergic reactions that were not been able to be controlled by antihistamines. However, while assessing her vital signs in the later part of the day, her blood pressure was found to be higher. The nurse therefore thought that it was necessary to make her blood pressure come under control. Therefore, without thinking much, she provided the patient with an antihypertensive drug, which treats high blood pressure. However she was not aware of the consequences that there results in an intensive drug-drug interaction when decongestants and antihypertensive are taken together as it results in further increase in the blood pressure levels causing potentation. Her mentor, who immediately managed this condition, prevented any further threat to the patient. Another similar incident took place in the case of patient who was admitted due to an infection in her intestines. She was prescribes tetracycline by the doctor in order to fight the harmful bacteria in her intestines. The nurse then provided her breakfast comprising of milk, egg and fruits. The nurse was however had no idea about the interaction that calcium usually has with that of tetracycline. She did not know that calcium reduces the effects of tetracycline destroying the potential effects of tetracycline. All these had concerned the higher authorities and the patients and their family members about the safety treatments that the nurses provide which in turn are having negative effects in the patients.
 
A drug-drug interaction is a situation when a substance as well as any other drug can affect the performance of another drug when administered together to a patient. The action that results can be of three different types. It can be either synergistic when the effect of the later drug is increased. It can also result in antagonistic effects which results in the effect of the later drug being reduced. Thirdly, it may also result in the initiation of a new kind of effect, which is completely different from the action of each of the drugs that interacted (Vallerand, Sanoski and Deglin, 2016). These types of interactions often prove to be harmful for the patient resulting in threatening the life of the patient who had come for service.
Another important situation that has come to the notice of the authority is the lack of providing proper medicine to the patients. The nurses are not consulting their medical history before prescribing any drugs. This in turn is resulting in the occurrence of different allergies in some patients, which enhances the adverse situations for the patient making them suffer more (Lewis et al. 2015).
Patients often require multiple medications in cases of their complex diseases or disorders that they are suffering from. However, after critically analyzing the symptom cluster of the patient, it is a duty of the nurse to jot down the medical history of the patient in order to know whether they are suffering from any previous diseases or not and the medications they take on a regular basis (Wang et al. 2016). Documentation of such medication is important so that the nurse develop a preliminary knowledge about the medications she should avoid. Besides, the nurse herself should have a detailed idea about the backgrounds and the ingredients of different medication that not only result in drug-drug interaction but may also result in allergies in the patients. These types of occurrences causes decreased therapeutic effects of the good medicines, increased adverse reaction and patient harm. It also results in an overall negative impact on the reputation of an organization serving for humankind (Lehne and Rosenthal, 2014).
The Australian nursing and midwifery board has stated the importance of maintain safety protocols while providing medicines to the patients. It usually expects every nurse to be responsible enough to the take into account the different ingredients of the medicines so that they can evaluate whether any interaction would take place or not. Moreover, they should also consider the half-life of the ingredients in cases if they have to administer two opposite drugs so that they do not tend to react in the patient. Moreover, they also tend to consider the bioavailability and peak level of each of the medications that they are administering (Muraro et al. 2014).
The standard 4 or medication safety that had been proposed by the  states in point number 5 under point 4.9 in management actions of medicines and implementation strategies ensures that they provide current as well as accurate medicines information along with decision supporting tools to the nurses. These are done to help the nurses make clinical decision effectively which remains related to medicinal use. Management of dug interaction databases is also proposed by them to be an  important criteria that should be maintained by the nurses. As suggested strategies, they have stated the utilization of decision support tools that accompany electronic medicine management systems like overriding of active alerts for drug interactions, contraindications, patient allergy alerts in prescribing and as well a s in dispensing systems.
Therefore, the main aim of the project of the MED SLA is to develop knowledge of the different nurses about the concept of nurse interaction. Its aim would be to make the nurses aware of the different steps that they may need to reduce chances of drug interaction in their practice and make their administration safe and of high quality.
 
The process used to complete the Med SLA:
The poster had been prepared in simple language with proper headings that would help the nurses in understanding each of the points in detail. They can follow it a as guidance in order to prevent any medication error. It shows that harmful effects that their negligence may have on their career and on the patient life. It says about the steps that they can undertake to reduce harmful practices and avoid negligence. It also describes the services where they can go to seek help when they are confused or when they want to clarify any doubts. This poster is expected to help the nurses in reducing medication error and developing their skills in medication administration.
The potential outcomes of the Med SLA:
Different types of initiatives have been taken to make the healthcare staffs aware of the harmful consequences that may lead to the life threatening situations for patients. The patient’s normal course of treatment would get affected and his recovery process may be delayed. This may also hamper the quality life that a service user expects. Besides, providing inappropriate medication not only results in drug-drug interactions and causes allergies but also harm the career and reputation of the nurse involving her in legal obligations. Therefore, the poster would contain the different effects it may have on the life of the patient and on the careers of patients. Besides, it would also help them to take precautions, which would prevent them from making such mistakes and help them in critically analyzing the medicines and their ingredients according to the medical history of the patients. This poster will also help the nurse to enhance their nursing practices in case of medication administration by consulting with the important websites, senior mentors and even going through different evidence based articles (Rampton et al. 2014).
 
