PSD4501: Assessment 1

Question 1

a. Explain the procedures that are in place regarding prescription, preparation, administration and recording of medication; and explain how these procedures prevent errors from occurring. (220 words)

b. Outline procedures associated with verbal medication orders, including legal and/or ethical principles and Standards that govern the Registered Nurses’ practice. (340 words)

Question 2

Patient transfer involves the risk of handover errors and miscommunications. The reporting of cumulative recent medication doses during any patient care handover is important.

a. Explain how the transfer of the patient and the handovers associated with her transfer of care contributed to the patient's outcome. (220 words)

b. Provide and discuss two (2) recommendations with supporting evidence that can help to mitigate/prevent incidents such as these occurring. (340 words)

Question 3

a. Discuss concerns that the patient may have about being transferred away from Country for health care. (340 words)

3. Explain how the Caritas Competencies/Principles could be used collaboratively to create and sustain a healing environment for the patient. (340 words)

A minimum of 12 peer reviewed references from module readings, textbooks, and professional manuals and documents are required to support your answers to the three (3) questions.

Scholarly papers, reports, or other similar assessment items must be ‘word processed’ and not handwritten. Requirements include:

Leave 2 cm margins and double line space your work;

Use 12pt font, Arial or Times New Roman;

Number all pages;

Insert your student name and number in header or footer of every page of every assignment; 

Include a title page that includes the subject name and code, title of the assessment task, due date, lecturer’s name, your name and your student number.

Review the marking rubric in the Subject Outline and make sure you understand what the marker will be looking for in this assessment.

Worth: 50%.

Length: 1800 words +/- 10%.

PLEASE NOTE : You don’t need to search for any other reference every part reference that can used is attached below for each question and please follow marking criteria where markers will be looking for to mark. This is bachelor’s degree nursing work. Read the case study but its up to you in first if you don’t want o to mention the case study its ok but gain check the marking criteria. Please if you need any information please let me know. Thank you

QUESTION 1

Explain the procedures that are in place regarding prescription, preparation, administration and recording of medication; and explain how these procedures prevent errors from occurring. (220 words) 10 marks

b. Outline procedures associated with verbal medication orders, including legal and/or ethical principles and Standards that govern the Registered Nurses’ practice. (340 words) 15 marks

Don’t forget these important resources for question 1

NSW Health Medication Handling Policy Directive PD2022_032 (click link)

Medication Safety Standard – An NSQHS Standard as part of the Australian Commission on Safety and Quality in Health Care

High Risk Medications – Narcotics and other sedatives

Guidelines for the use of the National Inpatient Medication Chart including the paediatric version by ACSQHC

Registered Nurse Standards for Practice by the Nursing and Midwifery Board of Australia

QUESTION 2 ALL DETALIS

Patient transfer involves the risk of handover errors and miscommunications. The reporting of cumulative recent medication doses during any patient care handover is important.

a. Explain how the transfer of the patient and the handovers associated with her transfer of care contributed to the patient's outcome. (220 words) 10 marks

b. Provide and discuss two (2) recommendations with supporting evidence that can help to mitigate/prevent incidents such as these occurring. (340 words) 15 marks

SOME RESOURCES FOR QESTION 2

NSW Health Clinical Handover Policy Directive PD2019_060

This is an old document, however it is very informative – Clinical handover: System change, leadership and principles

Journal article – Challenges of patient handover process in healthcare services: Systematic review

Question 3:

a. Discuss concerns that the patient may have about being transferred away from Country for health care. (340 words) 10 MARKS

b. Explain how the Caritas Competencies/Principles could be used collaboratively to create and sustain a healing environment for the patient? (340 words) 15 MARKS

Resources for question 3

Don’t forget to use the resources in the Modules related to the Caritas Processes and creating a healing environment.

Don’t forget your Biles and Biles textbook for assistance with 3a.

Cultural safety in health care for Indigenous Australians: Monitoring framework web report from the Australian Institute of Health and Welfare.

References

A minimum of twelve (12) credible and scholarly sources must be used to support your work.

APA 7th ed style MUST be applied.

