Clinical Audit Essay Example
Clinical Audit Essay Example

Clinical Audit Essay Example

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The author conducted an audit on her recent practice placement in a continuing care unit that primarily looked after patients in the final stages of life. Safe drug administration was chosen as the focus for the audit due to various reasons.

The unit had a total of 24 beds, with each bed being assigned to one qualified nurse who provided care for 12 patients. Many of these patients had complex health needs and required multiple medications at different times throughout the day. The author believed that the complexity of these medication regimens increased the likelihood of errors. Furthermore, it was observed that the on-duty staff nurse often worked extended shifts of up to 14 hours, while research has shown that nurses perform better on traditional 8-hour shifts compared to longer shifts lasting 12 hours or more (Fitzpatrick and While, 1999).

Medication errors not only e

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ndanger patients but also have significant financial implications. Inpatient drug errors are estimated to cost the NHS ?410 million per year. This amount does not include expenses related to legal action, which are estimated to be around ?750 million annually (National Patient Safety Agency, 2007).

To establish appropriate standards for a clinical audit, the author examined current guidelines and policies from various sources and applied them specifically to her clinical practice area.

To simplify the audit, the focus was placed on auditing the administration of regular drugs. Only drugs given orally were monitored, while the administration of controlled drugs or 'as required' drugs was not observed. If different routes of administration or the drug's controlled status were taken into account, different criteria would have been necessary. The author decided to analyze the process

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of regular, oral drug administration in five areas and referenced relevant literature to support each standard. The audit was conducted during two separate drug rounds and by two different staff nurses.

Each drug round involved 12 patients. Standard 1 states that hands should be washed with soap and water or bactericidal alcohol hand rub before giving the patient a drug. The purpose of this standard is to reduce the chances of spreading infection. According to the NMC (2006), infection control measures are essential for safe clinical practice. The Department of Health (DoH) (2006) also emphasizes that hand hygiene should be practiced right before every patient interaction, especially since the elderly and those with chronic illnesses are more vulnerable to infection.

Standard 2 - Before giving a drug, it is important to check the medicine kardex. This check should ensure that the drug is due, it has not been given previously, and that the information on the kardex is complete, correct, and legible. Several factors need to be verified within this standard, such as the dosage, the drug itself, the date and time of administration, the validity of the prescription, the doctor's signature, and the legibility of the kardex. According to Dougherty and Mallett (2001), thoroughly checking the kardex on every occasion is crucial in order to prevent harm to the patient. This helps ensure that the patient receives the correct drug, through the correct route, and at the appropriate dosage. The NPSA (2007) conducted studies and found that 57.3% of medication incidents can be attributed to non-compliance with this standard. These incidents include administering the wrong dose or strength of medication, giving it too frequently or

omitting it altogether, and administering the wrong medication.

Standard 3 - Once the required medication has been selected, it is important to check its expiry date and pour the necessary dose into a medication pot.

According to Dougherty and Mallett (2001), drugs can deteriorate with storage and it can be dangerous to administer drugs past their expiry date. To maintain good infection control, it is recommended to empty the drug into a medication pot without touching the drug. Standard 4 requires taking the patient's medicine and kardex to the patient and confirming their identity by asking for their name and date of birth or checking their wristband. As previously mentioned, a study by the NPSA (2007) found that 11.5% of drug incidents occurred when the wrong medicine was given. This can be prevented by ensuring that your patient's details match those on the kardex. Standard 5 involves administering the medicine, offering water if permitted, and recording the dose given in the drug's kardex.

According to the NMC (2004), it is required to immediately record a clear account of medications administered, declined, or withheld from the patient. This enables the subsequent medication provider to be aware of the patient's previous medication history and helps prevent medication errors. The secure documentation of drug administration is a legal obligation. Results from the conducted audit demonstrated that the practice successfully met the set standards overall. However, the standard that exhibited the greatest variability in outcome was standard 4.

The author will analyze the findings from the audit by categorizing them based on the audited standards. Standard 1: The results of this standard indicate that both nurses maintained good infection control procedures by using

alcohol gel between patients. Nurse 1 failed to wash her hands in only two instances, but in both cases there was no patient contact as the patients did not need help with taking their medication. Additionally, while the patients were having lunch in the dining room, the medication pot was left on the table for them. It could be argued that nurses are fully aware of how important it is to wash their hands when interacting with patients. The adherence to this standard can be attributed to poster campaigns promoting hand hygiene and the awareness among patients and their relatives about infection control.

The use of alcohol gel, rather than soap and water, between patients makes it easier and quicker to maintain infection control. Both nurses adhered to Standard 2, which requires competent practice and the ability to act safely and lawfully. According to the NMC Code of Professional Conduct (2004), nurses must possess the skills, knowledge, and abilities to ensure patient safety. Thoroughly checking the kardex before administering medication not only protects the patient but also safeguards the nurse's registration.

Standard 3: Both nurses demonstrated good adherence to this standard by maintaining proper infection control and selecting the correct medication from the drugs trolley. However, I did not observe them checking the expiry date on three separate occasions. It is possible that I overlooked their actions or they were aware the drug was not expired because they had just administered it to another patient.

Standard 4: Both nurses exhibited very little adherence to this standard.

The author questioned why the kardex was not taken to the patient and was informed that the residents on the unit were to

be treated like they were in their own home. Each resident had a name badge on their door and the staff knew which medication was going to each person because they had been on the unit for a long time. The author did not see the unit's policy, so it is unclear if this was an official view or just the opinion of the nurse giving the medication. Standard 5 was also 100% compliant. After administering the drug, the nurse would go back to the drugs trolley and write on the kardex if the patient could take the drug or provide a reason if they couldn't.

It is important and legally required to document the dose and time of administration. Nurses are responsible for their actions, and writing down what was done for the patient is essential. By accurately recording information on the kardex, the nurse not only ensures patient safety but also maintains professional practice. Most of the results supported the established standards, which are crucial for patient safety and NHS costs. Maintaining high levels of care in this nursing area can be achieved by keeping nurses informed about clinical guidelines and current policies. According to Craig and Smyth (2007), adherence to guidelines promotes safe practice, improves consistency of care, and ensures evidence-based treatment.

However, one could argue that while guidelines ensure the above, it is also necessary for the nurse herself to have a comprehensive understanding of the task at hand. In this particular unit, each client had their own individual room where they rarely left due to their terminal condition. The nurses were not interrupted during the drugs round, which may have contributed to

their adherence to the established standards. A trial conducted by the Clinical Governance Support Team (2007) discussed the use of tabards worn by nurses to indicate that they were conducting the drugs round and did not wish to be disturbed. This trial demonstrates that some trusts are actively seeking to reduce drug errors and prevent future occurrences.

Accessing resources on the unit is vital for enhancing or preserving high standards of care. Nurses can obtain information about unfamiliar medications and their contraindications from a current BNF. Administering drugs is the last stage in a collaborative process, so it is unjust to only hold the person administering the drug accountable for any errors that occur. By collaborating with doctors and pharmacists, the likelihood of drug mistakes can be minimized, resulting in a safer and more efficient drug administration process. This audit has shown that drug errors can have significant consequences for patients, nurses, and the NHS.

Having a thorough understanding and knowledge of the drugs being dispensed is crucial. It will enhance the author's future nursing practice by preventing complacency or over-familiarity with the drugs round. The unit was fortunate to have the opportunity to develop long-term relationships with their patients, but this may not be the case in every future practice placement.

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