Challenges and Safety Issues in ICU Care: Medication Errors and Patient Confidentiality

This article discusses the challenges and safety issues in ICU care, specifically medication errors and patient confidentiality. It explores the impact of medication errors on patients and care providers, and the importance of patient confidentiality. The article also suggests the need for flexible protocols and psychological support for care staff dealing with patient deaths.

Running head: MODULE ASSESSMENT
Module assessment
Name of the student:
Name of the university:
Author note:

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Table of Contents
Part A:..............................................................................................................................................2
Module 1:.....................................................................................................................................2
Module 2:.....................................................................................................................................4
Part B:..............................................................................................................................................6
Module 3:.....................................................................................................................................6
References:......................................................................................................................................9

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Part A:
Module 1:
The role of a specialist nurse is diverse, it encompasses multifactorial and
multidimensional professional competencies in order to address the different care needs that a
patient might encounter while availing specialist or critical care in the healthcare facility. Being
a student nurse with specialty area being high dependence care in the ICU units, I can state that
there are various crucial challenges and issues that present themselves regularly while providing
care for the critically ill patients in the ICUs. As discussed by Donnelly and Psirides, (2018)
providing safe and effective optimal care remains integral ideal of intensive care practitioners at
all times. There is mounting evidence that suggest that Intensive Care Units (ICU) are critical
settings, associated with an emergency and urgency oriented professional climate which is
susceptible to many errors, due to either technological infrastructure or human errors (Tracy et
al., 2013).
Hence, undoubtedly there are various safety issues plaguing the ICU scenario, and among
the various patient safety issues that are pertinent now, the most impactful and important safety
issue are medication errors (Garrouste-Orgeas, Flaatten & Moreno, 2016). Medication errors
have been defined as the consequence of multiple actions pertinence to a whole chain
organization and human interactions, where a single individual does not have the intention of
doing wrong or harm to the patients. In spite of that, the consequences of an adverse drug events
resulting from a medication error can have severe consequences resulting in the patient having to
experience exacerbation of the existing health issue that the patient is facing (Parshuram &
Dryden-Palmer, 2018).

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On the other hand medication errors also have been reported to prolong the hospital stay
and increase the cost associated with health care for patients in ICU as well (Nuckols et al.,
2014). All the most impactful and important impact of adverse drug event or medication error in
the ICU setting are fatal consequences, which can even lead to death of the patient. Hence,
regardless of the intention be Tracy hind the medication error, the impact is overwhelming for
both the patient and the care provider (Fridh, 2014). Medication error issue destroys the
professional competence and confidence in a nursing professional and also becomes a significant
emotional and moral burden on the conscience of the care provider that has been associated with
the medication error. For severe cases which lead to severe consequences for the patient, the
medication error is also associated with legal and professional implications which can encompass
monetary compensation, penalties, and even suspension. In terms of both the patient and the
care provider medication error is a grave issue which needs to be addressed at the earliest in all
care settings (Garrouste-Orgeas et al., 2015).
In order to address this particular safety issue it is also important to explore the exact
reasons contributing to the frequency of medication errors. One of the most important
contribution factors that contribute to enhance frequency of medication errors include extreme
workload and burnout, complicated and contradicting protocols in the Intensive Care Unit, and
most importantly symptoms of depression in the Intensive Care staff (Keiffer et al., 2015). The
daily struggle of dealing with life and death situation often takes a toll on the emotional health of
the ICU staff which in turn is reflected in differential and affects the professional competence
leading to various errors including medication errors. There is need for extensive research that
explores the root cause analysis of these medication errors and also research to discover different
intervention techniques to reduce medication errors such as one-on-one chaining and

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independent risk factor analysis for medication errors specific to ICU setting (Ryan & Seymour,
2013).
Module 2:
Holistic approach to healthcare is becoming more and more popular in various healthcare
settings across the globe. One of the most important elements of holistic care approach is the
patient centred care, providing priority to the patient and making the patent the centre of the care
delivery scenario at all circumstances In this context, confidentiality and patient privacy pertains
to the most fundamental aspect associated with care delivery which also is the origin of a
considerable ethical dilemma as well. On a more elaborative note, confidentiality is a very
important legal and ethical element of care delivery. It encompasses the rights of the patients to
have their personal information discrete unless the patient himself to disclosing the information.
On a more elaborative note it is the responsibility of the care providers to keep the information
shared by the patient and the information that has been generated during the care program
confidential under all circumstances unless instructed otherwise by the patient. Undoubtedly,
confidentiality and patient privacy is one of the most important aspects of the legal Framework
that healthcare delivery and composites and any breach of the confidentiality and patient privacy
is associated with many professional legal and ethical consequences (Echeverría et al., 2015).
The eminent ethico-legal construct that protects the confidentiality and patient privacy of
the patients are failing healthcare in Australia is the Commonwealth Privacy Act and privacy and
Personal Information Act (Health.gov.au, 2018). Although unintentional disclosure does not
necessarily include breach of these two ethical and legal requirements the intentional breach of
confidentiality is considered breach of these two legal elements which in turn leads to a

