Case 24: Medication Error
You are a physician making rounds on your patients when you arrive at Mrs. Buckman’s room. She’s an elderly lady in her late ’70s who recently had a colon surgery. She is also the wife of a prominent physician at the hospital. She has been known to be somewhat confrontational with the nursing staff. However, today she states she was just given a shot of insulin to cover her elevated blood sugar and the amount of insulin did not seem to be the usual amount. Even though Mrs. Buckman often complains, you are somewhat concerned about this observation and decide that it would be best to check on this. You ask the charge nurse to review the dose of insulin given. She, in turn, finds Mrs. Buckman’s nurse, who states that, as ordered, she had given the patient 80 units of insulin. You immediately become quite alarmed, as this is an extraordinarily large dosage. You make sure that the patient is given a large amount of glucose supplement and that her blood sugar is monitored every fifteen minutes for the next two hours. To follow up, you also review the chart and note an order from the house physician to give Mrs. Buckman 8.0 units of insulin. You can readily see how this could easily appear to be 80 units. You meet with the charge nurse, the nursing supervisor, the director of nursing, and the treating nurse to determine what can be done to prevent this type of error in the future.
CASE WRITE UP (PLEASE INCLUDE)
1 - Write a background statement
2- What are the major problems and secondary issues?
3- Your Role
4- Organizational Strengths and Weaknesses
5- Alternatives and Recommended Solution
THEIR IS AN EXAMPLE BELOW OF HOW THIS SHOULD LOOK!!!!
A Wiccan patient who visited a nondenominational community hospital was discussing her religious beliefs with her primary care nurse, Penny Baker, when suddenly another nurse, Ruth Goose, walked into the conversation and rudely stated, “Thou shalt not suffer a witch amongst you.” The Wiccan nurse felt offended and complained that she was discriminated in the hospital because of her religious beliefs.
Major Problems and Secondary Issues
The major problem is that the two nurses, Penny Baker and Ruth Goose, made the patient feel unwelcomed in the nondenominational community hospital because of her Wiccan religious beliefs. The secondary issues that the nondenominational community hospital may face is that the Wiccan patient is threatening to go to the media. This means that there may be news coverage that your hospital engages in religious discrimination. This may make people, especially Wiccans, look down on your medical services.
In this case, I am the Vice President of Nursing Services. As stated in the text, it writes, “You are the Vice President of Nursing Services in a nondenominational community hospital, and you receive a complaint from a patient, who is a Wiccan.” The advantages of this role are that I can sit down with Penny and Ruth to let them know that religious discrimination is not to be tolerated while we are caring for the patients. The disadvantages of this role are that I must decide how I am going to discuss this matter with Penny and Ruth because they’re passionate about being against the Wiccan patient. I need to let Penny and Ruth know that our patient’s care matters above everything else, not what religion they practice.
Organizational Strengths and Weaknesses
As the Vice President of Nursing Services, my strengths are that I can hold a training on racial, ethnic, and religious diversity. This training can supplement nurses with the information they need to work in a diverse environment. Nurses need to know that they must treat their patients justly despite their identity. The weaknesses I may face are that the two nurses are very religious themselves. They may not listen to what I have to say about religious discrimination because the two nurses try to justify their act by saying, “She did the right thing. We don’t have to pray with witches. They worship Satan. It’s blasphemy. What’s next? Human sacrifice?”
Alternatives and Recommended Solution
As a solution for this problem, I will make sure to provide all the nurses working in the hospital with diversity training. It is important that I sit down with the nurses and make it clear that discrimination will not be tolerated while they are working in our hospital. I can also offer every patient visiting the hospital with a survey. The patient can fill out the survey to let us know how they felt about their stay. Nurses who’ve been accused of any sort of discrimination, will have to speak with management. We would keep these incidences of discrimination in a file, and it the dilemma does not change, I would have to begin writing up the nurses. Discrimination would not be tolerated while the patient is in the hospital trying to recover from a medical condition. I would also recommend Penny and Ruth write an official letter of apology to the Wiccan patient before she decides to go to the media. Writing the official letter of apology would be my first recommended solution to Penny and Ruth, so that the patient does not feel unwelcomed to our hospital’s services in the future.
If there are enough surveys to prove that our medical treatment is getting better and there are less patients coming from the patients about discrimination, then I would know that the instances of discrimination have stopped. The goal is to aid in the medical recovery of patients. Patients must also feel welcomed to our hospital services despite their identity. By getting fewer, or even better, no discrimination complaints, I would know that my diversity trainings and meetings have worked.
Mrs. Beckman is a Patient admitted in the hospital and undergone recent colon surgery. She has complaint to the physician during the round that she just got a shot of insulin to cover up the high glucose level in the blood but she don't seems the dose given by the nurse was correct. This complaint given by the patient has alarm for a sign of medical error.
Major problem and secondary issues
The major problem is that the nurse given the shot of insulin with very high dose that is very risk for getting the patient for hypoglycemia. The secondary issue is that the nurse who is giving the insulin may get the penalty for the medication error.
In this case, i am the physician. The role of the physician in this situation is to provide immediate treatment to reverse back the effect of large dose given to the patient. Administer large amount of glucose or administer 5% dextrose. Identify the reason for the medication error and check the documentation of the physicians and nurses notes are regularly for compatibility. Discuss with the higher authority like nursing manager, director,nursing superintendent regarding the action to be taken to prevent further medication error. Advice all the nurses to cross check before administering any medication and provide education to the staff regarding how to prevent from medication error.
Strength and weakness
The strength of the organization is that regarding quick action for the complain given by the patient. To improve the quality of the care of patient, feedback of the patient is very valuable.
The weakness of the organization is that there is lack of education and inspection of the documentation done by the health care provider on time.
Alternate and recommended solution
The alternate and best way to solve the problem is to educate all the health care team member especially nurses regarding how to prevent medical error and proper documentations.
Evaluation of the performance should be done and identify for the effectiveness of the education given to the health care providers. The evaluation can be done by inspection of the documentation, reduction of incident rate of medical error in the organization and getting good feedback from the patient for getting high quality care.
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