Learn Reflection #1   

 

          During my placement of being a nursing student on the surgery unit at Ross Memorial

Hospital, I have had a few important experiences. One experience that has influenced me was

the overwhelming experience of having a patient who had multiple conditions, as well as had

very extensive needs. I never realized how much I’d be running around just for this one individual.

          In this situation, this patient was admitted for pneumonia, and was on droplet precautions.

Therefore, donning and doffing of PPEs was required. He was also getting weekly blood

transfusions due to having Non-Hodgkin’s Lymphoma, which required constant vital signs and

ensuring he was stable. That day he was getting the blood transfusion. He also had a colostomy

bag, which required special care. That day he was very nausea and started producing a significant amount of emesis. The nurses had asked him if he wanted an NG tube, but he refused. He also had a very extensive history, such as COPD and a small bowel obstruction. Therefore, priority assessments for this patient was to ensure the patient had O2 and that it was always on. 

          I found this individual to be challenging particularly due to the fact he was on droplet precautions. I would always forget many things before getting into his room and then I would have to yell down the hall for a fellow student to help me. This was challenging because organization skills and knowing what you need before hand is key to time management. It was difficult knowing what you needed before going into his room because I always discovered something new every time I went into his room. 

           Since, I didn’t know the patient very well, and could not access his chart before our shift, made him even more of a challenge. Not knowing who my patient was made me feel unknowledgeable, especially since I heard that he was challenging. I knew little to nothing about him, and was required to do a full head to toe assessment before hand to learn what he had. Another part I found challenging, was putting together all the information that I had gathered throughout my shift to write a progress note. I thought I was particularly strong with my charting skills, and knowing how to write progress notes but I’ve never had a patient in my years as a nursing student who was this interesting. It was hard remembering everything I had done, as I also wasn’t able to bring my notebook into his room due to droplet precautions. I felt very unorganized, and felt as though I didn’t know what I was doing for that time being.

          Overall, he was a very complicated individual and it made me feel very overwhelmed knowing that I could have several more patients with just as extensive needs as he did in the future. I really do enjoy the surgical floor, and I am starting to get into a routine. It is different from my previous placements, and I am excited to learn more about this floor and the opportunities it has to offer for nursing students.

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Learn Reflection #2

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          During my placement on the surgical floor at Ross Memorial Hospital (RMH) I came

across a situation involved with medication administration, which was an important lesson

as a student and as a future nurse.

          During this experience, I was giving medications with my clinical instructor during an

afternoon shift. Using the MAR, I gathered all the medications and had done two of my

medication checks while at the medication cart; the last medication check was at the

beside of the patient receiving it. Medication checks includes the right drug, the right dose,

the right route, the right time and the right patient, right reason, right documentation.

During my last check at the beside of the patient, my clinical instructor and I were going over our final check for medication administration until we noticed that there was not a second person to sign the order from the doctor. My clinical instructor quickly questioned the order as it was handwritten and she wanted to double check whether it was transcribed correctly from the doctor’s order. This written order involved us administering 4 g of this drug, which raised a flag since the medication was only available in 4 mg tablets. We went back to the patients chart and the doctor’s order stated that the patient was to receive only 2 mg of the drug. The nurse during the morning shift had given the incorrect dosage of the drug, therefore, if we were to give that drug to the patient without looking back at the order we would have made a medication error and gave the patient a full days’ worth of the medication in one administration.

          I think in this situation my clinical instructor and I handled the situation appropriately. My clinical instructor has taught me that I should always check in the patients chart and double check doctor’s order to ensure that nurses have transcribed the order accurately even if there was two co-signers for the order. This situation has taught me that it is easy for medication errors to be made. Medication administration is an important skill for nursing as you are always going to be giving medications to your patients, whether it be in the hospital, at home, or long-term care facility. Having knowledge about drugs, their uses and usual doses for the drugs can help prevent medication errors. I have discovered the importance of medication administration due to this situation. I learned how vital it is to transcribe medications properly as well as I have learned to question whether an order is right. I have learned to always double check written orders, even when there are 2 co-signers. The importance of double checking orders if you are unsure of its accuracy will avoid medication errors and the possibility of harming the patient by causing an adverse drug reaction. The sole goal of medication administration, is to improve the patient’s condition. I have learned that it is really importance to do your multiple checks because individuals may miss the errors the first and second time, which was in our circumstance.

          Nurses directly communicate with the patients on the units, and are the ones that directly administer their medication and ensure its effectiveness. Therefore, as nurses our role is to reduce medication errors since we are the last individual in the chain of health care professionals. We are responsible for ensuring that the prescriber and pharmacy are correct as well as ensuring the different rights of medication administration are followed.

Ways to control the amount of medication made in health care settings are to create an open environment where health care professionals (HCPs) are encouraged to report all medication errors made. This strategy can ensure that HCPs and other members of the team can develop a plan to understand and improve the outcomes of the previous mistakes that were made. Additionally, we need to encourage HCPs to report near misses. Near misses are not considered medication errors but they are a step before that occurs, so also reporting near misses helps identify areas for improvement before the medication error occurs. Health care settings need to provide staff with sessions regarding medication errors and nears misses and prevention strategies. Efforts need to be focused on high-alert drugs and error prone situations. HCPs need to be encouraged to participate and provide input and feedback into the development of quality improvements. If these prevention strategies are having rates of success, than the health care facilities are encouraged to work with other facilities in improving medication errors.

          Overall, medication areas is important focus for health care settings, which require a significant amount of focus. Educating yourself on best practices of medication administration will encourage excellent habits, and reduce the risks of making medication errors.