Medication administration is a common activity in nursing clinical practice.
Patient care is improved by safe medication administration.
When medication is prescribed, dispensing or administered, errors can happen.
Nursing can play a significant role in reducing medication errors by learning the factors that influence the regulation of drugs, pharmacology, as well as the error-producing conditions.
Q1 Pharmaceutical companies run clinical trials to evaluate the effectiveness (effectiveness) of a medication.
The FOUR (4) phases in clinical trials are briefly described.
a) A brief overview of the main responsibility for the Therapeutic Goods Administration, (TGA).
b. Describe TWO (2) ways that medications are regulated under the TGA in Australia
Q3 Briefly explain the terms pharmacokinetics (4 Marks) and pharmacodynamics (13 Marks).
Q4 Explain the phenomenon known to be the ‘hepatic second pass effect’ in relation oral medications
a) A brief explanation of why Glyceryl Trinitrate 600 Microgram Tablets must be used sublingually
b. List TWO (2) specific areas that should be taught to the patient about Glyceryl Trinitrate.
Q6 Outline FIVE (5) of the following roles and/or responsibility:
A) Registered Nurse
c.Pharmacist responsible for the safe and effective use of medication
Q7 Describe 5 (5) possible types of medication error and the cause.
a) Define the difference between the person centred approach (5 marks) versus the system-approach.
b. Defences, safeguards, and barriers are all part of James Reason’s (1990), “Swiss Cheese Model”.
These factors can be used to prevent medication errors.
c. Defective conditions and active failures can cause holes in the defenses.
You can identify medication errors by:
i.THREE (3) possible conditions Latent
Q9 Describe FIVE (five) factors that can contribute to medication errors and a possible cause of each
Pharmaceutical companies conduct clinical trials in order to assess the effectiveness (effectiveness) and safety of their medication.
These are the (4) phases of clinical trial.
Four phases of clinical trials are required. Each step must have a clear goal.
The first step is to test the drug on volunteers.
Usually, there are between 20 and 80 volunteers.
This phase is for testing the drug’s metabolism, excretion, as well as monitoring any side-effects.
This phase is for testing the drug’s efficacy on volunteers. It can last anywhere from a few months to two decades.
A mostly blinded phase in which two groups of people are involved. One group is administered the drug and the other with a placebo.
It is also examined whether the drug is safe for the patients.
In this phase, further efficacy, safety, and the effect of drugs upon patients are tested.
The number of volunteers grows to thousands.
This phase serves as a ‘Postmarketing surveillance’ of the drug. It is used to test the effectiveness, safety features, and the quality of patient’s health.
At this stage, the drug is also compared with other drugs available on the market.
(Overview of clinical trials)
2 A. Briefly Outline the Principal Responsibility for Therapeutic Goods
Answer: TGA, the regulatory authority for therapeutic products, includes drugs, medical devices and other related products, is responsible.
TGA has the responsibility to ensure that drugs are available on the market meet the required standards.
TGA is also responsible to import and export drugs as well as advertisements for therapeutic products in Australia.
(Australian Government Department of Health
B) Describe (2) How Medications are Regulated by The TGA
Every therapeutic product has some risk. The TGA evaluates them using clinical and scientific expertise.
Recognize, evaluate and assess any potential dangers that drugs may pose to your health.
To reduce or eliminate the threat, you can take corrective actions.
Monitor the progress of the medication after corrective actions have been taken in order to ensure its safety.
After these processes are completed, the two numbers assigned to medicines depend on the type and certification of the drug.
The Australian Register of Therapeutic Goods registers any high-risk medicine by evaluating its quality, safety, and effectiveness.
After successful clinical trials, the AUSTR number is awarded to them.
The AUST number can be used to identify Listed medicines such as herbal and vitamin medications that have low risk ingredients.
(Australian Department of Health).
3 Briefly Define Pharmacokinetics & Pharmacodynamics.
The Four Phases of Pharmacokinetics are:
Absorption-This is the phase that determines how the drug moves from the time it’s administered to the time it enters your bloodstream.
Distribution – This is the phase in which the drug is delivered through the bloodstream to the intended location.
Each drug has a different distribution depending on its action.
It takes place in the liver.
Excretionis the process by which the drug is excreted from the body following metabolism (The Free Dictionary 2017).
This is a branch in pharmacology that studies the impact of drugs on the body. It includes the biochemical, molecular, physiological and psychological effects.
This study is crucial in determining the dose of a drug. It also aids in predicting how a patient will respond to that drug.
The pharmacodynamics (or pharmacokinetics) of a drug may be affected by any disease, age, or the involvement of other drugs.
