你是一个新的研究生护士，在夜班的普通外科病房工作。这是1600hrs你收到急救部门的新入场。Vera Wong女士是一位24岁的女性，已经承认有12小时的历史，下腹部疼痛，增加强度的Iliac fossa的最后4小时（RIF）。她虽然她是肥胖的体重和身高168cm 145kg无相关病史。
她在急诊科接受外科手术组的检查，并对急性阑尾炎作了临时诊断。如果病人的症状持续下去，她也将于晚上晚些时候在病房接受手术检查。Wong女士目前是零对嘴，麦吉尔疼痛评分为7/10分。你回顾她服药和注意以下PRN药物：吗啡100 IMI 1次，甲氧氯普胺10mg IMI q8h和扑热息痛1gm坡组。
你把自己介绍给Wong女士，她告诉你她处于严重的疼痛中，并要求减轻疼痛。你告诉Wong女士你要给她注射吗啡止痛。你问一个注册护士检查了吗啡，在下面的安瓿优势提供：10mg／1ml和30mg／1ml。你看看3x 30mg安瓿和1x 10mg安瓿而正确地完成S8登记。你准备注射用甲氧氯普胺10mg随着无菌技术。你执行医嘱IMI Wong女士。
You are a new graduate nurse working in a general surgical ward on an evening shift. It is 1600hrs and you receive a new admission from the Emergency Department. Ms. Vera Wong is a 24 year old female who has been admitted with a 12 hour history of lower abdominal pain, increasing in intensity over the last 4 hours in the right Iliac fossa (RIF). She has no relevant medical history although she is obese weighing 145kg and is 168cm tall.
She was reviewed by the surgical team in the Emergency Department and a provisional diagnosis of acute appendicitis was given. She is also to be reviewed by the surgical registrar on the ward later in the evening for possible surgery if her symptoms persist. Ms. Wong is currently Nil by Mouth and has a McGill pain score of 7/10. You review her medication chart and note the following PRN medications: Morphine 100mg IMI q4h, Metoclopramide 10mg IMI q8h and Paracetamol 1gm PO q6h.
You introduce yourself to Ms. Wong and she informs you that she is in significant pain and requests pain relief. You inform Ms. Wong that you will administer a Morphine injection for her pain. You ask a fellow Registered Nurse to check out the Morphine which is supplied in the following ampoule strengths: 10mg/1ml and 30mg/1ml. You check out 3x 30mg ampoules and 1x 10mg ampoule whilst correctly completing the S8 register. You prepare the injection using a sterile technique along with Metoclopramide 10mg. You administer the medication IMI to Ms. Wong.
It is now 1800hrs and you are undertaking your medication and observation round, when you get to Ms. Wong, you find her to be unrefusable with a respiratory rate of 6. You immediately activate the Rapid Response Team. When the Team arrives they undertake a primary survey and assess the patient notes. You inform them of the medication you have administered. The team administers Naloxone Hydrochloride 1200μg IV. Ms. Wong’s level of consciousness and respiratory rate improve. The surgical registrar attends the MET call also and states he accidentally wrote 100mg instead of 10mg for the morphine dose.
Q1. This case study illustrates a medication error where the wrong dose was prescribed and administered. In 500 words, state how this adverse event could have been prevented. You should systematically work through the six rights and discuss what strategies you would employ to ensure you administer the right dose.
In the case mentioned above, a new graduate nurse is responsible for taking care of a patient with a low abdominal pain lasting for 12 hours. When she was told that the pain of patient in the right iliac fossa was intense, new nurse checked the patient’s medication chart and informed the patient that Morphine injection would be administered to relieve the pain. However, a terrible medical accident occurred because of silly mistake which was made by surgical registrar who inadvertently prescribed the overdosed morphine to the patient. And the new nurse injected the morphine to the patient without recheck the prescription.
After carefully analysing this case, I think that it is the working procedure of this hospital which causes such an adverse event. The hospital should design a sound working procedure for the nurse and require them to follow the procedure. Before giving any drugs to patient, the nurse is responsible for making sure that they know all the detail information about the patient including the age, medical history, the drug used etc. The nurse should also have the basic knowledge of drugs used for the patient such as the normal dose, side effects, and so on (Dolansky et al. 2013).
In my opinion, the nurse should follow “six rights” to diminish the ratio of medical events and benefit the patient (Medication management guidelines for Nurses and Midwives, 2010). First, it is vital that the nurse should make sure that the drug administered to patient is right. The nurse should have knowledge of the effect and caution of drugs including pharmacology, toxicology, and physiology. Besides, the nurse also should keep in mind the normal dose range of the drug administered to patient. Before injecting the drug to the patient, the nurse should read the container label, calculate the does.