Using the Joint Commisions 2022 National Patient Safety Goals as a guideline

1. Using the Joint Commisions 2022 National Patient Safety Goals as a guideline to improve medication accuracy and administration, Millie’s nurse could have performed interventions that would have elminated the error that occured with Millie’s insulin. Medication reconciliation is most often the responsibility of the nurse and is defined by the text as the “process used by the health care team where the current medication orders are compared to patient report, the patient’s medical record, and prescriiptions that may have been in place prior to the transition of care” (Taylor et. al, 2019, pg. 831). Due to Millie’s condition, she was unable to verbalize what medications she takes at home. The admitting nurse could have contacted family or patients emergency contact to gather more information on what the patient takes for medications at home. Once Millie is in better condition, the nurse should educate the patient on the importance of having a list available of current medications (Karch, 2020, pg. 51). The text also mentions that most of the time, patients’ home medications are discontinued and new orders are placed once a patient is admitted to a hospital (Taylor et. al, 2019, pg. 831). The nurse should have the knowledge that with the patients’ history of type 1 diabetes and elevated blood glucose on the lab work, that frequent blood sugar checks and insulin will most likely be required. The nurse should communicate this information with the doctors and request appropriate orders.
References:
Karch, A.M., (2020). Focus on nursing pharmacology (8th ed.). Wolters Kluwer.
Taylor, C., Lynn, P., & Bartlett, J.L. (2019). Fundamentals of nursing: The art and science of person-centered care (9th ed.). Wolters Kluwer.
The Joint Commission. (2022). National Patient Safety Goals.
2. Millie Larson’s case is one of the many reasons EMRs are a big improvement to patient care, because even if she is not alert or awake, we are able to see what medications she has been recently prescribed and using, This helps reduce the lapse in medicine administration. However, in the case of Millie she has been in the hospital for quite some time, and her condition has changed dramatically from the time when she was admitted until now. Because of this I am a large proponent of completing a medication reconciliation not only at admission, but with transfers throughout the hospital. Because it lets the admitting nurse know that she has certain health concerns and needs, such as monitoring her Blood sugar. Furthermore, if the patient is a recorded diabetic, such as Millie Larson, we should continue regular monitoring of her blood sugar even if the sugar is managed. This is also why the sugar should be monitored standardly when the patient is NPO. In a study that looked at the collation of blood glucose monitoring and critical glycemic findings, it was found that routine monitoring of blood sugars resulted in significant findings of hyperglycemia and hypoglycemic conditions, before they became critical. (Riberio, ET AL, 2011) For the nurse the question of do least harm comes into play, as the consistent pricking of the finger can be very traumatic for the patient too. For patients with a diagnosis of Diabetes, who have a well-maintained blood sugar level glucose monitoring should not be eliminated, however reduction in frequency of monitoring can be done, and depending on your clinical location you can monitor with other resources, such as monitoring with a metabolic panel during morning blood work, if the patient has routine blood work. This would be the case with Millie, as she has an active infection and the doctors would be following her white blood cell count, and serum electrolytes regularly. varying numbers between blood draws would indicate the need for increased glucose screening. Knowing the side effects of medications as a nurse is also important, for example if Millie was started on a steroid such as prednisone, this would cause her glucose to be unstable, increasing the need for monitoring of blood sugar. (Pearson, 2019)
References
Ribeiro, R. S., Peres, R. B., Yamamoto, M. T., Novaes, A. P., Laselva, C. R., Leme Faulhaber, A. C., Neto, M. C., Lottenberg, S. A., Hidal, J. T., & de Carvalho, J. A. M. (2011). Impact of screening and monitoring of capillary blood glucose in the detection of hyperglycemia and hypoglycemia in non-critical inpatients. Einstein (16794508), 9(1), 14–17. https://doi.org/10.1590/s1679-45082011ao1840 (Links to an external site.)
Pearson. (2019). Nursing: A concept-based approach to learning (3rd ed., Vol. 1). Chapter 12 A, pp 817-821

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