Q 4 – Explain the phenomenon known as The, in relation to oral Medications
‘Hepatic First Pass Effect’
The first pass metabolism or the hepatic first passing effect is a process in which some of the active ingredient is removed from the blood stream.
Through the first passing effect, the drug’s concentration is reduced.
Because the drug is metabolized in the liver, it is called the Hepatic First-pass effect.
This effect occurs when drugs are absorbed and transferred from their administration site to their site of action.
Study.com, 2017: The possible sites of metabolism include the liver and the gut wall.
Orally administered drugs pass through the digestive system and reach the liver.
The drug is carried to the liver by the portal veins of the hepatic organ.
The potential enzymes in the liver metabolize the drug. Thus, only a fraction of potentially active substances can escape into the circulation.
The hepatic initial pass effect reduces drug bio-availability.
The active ingredients of the drug are metabolized by enzymes found in the liver, gut wall, and hepatic system.
High hepatic effects are therefore given in higher oral doses. This allows at least a significant amount of active ingredients to reach potential sites (and the circulatory systems) after it passes through the liver.
Diazepam, morphine, and other drugs that have a high hepatic first pass effect are examples (Encyclopedia.com 2016).
Q.5 – Briefly explain why 600 Microgram Tablets of Glyceryltrinitrate must be taken sublingually.
There are many tiny blood vessels in the area below the cheek and under the tongue.
This facilitates the absorption of medications directly into the bloodstream rather than the lengthy route through the digestive system or the liver.
Glyceryl Trinitrate, a drug used to improve the function of the heart, is usually given sublingually.
Sublingual administration is recommended because it must be absorbed immediately in cases of heart attacks and seizures.
You should only address the Glyceryl Trinitrate medication.
Glyceryl Trinitrate should be used with caution. The following instructions must be followed:
You should not chew the tablets or swallow them.
Place them under your tongue, and let them dissolve slowly.
To avoid dizziness, one should always rest and sit while taking the tablet.
If you have heart pain, place the tablet under your tongue. Repeat the procedure if necessary.
Medical intervention is necessary if the pain lasts more than 15 min.
6.An outline of the (5) different roles and/or responsibilities of the RNs/Doctors and Pharmacists involved in safe use
Registered nurses, or RNs, play many roles in hospitals, clinics, and healthcare units.
The duties of nurses depend on the place they work. They may also be involved in diagnosing and treating patients.
A registered nurse’s duties include:
Monitoring, recording, and recording the condition of patients (changes and stability)
Maintain accurate and detailed reports on the conditions and changes.
Patients should be educated about drugs and the prescribed dosages.
Interpret the results of diagnostic tests to modify medications
Prepare patients for examination and help the consultants during physical examination (Greenwood 2017, 2017).
Clinics and hospitals are dominated by consultants and doctors.
The Doctors’ Specializations may vary
According to the needs of the patient, prescribe medications and order diagnostic tests.
Perform all types of surgeries, even emergency ones, when and where necessary.
In major operations, neurologists, cardiologists, aesthetics all play a role.
Doctors make key decisions about patient care and give instructions to nurses and health workers regarding how and what medications should be administered and to whom to give them.
To improve the patient’s condition, doctors can make changes to medication, increase dosages, or introduce new drugs.
The Pharmacist should:
You must be able to give the prescribed medication and appropriate treatment to patients.
To be able to respond quickly to emergency situations, you will need computer and managerial skills.
Work with doctors and health workers to distribute medications when prescribed.
In depth knowledge about the medication and their use.
Supervise and counsel patients regarding health and nutrition.
Dispense medications that are appropriate for specific purposes, such as cancer and heart disease.
You can find the possible causes and errors here:
An error in prescribing includes incorrect dose, wrong route, wrong frequency and wrong time.
Dispensing mistakes include improper preparation of an injection solution, dispensing expired drugs, equipment failures (syringe defects), IV fluid leakage or the line struck and dispensing drugs too late.
Infusion pump – forgetting to set infusion line, non-compliance failure or written communication (Allard et. al. 2008).
Fragmented care errors can include poor communication between the doctor or health care professional.
Faulty drug preparation error in which intravenously administered drugs are administered orally or vice versa.
Memory loss, when a nurse may forget that a patient has an allergy to a drug.
This can happen due to distraction.
Memory lapse may also result from forgetting the maximum daily dose, or administration of more or less than needed.
Systems problems such as not labeling drugs categorically or placing medicines near each other, or a lack of bar code can lead to mistakes.
Incorrect knowledge or lack of understanding by health workers can cause errors in the administration or recalling of drugs with generic names.