References should not exceed 8 years (2015) in age, unless they are the most up-to-date guidelines/frameworks or seminal works.

Credible websites are acceptable for this paper as sources. In order of credibility - .gov, .edu and .org.

Please do not use the I2 site as a source, but rather use the information that was used for the content via the sources that support this.

Format and structure

Write this paper as an essay – follow the template and you can’t go wrong!

No colloquialisms!

No contractures!

Minimal abbreviations.

Consider grammar, spelling, punctuation

CASE STUDY READ HERE

This case study is based on true events and comes from a Coroner’s inquest finding. To maintain confidentiality, names and places have been altered. The content may be confronting to some students. If you need personal support in relation to the content, please access student support services: https://student.csu.edu.au/support-services A 19-year-old Aboriginal woman, Ellen1, died as an inpatient of a psychiatric ward from combined drug effect and myocarditis. She was, at that time, an involuntary patient under the Mental Health Act 1996. She was initially seen by Doctor Low in the local hospital in her small rural hometown over the course of two days following two attempts to hang herself while intoxicated and distressed. Ellen declined voluntary admission to the local mental health unit; so, due to her ongoing high risk of harm to herself, a decision was made to transfer her to a regional hospital under the Mental Health Act. The patient, as well as her mother, became angry on being informed of this decision. As such, Ellen required restraint and intravenous sedation, while Ellen’s mother was escorted away from Ellen. While awaiting medical retrieval by fixed wing (aeroplane) transport, Ellen was given medications including 100mg promethazine, 5mg droperidol, 40mg olanzapine, 8mg clonazepam, 52.5mg haloperidol and 30mg midazolam. Of those drugs, haloperidol and midazolam were deemed to be the most relevant. Haloperidol is used to settle agitation without causing as much sedation as drugs such as midazolam, and it takes a relatively long time to wear off.

Midazolam is a fast-acting sedative that wears off quickly as it is rapidly removed from the body. Ellen was given more sedative medication than the prescribed dosages set out in the local health service protocols for sedation for mental health patients, but Doctor Low considered the risks to be less than those associated with the only other alternative: intubation. Ellen was monitored closely however and did not appear to suffer any adverse effects from these medications at the time. The medical retrieval team (hereby referred to as “retrieval”) was contacted to arrange Ellen’s transfer. At the time, two other patients in the same facility also needed transfer to the bigger regional hospital – one was intubated and therefore required imminent transfer and one-on-one care by a specialist doctor, while the other patient was urgent, but could wait longer than the intubated patient and Ellen. Retrieval staff had assessed priorities and decided to take Ellen and the intubated patient in one plane, and another plane would be sent for the other patient later on that day.

The retrieval staff arrived at the local rural hospital and reviewed both Ellen and the intubated patient. One of the retrieval staff members requested that local staff prepare syringes of haloperidol and midazolam for the flight. This was given as a verbal order, and due to a misunderstanding among the nursing staff and a difference in the usual presentation of the particular medication, a syringe of haloperidol was drawn up at a concentration of 5mg/mL instead of the expected concentration of 1mg/mL. The local staff labelled the syringe correctly, however failed to handover the difference in the expected concentration to the retrieval staff.

During the flight, Ellen became agitated and aggressive – rearing up on the stretcher, shaking her head, growling, and fighting her restraints, thus retrieval Doctor Scott and retrieval Nurse Rose determined that she required further sedation. Ellen settled for a short time after this, but soon became agitated again. Nurse Rose asked Doctor Scott if she should try haloperidol and the doctor reportedly told her to “give her five” which she took to mean 5mg. Nurse Rose then administered Ellen 5mL of the haloperidol solution, believing it to be 5mg of haloperidol at a concentration of 1mg/1mL as it had always been in her experience. Nurse Rose had actually administered 25mg of haloperidol. Nurse Rose said that she would usually check the labelling on a syringe and would get her doctor colleague to also check it before administering a drug, but that she did not do either on this occasion because of the urgency of the situation and the fact that the doctor was busy attending to the intubated patient. Ellen was then given a further 3mg of midazolam and then another 5mL dose of ha After the second injection of haloperidol, Ellen settled. In the relative calm that followed, Nurse Rose had time to complete her recording of the drugs administered. At this time, she discovered that the syringe of haloperidol was labelled 200mg/40mL. She had trouble believing that the label was correct because it meant that someone would have had to draw up 40 ampoules of haloperidol in order to prepare the syringe. She immediately informed Doctor Scott that she had administered Ellen with 25mg of haloperidol on each occasion instead of 5mg. Doctor Scott moved up the aircraft and assessed Ellen. Her status remained unchanged with little apparent effect from the haloperidol. Doctor Scott advised Nurse Rose to monitor Ellen closely but considered that she would be fine. Doctor Scott also told Nurse Rose that she should document the incident as a drug error and that they would need to complete a ‘clinical incident form’loperidol before the increased concentration of drug in the syringe was noticed.

