What are the most important things you can do to protect yourself against medication errors?
Nurse with aggressive defensiveness: the compressed and pressured zeitgeist of the emergency department is skewed to siphon potentially catastrophic errors straight into your underpants. Be vigilant always. And encourage a culture of pro-tection (yourself) and co-tection (your colleagues).
Advocate for developing an information rich environment. Easy access to current hospital medication policies, drug guidelines and relevant information at the point of medication dispensing.
Be attentive. When handling medications try to punch a little space in your multi-exponential-tasking of urgent things that need to be done hours ago. Slow down and turn on your lights. Medication. Meditation. Nearly the same word.
Be accountable: When you do make an error (not if, but when), the worse thing you can do is to ignore it or try to cover it up. Immediately let your supervisor, the patients doctor and the patient know.
Be supportive. Nobody gets out of a career in nursing without a medication error or two sagging in their underpants. It is the worst feeling in the world. Even worse than getting a needle stick injury.
You are in the middle of a medication round at 0800hrs on a medical ward. You note that your patient’s anti–hypertensive medication, due at 0600hours has not been signed for. The patient does not remember if he had the medication. What would you do?
Electronic foetal heart rate monitoring…
Indications for Electronic Foetal heart rate Monitoring…
Symptoms of panic attack. Panic attacks can occur in any type of anxiety.
My upcoming clinical will be the first time I've worked in maternity and emergency... Any suggestions?
Medication administration abbreviations
- bd- twice a day
- tds- three times a day
- qid- four times a day
- mane- morning
- nocte- night
- prn- as required
- stat- immediately
- ac- before food
- pc- after food
- subcut- subcutaneous
- IM- intramuscular
- IV- intravenous
- PO- orally
- Neb- nebuliser
- Sublingual- under tongue
- PR- per rectum
- PV- per vaginal
- TOP- topical
Commonly used abbreviations to know
- ABG- arterial blood gas
- ABO- three blood groups
- ACE- angiotension converting enzyme
- ADH- antidiuretic hormone
- ADL- activities of daily living
- AMI- acute myocardial infarction
- BP- blood pressure
- CABG- coronary artery bypass graft
- c/o- complains of
- DKA- diabetic ketoacidosis
- DOB- date of birth
- DT- delirium tremens
- ECG- electrocardiogram
- ENT- ear, nose and throat
- GI- gastointestinal
- Hb- haemoglobin
- HCT- haematocrit
- ICP- intracranial pressure
- IDC- indwelling catheter
- IDDM- insulin dependant diabetes mellitus
- IMI- intramuscular injection
- IV- intravenous
- KVO- keep vein open
- LOC- level of consciousness
- NBM- nil by mouth
- NG- nasogastric
- NIDDIM- non insulin dependant diabetes mellitus
- N/S- normal saline
- NAID- non-steriodal anti-inflammatory drug
- PCA- patient controlled analgesia
- RBC- red blood cell
- SC- subcutaneous
- SOB- shortness of breath
- stat- immediately
- TEDS- thromboembolic disease stockings
- TPN- total parenteral nutrition
- UA- urinary analysis
The most important initial assessment
D- disability (neurological)
E- exposure (head to toe quick check over to detect abnormalities)
Gastro-oesophageal reflux disease (GORD)
GORD is not a disease but rather a syndrome. The term GORD is defined as: any clinically significant symptomatic condition or histopathological alteration presumed to be secondary to reflux of the gastric contents into the lower oesophagus. It is the most common upper GI problem seen in adults, with approximately 5-7% of the population experiencing GORD. There is no single cause of GORD, several factors can be involved: dysfunction of the lower oesophageal sphincter (LOS), delayed gastric emptying, reflux of gastric contents, defective mucosal defence, and impaired oesophageal motility.
Complications of GORD are related to the direct local effects of gastric acid on the oesophageal mucosa. Oesophagitis (inflammation of the oesophagus) is a common complication of GORD. Repeated exposure may cause scar tissue formation, oesophageal stricture and dysphagia. Barrett’s oesophagus (oesophageal metaplasia) is a precancerous lesion that approximately 10-15% of patients with chronic reflux develop. These patients are at risk of oesophageal cancer and therefore will need to be monitored every 1-3 years by endoscopy and biopsy. Other complications of GORD include respiratory complications due to either the irritation of the upper airway by gastric secretions or aspiration of gastric secretions into the respiratory system. These include: bronchospasm, laryngospasm, asthma, chronic bronchitis, and pneumonia.
Nursing interventions of GORD mostly involve patient education.
- The patient’s head of the bed should be elevated 30 degrees as gravity assists with gastric emptying
- The patient shouldn’t lie down 2-3 hours after eating
- If the patient smokes they should be encouraged to quit as smoking causes an almost immediate drop in LOS pressure and decreases the ability to clear acid from the oesophagus
- If needed the patient should be encouraged to lose weight as obesity raises the intra-abdominal pressure, therefore overtaking the resting pressure of LOS
- Encourage the patient to eat small frequent (high protein, low fat) meals
If the patient requires surgery regular postoperative nursing care is provided. This entails:
- Prevention of respiratory complications via deep breathing exercises
- Maintenance of fluid and electrolyte balance via IV fluids, diet and fluids as ordered
- Prevention of infection
- Patient comfort