Evaluation of the project result:
The evaluation of the outcome of the project is necessary to understand whether the project had been successful in its aim of making nurses aware of the consequences of inappropriate medication administration. In order to evaluate it, the authority may conduct a clinical audit to assess the present scenario (Black and Dawood, 2014). Reduction in the number of cases of drug-drug interaction and allergies will automatically implement that the project had a positive effect on the practice of the nurses (Fernando et al. 2014).
Besides, inviting reflective pieces of work from the nurses is believed to be helpful in understanding the impact so the project in the current nursing practices. Reflections of the nurses will not only make them realize their own positive and negative aspects but will also help the governing body to know about the perceptions that the nurses are harboring in them (Wheatley et al. 2015).
Changes to my practice:
While preparing the project for the nurses, I have been benefitted also as the different procedures have enhanced my knowledge and helped me in applying the guidelines in my practice as well. While researching the various data on the National and Quality Health Service Standard 4 (2012), I came across many research articles and journals, which helped in collecting information that would help me in providing skills that, are more expertised. This will definitely provide a better care to the patients and the patients will be satisfied (Roujeau et al., 2014).
Therefore, the project of the MED SLA is a very noble initiative that will benefit each members of the healthcare team at the hospital. The nurses will be more careful while setting up intervention plan for the patient so that no drug-drug interaction and allergic reactions occur in the patients. The nurses will follow a safe practice that will be evidence based and will properly analyze the patient’s medical records, history of allergic reactions and others. The nurses would be expected to harbor a detailed knowledge about the ingredients of the medicines, their reactions with other components along with the allergic reactions that they may result in certain cases (Bluementhal et al. 2014).
 
Conclusion:
The project is an innovative way of guiding nurses in such a way so that the cases of inappropriate medication administration are reduced in the hospital. A nurse who would be well trained in medication and at the same time is cautious and careful with genuine feelings of providing the best care to patients would always be respected and loved both by organization and by patients.
 
References:
Black, A. and Dawood, M., 2014. A comparison in independent nurse prescribing and patient group directions by nurse practitioners in the emergency department: a cross sectional review. International emergency nursing, 22(1), pp.10-17.
Blumenthal, K.G., Shenoy, E.S., Hurwitz, S., Varughese, C.A., Hooper, D.C. and Banerji, A., 2014. Effect of a drug allergy educational program and antibiotic prescribing guideline on inpatient clinical providers’ antibiotic prescribing knowledge. The Journal of Allergy and Clinical Immunology: In Practice, 2(4), pp.407-413.
Fernando, B., Morrison, Z., Kalra, D., Cresswell, K. and Sheikh, A., 2014. Approaches to recording drug allergies in electronic health records: qualitative study. PloS one, 9(4), p.e93047.
Lehne, R.A. and Rosenthal, L., 2014. Pharmacology for nursing care. Elsevier Health Sciences.
Lewis, S.L., Maltas, J., Dirksen, S.R. and Bucher, L., 2015. Study guide for medical-surgical nursing: Assessment and management of clinical problems. Elsevier Health Sciences.
Muraro, A., Agache, I., Clark, A., Sheikh, A., Roberts, G., Akdis, C.A., Borrego, L.M., Higgs, J., Hourihane, J.B., Jorgensen, P. and Mazon, A., 2014. EAACI Food Allergy and Anaphylaxis Guidelines: managing patients with food allergy in the community. Allergy, 69(8), pp.1046-1057.
Rampton, D., Folkersen, J., Fishbane, S., Hedenus, M., Howaldt, S., Locatelli, F., Patni, S., Szebeni, J. and Weiss, G., 2014. Hypersensitivity reactions to intravenous iron: guidance for risk minimization and management. Haematologica, 99(11), pp.1671-1676.
Roujeau, J.C., Haddad, C., Paulmann, M. and Mockenhaupt, M., 2014. Management of nonimmediate hypersensitivity reactions to drugs. Immunology and allergy clinics of North America, 34(3), pp.473-487.
Vallerand, A.H., Sanoski, C.A. and Deglin, J.H., 2016. Davis’s Canadian Drug Guide for Nurses. FA Davis.
Wang, Y., Zhu, R., Huang, N., Li, W., Yang, L., Zhang, S. and Liu, G., 2016. Knowledge, attitudes, and practices survey of drug allergy among healthcare practitioners in central china: a multicenter study. Asia Pacific Allergy, 6(2), p.105.
Wheatley, L.M., Plaut, M., Schwaninger, J.M., Banerji, A., Castells, M., Finkelman, F.D., Gleich, G.J., Guttman-Yassky, E., Mallal, S.A., Naisbitt, D.J. and Ostrov, D.A., 2015. Report from the National Institute of Allergy and Infectious Diseases workshop on drug allergy. Journal of allergy and clinical immunology, 136(2), pp.262-271.

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