Clinical Practice Sample Assignment Paper

The initiating event is the fall of the 93 year old woman. Mrs. Johnson is found with a urinal tract infection, the doctor prescribes nitrofurantoin, and the nurses omit administering the prescribed medicine. This event leads to severe side effects in the patient which eventually leads to the death of the 93 year woman.Clinical Practice Sample Assignment Paper.

The method I have used tries to analyze is  the root cause and contributory factors to incident of death of Mrs. Johnson is both easy and dynamic in nature. It is easy to understand and both efficient as it captures both factors. The cause consequence analysis captures both cause of a risk and the consequence of exposure to that risk. It shows both the consequences of the risk occurring and if it could have not occurred. This is the same as the one used by the NPSA to analyze the root causes of medical errors (NPSA 2008).

The analysis is both clear and simple. The management will find it easy to use this method for decision making. The management will find it easy to find the root causes and the contributory factors to the problem; they can then put in place the necessary mechanisms to prevent the consequences from occurring again. The analysis showed that that the cause to the death of the 93 year old woman is the omission  to deliver medication during the lunch hour and also failing to give the medicine in the recommended  manner, which is giving with food to increase the absorption of the medicine.

Ethics is the set codes and principles in a certain professional fields. There are many ethical issues violated in this incident of the 93 year woman. The general ethical issues in the risk assessment include:

Clinical ethics is a tool that enables physicians to identify, analyze and resolve ethical issues. The ethical issues in clinical care issues usually are: informed consent which requires that the patient is informed of all the risks in administering a given procedure and he or she gives an informed consent, based on the disseminated information. Clinical Practice Sample Assignment Paper. The consent should be free of any influence and coercion from the nurse or physician.

Another ethical issue is pain relief. This brings in the much debated issue of voluntary euthanasia. This is the debate whether the patient has a right to will for her life to be terminated in order, to relief him or her from pain. Some countries like the Netherlands have legalized it but, it still remains an issue that will show up in the agendas of many debates.

Other ethical issues in clinical care practice include: patient confidentiality, where information is to be shared only between the physician and the patient. Patient rights where the rights of the patient are often not clearly defined, and end of life care. Most clinical care issues arise when there is difference in values between the physician and the patient. The moral values that commonly characterize the relationship between the patient and physician include honesty, trustworthiness, commitment and compassion. The clinical ethical issues are complex and dynamic and often have no definite set way of tackling them. Nurses and physicians should mostly analyze the situation and give a solution. The solution is usually required within a short period of time.

The example given in this essay violates and is in conflict with some of the clinical care ethics. The ethical risks in the example include: violation of patient’s rights. Patients have a right to receive quality and efficient clinical care from their nurses Frith (1999). Mrs. Johnson was denied quality care by her nurse, failing to give her the prescribed dosage of nitrofurantoin. The patient had a right to receive medication as prescribed by her doctor; the nurse negligently due to fatigue and burn out gave her the medicine without food to enhance absorption of the drug. This finally led to the death of Mrs. Johnson.

Another clinical issue that is violated is truth telling and informed consent. Mrs. Johnson had a right to know the side effects of her treatment.Clinical Practice Sample Assignment. The physician should have revealed the side effects of vomiting, bleeding in the stomach, nausea, headache and fever of using nitrofurantoin in the treatment of urinal tract infection. The nurses should have been informed of the adverse effects of not administering the dosage by the physician. Due to the infringement of the patient’s right of informed consent. The patient lost his life.Clinical Practice Sample Assignment Paper

The nurses have a commitment of ensuring that every patient gets the right of good clinical care Frith (1999). The nurses are entrusted by the patient the role of providing quality clinical care as per NMC’s Code of Professional Conduct (2008). This was not the case as the nurse on duty did not perform his task of administering medicine. The patients trust was further violated through; administering it the wrong way and further signing the drug register leading to no action being taken to save Mrs. Johnson, which ultimately led to the loss of human life.

The patient’s right to life was also denied in violation of a section of the Human Rights Act 1998,  the patient lost his life negligently to human error Tingle (2002) which could be charged in a court of law. Her death was not natural. The nurse’s errors, ultimately led to the loss of the patient’s life.

There are many ethical notions in the clinical care field. These notions propose certain standards of behavior and attitudes that are morally appropriate to nurses, physicians and other health care providers. Therefore, these concerned parties should strive to meet these set of rules and principles, so as to meet the task entrusted to them by the patients.

The NPSA (2004) produced guidelines entitled the Seven steps to patient safety from recommendations by the DH’s report, Organisation with a memory (2000),and relevant patient safety literature. They aim, to improve patient safety within the NHS ensuring patients gets quality services.

Patient safety is a discipline that emphasizes reporting, analyzing and prevention of medical error that would result in health care problems like death. There are many organizations today that are committed to ensuring customer safety. The Institute for Healthcare Improvement (IHI) is an international organization, who work with healthcare professionals to ensure that people receive the best and safest care available (IHI online 2011).  The Medicines and Healthcare Products Regulatory Agency (MHRA) is a government Agency established in 2003 who are responsible for ensuring that medicines and medical devices work (MHRA 2003 online)Clinical Practice Sample Assignment Paper.

National patient safety agency (NPSA online 2010) has put in place reporting mechanism to report adverse health care events and near misses. They have put in place policies to minimize the occurrence of such events. The policies include: ensuring the registration of nurses, Professional nurses play key role in pain management. Good assessment skills are necessary in nurses to identify and relieve discomfort especially where the patient has been verbally impaired.

Centers for Medicare and Medicaid services (CMS) have also set policies to improve quality and avoid unnecessary Medicare costs in the United Kingdom (CMS online 2011). The incentives include: reward to nurses and physicians for improving clinical care to the terminally ill through use information technology. Hospitals in the UK want to cut costs in wake of the recession, and are therefore lying off nurses with the Latest study showing that they could cut £421 million. Other recommendations by the CMS include payment for better home, hospital and office clinical care for patients with chronic diseases. Removing disincentives to provide quality health care and payment to hospitals to improve the quality of Medicare they offer.

Another policy is the bridging the gap between health and social care. For example, to test how nurses across the UK are coping with changes, nurses will be employed by NHS highland to start working in partnership with the highland council to provide integrated services to the population (NHS online 2012).

Knowledge on risk assessment has greatly impacted my professional knowledge. I have learnt that risk assessment is an important tool, for identifying, analyzing and priotization of risk. Through carrying out a risk assessment, will minimize the risks that face the patient. Risk analysis involves breaking down the risk into its root cause or contributory factors.

Mechanisms should be put in place, through reporting systems like, the National Patient safety agency (NPSA), so as to identify risks and provide a thorough analysis. It is only through identifying the root cause of an adverse health care event that we can effectively reduce or remove them completely.Clinical Practice Sample Assignment Paper.

After carrying out a risk assessment, considerable steps should be taken to reduce the occurrence of adverse health care events. The steps include professionalization of the nursing profession, better remuneration to the nurses to motivate them, integration of health care and social care, a better structure of line of authority and putting in place mechanisms for reporting the adverse health care events due to omissions and other medical errors.

Through taking the above steps would there be a positive and beneficial change in the clinical practice field. The changes would ensure better remunerated, motivated, socially responsible, committed and efficient personnel in hospitals, to ensure good health of our population.Clinical Practice Sample Assignment Paper.