In the interim, Doctor Scott called the regional hospital’s emergency department (ED) and spoke to Doctor King in an attempt to have Ellen transferred directly to the ED instead of the psychiatric ward where she was supposed to go, however the concerns he relayed were regarding potential sedation rather than the overdose that occurred, and he was unsuccessful in his attempts to alter her destination. During this phone call, Doctor Scott made no mention of the excessive dosage of haloperidol. In evidence supplied later, Doctor King said that if he had been told that Ellen had been given 102.5mg of haloperidol in a 24- hour period, he would have accepted her as a patient to the ED because the tranquillisation protocol at the ED stipulates a maximum of 30mg of haloperidol in a 24-hour period. Doctor King said that he would have been concerned of the potential of sudden death from prolonged QT syndrome, which may result from large doses of intravenous haloperidol.

Ellen was transferred from the airport to the regional hospital by a paramedic team and the information regarding the doses given was lost in the multiple verbal handovers that occurred. On direct admission to the psychiatric ward, it was assumed that the documented doses of 25mg were miswritten and must have been 2.5mg doses. The following day, Ellen was unable to be roused from sleep, and so 15-minutely visual monitoring was continued through the day. She was roused briefly to change her clothes in the late morning. Respiratory rates were documented, and it appears that in the afternoon, the numbers were simply copied from previous entries rather than being observed each time. In later evidence, the afternoon psychiatric ward nurse who was caring for Ellen, Nurse Creed, said that he did not go into Ellen’s room to check on her because, as a matter of practice, male nurses are not allowed to go into female patients’ rooms alone. Nurse Creed said that he stood outside her door and observed her through a window. He initially said that he would count respirations for 15-seconds and multiply by 4 to arrive at the respiration rate, but when he was asked how he arrived at 17, he began to prevaricate. When pressed, he eventually admitted that it was difficult to see Ellen, so he looked at the observations checklist and saw that her previous respirations were all 17, so he wrote 17. At 5.00pm that afternoon, the shift coordinator attempted to rouse Ellen, but found her cold, stiff, and unresponsive. Resuscitation efforts were unsuccessful.

Inquest findings and comments: Post-mortem examination revealed widespread myocarditis, and it was commented that there was nothing in Ellen’s prior history that would have alerted any staff to this possibility. Toxicological input suggested she most likely suffered a fatal cardiac arrhythmia secondary to the excessive haloperidol dosage, which is associated with prolonged QT syndrome. The coroner found death occurred by way of misadventure and commented that Ellen’s management was beset with a series of errors and failures that resulted in her being provided with an overall sub-standard level of care.

Step 7. Editing / Reviewing

It is important that you leave yourself enough time to ensure your work is written to a high academic standard. As this is a third year subject, the expectation is that your referencing and presentation will be polished and you have minimised the errors in grammar, etc. 

The ability to communicate coherently is important for Registered Nurses. This assessment is very clinically focused and you have been provided with several good resources and templates to ensure the assessment is to a good standard. Make the best of this and ensure the work is your best effort and easy to read. 

Use the template to complete the assessment.

Please see the for guidance with APA 7th edition. In particular, is an excellent resource that gives you examples of each type of source (in text and reference list) as well as other information that helps you to format your work correctly.