Reflective Practice Model: Gibbs' Reflective Cycle

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CHCPRP003 Reflect on and improve
own clinical practice
Case Study

Assessment Instructions
Achieving competency
This assessment task contains 1 Case Study. In order for you to meet the requirements of this assessment
task you are complete the case study by providing satisfactory answer to the related questions.
The task is to be completed in your own time using available reliable sources such as the course text books
provided to you at orientation, credible internet sources such as the department of health and other text
and online journals available to you through the online library service offered to all students and discussed
at orientation.
It is important that you reference all sources of information that you use to obtain information used in your
answers. Referencing must be included and failure to adhere to this requirement will result in a not
satisfactory outcome for the assessment.
The case study is available in the Student Portal. You will need to download the case study and complete it
then submit it through the Student Portal
Plagiarism will result in an immediate Not yet Competent – all copied material MUST be referenced
accordingly. See you Student Handbook for more information.
Reassessment
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requirements of one, multiple or all aspects of the task. Your Assessor will provide you with feedback as to
where you did not meet the requirement. You will have another opportunity to resubmit your assessment
work addressing the areas as identified in your assessor feedback.
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should follow the Academic-Non Academic Grievance policy and procedure available in the Student
Handbook and Skills Training Australia website.
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All assessments are due on the assessment due date as identified on the assessment task document and
confirmed by your Trainer/Assessor on the first day of the unit.
If you are unable, due to exceptional circumstances, to submit your assessment tasks on the required due
date, you MUST submit a completed Assessment Extension Form to your Trainer/Assessor.
Extensions may be granted by your trainer under exceptional circumstances and will only be granted for a
maximum of 2 weeks.
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assessment task and placed in your student file).
Please type your responses in the spaces provided below each question and submit as per the instructions
in the assessment document.
Please note: The space below is not indicative to the required length of the response; you are to ensure
that you thoroughly answer the question.
Skills Training Australia Quality Controlled Document │ Version 2018.0.1 │ 30 Dec2018 │CHCPRP003 │CS_HLTENN020Page 2

Case Study 1:
Medication Administration Error and Failure to Monitor
A 23-year-old woman with no significant medical history presented to ED with flu-like symptoms. She complained of
generalized body ache and had a fever of 38.8. For the past two weeks, she self-administered over- the-counter
medications with no relief. Instead, her condition deteriorated and she developed both shortness of breath and a
cough.
Following an abnormal CT Scan of the chest, an elevated white blood count and abnormal liver function test results,
the emergency department physician admitted the patient to ICU.
The patient was started on oxygen and antibiotic therapy. Blood cultures were drawn and showed Streptococcus
Pneumoniae and antibiotics were appropriately adjusted per recommendation of the infectious disease specialist.
The attending physician first saw the patient in the ICU. At the time of his initial exam, the patient was not in
significant respiratory distress, was responding well to the oxygen and antibiotic therapy, and was subsequently
continued on the same therapy. The attending physician noted that while the patient was not in acute distress, her
blood chemistry was abnormal with a potassium level of 2.9 (normal range is 3.5 to 5.0).
The physician ordered 30mEq of potassium to be added to each bag of the patient’s intravenous fluid, infused at 80
millilitres per hour. The order was to be maintained through the remainder of her course of treatment. Two days
later and despite the potassium added to her intravenous fluids, the patient’s potassium level was noted to be 3.0
and the attending physician ordered 80 mEq of potassium to be administered by mouth.
The patient vomited the medication (amount retained undetermined). The attending physician then ordered two
doses of 40 mEq of intravenous potassium to infuse over a four-hour time period.
Documentation is problematic. It appears that despite the order for two doses of potassium 40 mEq to be infused
over four hours, the nurse administered two intravenous potassium doses of 20 mEq over approximately one hour
(documentation regarding this is inconclusive).
Throughout the day the nurse documented the patient’s heart rate in the patient care record. At 7:30 a.m. it was 72
beats per minute, at 1:30 p.m. it was 96 beats per minute and at 4:30 p.m. it was 116 beats per minute. The
patient’s blood pressure remained stable at 120/80. The nurse did not specifically notify the physician of the
pattern of rising heart rate. When the physician saw the patient that day, he noted that the patient’s white blood
cell and platelet counts remained higher than normal but were dropping.
In addition, her vital signs were within normal range and she was not in respiratory distress. He ordered a
pulmonary consult for possible bronchoscopy but deemed that she was stable, and that vasopressors and
aggressive pulmonary treatment were not necessary at that time. He ordered the patient to be transferred to the
High Dependency Unit. The nurse’s documentation fails to provide the exact time of transfer from the ICU to HDU
although it appears to have been between 7:15 p.m. and 7:30 p.m. The documentation also fails to validate the
nurse’s statement that the patient was on a cardiac monitor during her intensive care stay and that she was
transferred to the HDU with a cardiac monitor and oxygen therapy. The HDU nurse stated the patient did not arrive
with a monitor. Other HDU staff indicated that the unit was in an overflow situation when the patient was
transferred and the central monitoring station was not functioning. Shortly after the transfer, the patient became
unconscious and unresponsive. A MET was called and the critical response team attempted to resuscitate the
patient with no success. The patient had gone into cardiac arrest and died.
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