ASSESSMENT : PROFESSIONAL ACCOUNTABILITY AND PATIENT SAFETY ESSAY
Identify a case from the NSW Nurses and Midwives’ Board or HCCC, Caselaw or AHPRA website which involved a REGRISTERED NURSE(S) who had their registration cancelled or suspended for greater than 6 months due to their involvement in an adverse event for a patient in their care (This will be workshopped in tutorial 2).
THEN structure your assignment to include the following information
NB: you do not need to provide references here - you have already told us which case you are reporting on
NB: This section does require evidence – remember if you don’t reference your work it reads just like your opinion on something and this will pull your mark down. Please ensure you use not only policies etc but also use evidence based literature to support your discussion -this is specified in the rubric
Academic integrity and referencing
Patient safety is a critical component of quality healthcare provision. This can be efficiently done by maintaining professional accountability that is being responsible for one's own actions (Moffatt et al., 2018). As a measure, different regulatory bodies maintain that reliable services are provided and that RNs do everything possible to save lives. Despite these efforts and quality care provisions many nurses fail to ensure patient safety resulting in adverse health outcomes. This assessment aims at highlighting the case study “health care complaints commission (HCCC) v Shah ”. The registered nurse is liable for unsatisfactory professional conduct under sections 139 B and 139 E (NSW, 2013). Also, the nurse showed a lack of competence and could not pass the International English Language Testing System (IELTS).
What actions/omissions on the part of the Registered Nurse(s) contributed to the adverse outcome for the patient?
In brief, the charges allege that Mr Shah engaged in unprofessional behaviour by administering dishwashing liquid to Patient A without first confirming that it was his prescription drug or verifying that the dosage given was right, and then failing to alert a senior nurse after Patient A reported of vomiting, nausea and feeling sick. Mr Shah failed to complete the IELTS review to the appropriate level, according to the second complaint (NSW, 2013). This error is seen as being unsatisfactory professional conduct. Mr Shah is not qualified to practise nursing, according to the third allegation, because of his conduct and lack of sufficient action after Patient A consumed the dishwashing solvent, as well as his inability to pass the IELTS test. According to the descriptions in the first two charges, Mr Shah is accused of professional misconduct, or that he has participated in more than one incident of unsatisfied professional behaviour that, when taken together, amounts to the conduct of reasonably severe nature to cause suspension or cancellation of his certification (NSW, 2013).
Actions- The registered nurse administered dishwashing liquid to the patient. This led to adverse health outcomes for the patient causing nausea, diarrhoea and vomiting. According to Bates (2017), dishwashing liquids have potassium carbonates and sodium carbonates and can cause severe burns in the throat, tongue and lips of the patient. Also, it causes gastrointestinal symptoms such as vomiting as evident in the given case study (Bates, 2017). Although Mr Shah examined the vitals of the patient after the complaint but failed to report it to the senior staff. Further, this was a serious medication error and could have led to the health deterioration of the patient.
Omissions- the case study demonstrates several errors that could have been prevented with competent nursing. The first omission is that nurse failed to check the prescribed medication chart before medication administration. Medication errors are the most common form of medical errors (Rodziewicz & Hipskind, 2018). Medication management that is both safe and effective is a crucial and potentially complex nursing responsibility. Before medication delivery, all prescriptions must be assessed to ensure that the patient is taking the right medication for the correct cause. Drug administration necessitates sound decision-making and professional judgement, and the nurse is accountable for maintaining that all aspects of medication administration and their consequences for patient care are well understood (Bucknall et al., 2019). In this case, the nurse failed to meet the 5 rights of medication administration and did not follow regulatory standards. Next, the nurse did not notify the adverse outcomes to the senior nursing staff. Medication errors have serious consequences for patient care. Medication errors are disclosed and safe habits are encouraged as errors are detected by careful monitoring and an appropriate reporting mechanism (Bucknall et al., 2019). The nurse failed to meet this criterion also.
Where there any other factors (e.g. systems-based) that contributed to the adverse outcome for this patient?
Many other factors have caused this professional error and issue. The major reason is the registered nurse was assessed as competent without meeting the standards for medication administration. In 2009 during the placement, Mr Shah was assessed for medication administration. During this, it was reported that Shah did not take vitals and administered medications on two occasions. Despite this fact, he was marked as competent (NSW, 2013). Next, the lack of teamwork and collaboration among the nursing staff has resulted in this situation. Mr Shah stated that he was looking after another patient and at the same time patient A buzzed for the medication. Cooperation is critical in the delivery of care and adequate services to patients in need in the area of healthcare. It is essential that everyone working in the health-care system work together to ensure that no one is refused services and that no one ignores any responsibility (Emich, 2018). The workload would have been reduced if the work had been evenly divided amongst the staff as a team (Rosen et al., 2018).