Incorrect information about patients or a lack of information like allergies or past history can cause errors.
A fatigued nurse or health worker could make errors due to overwork.
8. Discuss the Difference between The Person-Centered Approach To Human Error and The System-Approach
A person-centered approach refers to a system where all aspects of care, including drug administration, revolve around the patient.
Here, the person is the centre and is trained to administer prescribed drug dosages.
This is where the problem lies. The patient may not have the right knowledge and could take too much, too little, or time the drug intake incorrectly.
The system is centralized, meaning that the system includes everyone from nurses to doctors.
The error can be caused by several factors: poor communication, untrained staff, insufficient lighting, negligence, and loss of memory.
B) James’ Components include defenses, barriers, as well as safeguards
Reason’s (1990), ‘Swiss Cheese Model.
These factors can be used to prevent medication errors (4 marks).
Defence layer was described by Swiss cheese as a way to prevent errors.
High-tech hospitals often have alarm systems and physical barriers that ‘defence against error’.
Barriers might appear in the form ‘holes’ that are not aligned to one another. In this instance, a nurse might be asked to report to a health worker on the drug administered.
A single point failure does not always mean total error. There are many layers of’safeguards.
This sequence could become impractical as the ‘holes or errors’ in the chain can be reversed by non-alignment.
According to the model, having one system or more than one can help prevent errors from happening.
A nurse can correct an error made by a health care worker or other staff member immediately.
In error defection, the Swiss Cheese model can be used (Duke University School of Medicine 2016).
c. Holes in the defenses are caused by active failures or latent circumstances.
Recognize medication errors
In the system, latent or dormant situations are possible and sometimes even inevitable.
The nurses and health workers work under time pressure
Overworking, poor staffing conditions, and inadequate equipment
There are no alarms or indicators that work efficiently, there are no standard procedures and the equipments have no design defects.
Although latent failures can cause errors, they are possible to be prevented by the person monitoring or in charge.
If latent conditions are not addressed, they can lead to long-lasting problems in the system (Reason2000).
Three (3) Potential Active Failures
Nursing staff and health care workers are often in direct contact and can commit violations such as slips and errors in medication administration or procedural violations.
Instructions not properly read, understood, or ignored.
Infusion errors or IV fluids and potent drugs administration mistakes.
9 Describe FIVE (five) Factors That Lead To Medication Error AND A
All systems are susceptible to error, and the medical profession is no different.
Multiple factors contribute to medication errors.
Administration errors such as giving incorrect dosages, using the wrong drug or not reducing allergy symptoms.
Causes: Lookalike and should-like medications can lead to confusion in health care workers. They lack a proper system to communicate information, have no proper knowledge to administer medicines or understand instructions.
Medcom Trainex, 2017, p.
Errors in the prescription of drugs by doctors and nurses, wherein the patient condition wasn’t properly monitored and thus the doctor made the error of prescribing the wrong medication.
Causes: Poor communication. Poor communication within the system – Between nurses and health workers, doctors and nurses as well as patients and nurses.
It is difficult to identify the allergic symptoms.
How to administer a drug: Infusions or orally administered IV fluids can lead to serious errors.
Causes: Again, this could be because of improper communication, lack of knowledge or inappropriate administration techniques.
Inaccurate diagnosis or incomplete diagnosis for a disease or illness
Causes: The doctor does not know the cause of the problem. Communication errors between patients and doctors.
Negligence can lead to errors in nursing care.
Causes: Poor knowledge, uncooperative patients, overworked staff or inability to share vital information between doctors and caregivers.
U.S. Food and Drug Administration commissioner (2017).
Step 3 in the Drug Development Process – Clinical Research.
Center Watch (2017).
Overview of Clinical Trials.
Australian Government Department of Health.
Therapeutic Goods Administration.
About the TGA.
Australian Government Department of Health.
Therapeutic Goods Administration.
Listed medicines: The role Australia’s medicines regulator.
Australian Government Department of Health.
Therapeutic Goods Administration.
Duke University School of Medicine (2016)
Swiss Cheese Model.
The Free Dictionary (2017).
The First Pass Effect of Pharmacology.
GTN sublingual tablet (glyceryltrinitrate).
Role of a nurse in health care.
What are the duties and responsibilities of a pharmacist?
Medication Errors: Causes. Prevention. and Reduction.
Medcom Trainex (2017).
Common types, causes, and prevention of medication errors in nursing
Terry’s Post (2013).
Describe Person-Centred Ways to Administer Medicines while adhering To Administration.
Management and models of human error.
West J Med. 172(6): 393-396.