Portfolio Reflection

On week one of clinical practise unit (CPU) we learned and practised the procedures of medication administration. Medication administration is not a single task, but a process, which comprises multiple interconnected tasks, some of which contribute directly to the act of administering the dose to the patient, and some are defence barriers against medication administration errors (MAEs). It is therefore important that multiple components of the medication administration process is measured and used to evaluate systems-based interventions (McLeod, 2013. p22). This is a reflection of my experience in the CPU labs, as I was not scheduled for clinical placement at this time. The reflection is based using the Gibbs cycle of reflection (1988) (Dempsey, Hillege, & Hill, 2014). It is used to critically reflect on my experiences whilst practising. On arrival in the CPU labs, we were asked to form into groups and go to a bedside to complete the tasks required for the case scenario given, administration of schedule medication. I felt very nervous due to being completely unfamiliar of what I was doing in the task and the minimal knowledge I actually had with regards to medication administration and the legal requirements, at the same time I felt confident as two peers in the team (Crisp, Taylor, Douglas, & Rebeiro, 2013), were practising Endorsed Enrolled Nurses (EEN) working in a hospital. Their knowledge and practise methods I believed would be valuable to me as they would be more familiar with Nursing and Midwifery Board of Australia (2008), code of professional conduct and code of ethics as well as the legalities of medication administration, Poisons and Therapeutic Goods Act 1966 (NSW Health, 2013). Over the lesson we worked together without demonstration from our teacher, any questions that arose were communicated clearly and effectively and discussed amongst us (Chang & Daly, 2012). On progression through the lesson and on discussion with the teacher when she came to our group it was evident that what the teacher was saying, and what the fellow peers of our team were saying, was different, which made learning conflicting and confusing for me. Basing knowledge on peers, who practised this as a part of their job (as EEN – not a RN) seemed positive initially, although this then made me feel it was negative due to “bad habits” that these particular students had picked up, leading to short cuts or “workarounds” which according to Debono et al., (2013.p2) “are observed or described behaviours that may differ from organisationally prescribed or intended procedures”, which could result in possible medication errors as steps may be missed in this short cut process. Learning from the teacher was structured, detailed and methodical in nature, e.g.: validate order – involving all aspects from Dr’s full printed name and signature to patient details, allergies, order of generic name, dose, route, time, frequency and indication for the medication as well as the incorporation of the five rights and three checks, in comparison to my peers which skimmed over the importance of the validated order as a legal requirement under Poisons and Therapeutic Goods Act (1966) (NSW Health, 2013), and gave different input to the five rights and three checks.

Conflicts of what happens in the hospital - daily practise of my peers - and what the teacher informed us was correct just caused me confusion as I had already accepted the statements from the peers. On analysis of the experience, more preparation and research could have been undertaken by me to become familiar with legal requirements and competencies required, rather than relying of teammates just because they work in the industry. Also, with regard to this, they work as EEN’s therefore their rights and responsibilities differ to those of a RN (NMBA, 2010). The teacher should have been the only one to guide me when queries and concerns were raised, to ensure my work adheres to correct practise. As a student soon to be on clinical placement, I would become familiar and confident with the rules and regulations of the NMBA (2008) and poisons act (1966) (NSW Health, 2013) and do what is expected of me as a second year student nurse (administer oral, IM, SD, SC and rectal medication to adults – only under direct supervision of RN, as well as Schedule 8, administration of blood products and management of IV only according to hospital policy). In the long-term future I would adhere and practise facility protocol on the administration of medication. As stated by Cheragi, Manoocheri, Mohammadnejad, & Ehsani, (2013) pp7-8, “execution of medical orders is an important part of the healing process and patient care, it is also the main component of nursing performance which has a prominent role in patient safety. Giving medicine is one of the most critical duties as a nurse and since errors may be unintended can cause serious consequences for the patient”. Becoming familiar and confident with medication administration from the right source (not peers and colleagues) ensures I am abiding by NMBA (2008)(2010) national competency standards. By undertaking correct procedures from the right channels and not letting others knowledge and habits influence me, protects me as a skilled, professional, practising RN and maximises good outcomes for patients.