There is a mistake in terms of a storage that is the bottle was marked as "Cardizem Capsules 180mg. take 1 p.o. daily” but was containing dishwashing liquid which could be misleading for the nurse. It's particularly questionable to put a comparative novice nurse in charge of a ward with vulnerable individuals. For the very inexperienced nurses, the appointments should be made based on their expertise and track record.
Moreover, the unit manager/supervisor was absent. Every healthcare facility should have a unit manager whose duty is to perform regular rounds after each period. It would ensure that no licenced nurse spends time doing anything other than their task and that no misconducting practice happens (Gronow, 2018). In such facilities, managing and treating patients necessitates a higher level of expertise, and nurses must be vigilant at all times. Mr Shah would be afraid of being reprimanded if the regular rounds were undertaken, and she would have performed her medication administration duty with loyalty and concern. To ensure that the patient gets achieving high-quality care, registered nurses must have greater coordination and teamwork with one another and with patients (Magda, 2019). The nurse could not pass the IELTS assessment and his poor language efficiency is among the few reasons for medication error and adverse patent health outcomes in this case study.
Outline the actions that should have been taken by the Registered Nurse(s) to prevent the adverse outcome for the patient
The first action that could have prevented this incident is that there should be the inclusion of competent nurses. If the nurse is found to be incompetent and they should be further provided with training and education. Inter-professional training for nurses is the first step in preventing prescription errors. It can include medical chart analysis practice, organisational skills, proper handover procedures, decision-making, and mandatory documentation to help eliminate prescription errors (Bridgeman et al. 2018). This makes it easier to collaborate and act as a team. They learn how to deal with distractions and chaotic scenarios to avoid making missteps (Brigeman et al. 2018). Workshops for professionals can help with conceptual communication, flexibility, collaboration, and participation. In addition to this, all the nurses need to use 5 Rs of medication. This implies the right time, right medication, right patient, right route and the right dosage. The right patient can be better achieved by nurses telling a patient's full name out and, if applicable, inspecting medical armbands for a match to the name and ID number on the report (WHO, n.d.). The right drug helps in ensuring that the drug to be given is the same as the one that was prescribed. The right route helps in identifying whether the medicine has to be given orally, intravenously or intramuscularly. The right time and dose must be managed by time and dose intended by the prescriber (WHO, n.d.). These factors help in complying with standards of medication administration or patient safety and wellbeing. Bryan et al. (2021) contend that by using the 5 rights of medication management nurses can prevent medication errors by 89%.
Healthcare laws mandate the reporting of medication errors. According to a study by Hammoudi et al. (2018), many nurses fail to report medication errors due to fear of losing job and punishments. As per hospital regulations, healthcare professionals are required to report incidents so that they could learn from such an error that jeopardised patient safety. To protect the patients, healthcare practitioners are required to disclose notifiable activity under section 140 of the National Law (AHPRA, 2014). Furthermore, according to section 142 of the national legislation, if a healthcare provider fails to report the required monitoring, she or he will be subjected to conduct, safety, or competence action and will deal with the consequences (Pacey et al., 2017). The nurse should also immediately report health deterioration as per NSW standards “identifying and responding to health deterioration” (NSW, 2013).
Further, the major responsibility of the healthcare staff is to comply with the professional rules and regulations this ensures proper obligations and duty of care towards patients. In this case study, the nurse could have improved her practice to a much extent by complying with rules and performing duties with compassion. To prevent the patient from being overlooked or neglected by the nurse, nurses should follow-up or monitor them regularly (Myhre et al., 2020). It is the ethical and legal obligation of registered nurses to continue providing adequate and secure care, pursuant to norm 6 NMBA standards (NMBA, 2017). It is also critical to provide crucial support and appropriate timely guidance to provide proper and safe treatment (NMBA, 2017). Mr Shah must have reported the incident and should have taken adequate steps and assessment to stabilize the patients’ health (NSQHS, 2017). Mr Shah should have relied on the nursing guideline's processes to ensure that no patient was left in deteriorated condition. It addresses the underpinnings of patient care standards, as well as the value of reporting and recognising a person's potential factors that could lead to deterioration.
From the above assessment, it can be concluded that the decision taken by the regulatory authority is valid. The nurse made a medication error and failed to report it. Further, there should be continuous training and learning for the nurse to improve practice and safety. Also, proper storage of medications, incident reporting, proper assessment of prescription documents, supervision and language competency can prevent such incidents.