Question

Case Study: Patient with Hypertension and Medication Error

Handoff report at 0700

You are assigned to the following two patients:

Mrs. Allen is 67 ye4ars old and has diabetes mellitus type 1 and hypertension. She is in for a pressure ulcer on her right heel. She is on bedrest and the right leg elevated and she only has BRP. There is a wet-to-dry dressing change due at 10am. VS are stable and her latest BP is 170/108, denies pain, pulse ox 97% .

Mrs. . Carter is 73 years old and was admitted with dehydration 3 days ago. She is eating and voiding well. There is a possibility that she is going home today. I removed her saline lock; there was some redness at the IV site. She is not on any IV meds, so I decided not to restart. She says that she is going home this afternoon, although there is no order. Her morning vital signs are: T:97, P:82, R:18, BP:130/90, pluse ox 98%, pain level 0

Medication Record Patient: Mrs. Allen                                       Allergies: None Routine                                                               Time Humulin N 26u SQ qAM                                    0730 30 minutes ac breakfast Tenormin 25mg po daily                                  1100 (Pt requests this time) Furosemide 20mg po BID                                 1100-1700 Ceftazidine 0.5g IVPB q8h                                1000-1800-                                                                                0200 PRN Medication MOM 30mL prn constipation Temazepam 30mg po at bedtime may Repeat x 1

Mrs. Allen and Mrs. Carters medication records contain the following:

Medication Record Patient: Mrs. Carter                                   Allergies: None Routine                                                               Time Prazosin 1 mg po qAM                                       0900 Multivitamin tab 1 po qAM                               0900 PRN Medication MOM 30mL prn constipation

  

Use the clinical situation and the flowcharts to:

Identify the pertinent patient information made known to you in the report

Identify the pertinent patient information made known to you in the flowcharts

Review the data in columns 1 & 2 and identify information that needs follow-up

Mrs. Allen Mrs. Carter

Mrs. Allen Mrs. Carter

Mrs. Allen Mrs. Carter

It is 0800; prioritize your plan of care for both patients for the next 3 hours

Time                                        Plan of Nursing Care

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You return from lunch ar 1200 and Mrs. Allen is asking for her antihypertensive medication. You know you gave the medication but insists that you did not give her the medication. As you investigate, the nursing assistant tells you that Mrs. Carter is very lethargic and unresponsive. You suddenly realize that you gave Mrs. Aleen’s 1100 medications to Mrs. Carter.

Identify the nursing interventions that you would plan to implement immediately.	Make a nurse’s note entry as to how you might document this incident in the patient’s chart/electronic medical record.

Critical Reflection: To promote safe nursing practice in medication administration when caring for multiple patients, identify nursing actions:

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Answer 1

1, Report:
Mrs. Allen 67 years old patient with type 1 diabetes and hypertension. patient with right heel pressure ulcer, on bedrest with the right leg elevated. wet to dry dressing change at 10 am. Vs stable and BP 170/108 on medications.
Mrs. carter 73years old patient admitted with dehydration 3 days ago. discharge today. Iv site redness presents while removing the saline lock. she is stable ad vital signs are normal.
Flow chart:
Mr. Allen
7.30 am humulin N 26NSQ QAM
Tenormin 25mg PO daily
fusrosimide 20mg po BID
Ceftazidine 0.5g IV PB Q8h
Temazepam 30mg PO bedtime
Mrs. carter
Prazosin 1mg po QAM
Multivitamin 1 PO QAM
Followup:
Mrs. Allen
The patient is on pressure sore need dressing and patient pressure and sugar level to be monitoring before medication.
Mrs. carter
The patient needs discharge education and followup advice for medication continuation.
Plan of care in the next 3hours
Mrs. Allen
11.00 am -Tenormin 25mg PO
11.00 am furosemide 20mg PO
wound care at 10.00 am
Mrs. carter
9.00am -prazosin 1mg PO
9.00 am -multivitamin 1 tab PO
As soon as the error identified to accept the truth and error. disclose the error immediately to collegues, doctor, risk manager, supervisor and patient and apologies to them.
The benefit of the report in error prevention is disclosure and reporting the documentation in the patient's record. error report documentation in the patient chart should include the type of error, time and data, error disclosure, adverse condition of the patient or type of harm due to this error.
Practice safe medication practice with adequate skills, decision-making process, clinical judgment to promote patient safety. check patient allergy condition before administration, follow the policy for the patient identification, check the patient name, dose, medication indication, and calculation before administering medication, avoid overcrowd and tension and rapid administration of medication, make interaction with the patient before medication administration, use checklist, report near miss, error and adverse reaction. get supervisor support if any query regarding medication.