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professional show cause followed by investigation and penalty where the convicted care
professional would require to either go through monetary compensation or even suspension
depending on the intensity of the privacy breach (Health.nsw.gov.au. 2018).
There are certain circumstances where the nurse often faces a particular article dilemmas
regarding disclosing care information about the patient to the career or the closest family
member on next to kin of the patient. The right to privacy is considered fundamental in medical
care where staff nurse and physicians act as guardian of the physical information or personal
information of the patient. However, when the health of the patient declines the nurses in
physicians with need to protect patient privacy along with addressing the Expectations of the
patients careers that seek medical information so that appropriate care can be provided to the
patient by the carers (Echeverría et al., 2015). It has to be mentioned in this context that the
Expectations of the patients and their careers that of the medical staff due to the emotional
investment that the carers have with their patients. In most cases the carers are either the spouse
children or close family members of the patient who is going to the critical condition, and in
these cases it is second nature for the carers to demand as much information as possible from the
medical staff so that they have a clear idea of the progress of the patient is making. Inversely the
medical staff typically follows the protocol of discussions and sharing of information with the
carers based on the patients’ clear instruction or permission (Gold et al., 2009). For the patients
in ICUs, they are rarely capable of providing conscious consent to share information which
provides in ethical to the cost of regarding whether they should be sharing information and to
what extent they are required to share information to the careless or closest family members of
the patient. In this case I believe there should be a clear understanding between the expectations
of patients and their careers with respect to the medical staff and Information sharing along with

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communication should be prompt and regular so that there is transparency and patient or family
centred care being respected throughout the care journey. Although care should be taken to
protect the patients right to privacy and confidentiality while sharing information emphasizing on
only the key information which is required by the carer or the family member to know in order to
care for the patient in the future to honour the right of the patient to confidentiality (Wilson et al.,
2015).
Part B:
Module 3:
Reporting As a student nurse with a specialty area of high dependency care in
the ICU, the concept of death and coping with the dying of a patient
under my care has always haunted my mind. This activity has
provided me the opportunity to identify a piece of literature evidence
that has advertised on the physical and emotional turmoil that care
staff has to undergo while dealing with the death of a patient in the
ICU. The evidence Donnelly and Psirides, (2018) indicates that
there is significant distress among the nurses that have to go through
the death of a patient that they have been caring for in the ICU.
Along with that comparing with the experience of the relative for
families, strong sense of emotional connection and
disenfranchisement, has been reported in nurses and doctors post
the death of a patient. The key theme identified from this literature
evidence indicates at the need for ICU protocols to be flexible when
a patient is time so that the emotional turmoil care staff of is going

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through can be addressed adequately (Donnelly & Psirides, 2018).
Responding As per my opinion, nurses are the first point of contact between the
patient and the care delivery scenario. Hence, with respect to the
therapeutic connection that a nurse is professionally and legally
bound to develop with the patients have a strong emotional
connection as well. When the same nurses are faced with the
inevitable end of a patient despite the days of comprehensive care,
the bereavement stress is no less than that of a family member.
Hence, the distress and emotional burnout affects the coping
mechanism and in turn professionalism of the care staff which in
turn might lead to various errors.
Relating Death and dying is a constant factor in Intensive Care units. ICU
represents the clinical setting for the patient struggling with one or
more than one critical chronic and acute health conditions. Often the
patients are not able to recover from the adverse health conditions
we have been suffering from and the inevitable death has a
significantly detrimental impact on the staff that has been associated
with caring for the patient (Donnelly & Psirides, 2018). The research
findings indicate at the need for a comprehensive flexibility in the
protocol post a death in the ICU so make the environment more
feasible and merciful for the care staff going through a similar sense
of bereavement as compared to the Family members. Relating the
context to my personal practice, I can state that I would appreciate a

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little less rigidity in the practice protocol after the death of a patient I
had been caring for as well in the ICU units (Ryan & Seymour,
2013).
Reasoning The mortality rate of the ICUs is 18-24% all over the globe.
Inevidently, the care staff of the ICU without a doubt faces a far
greater emotional stress of having to encounter the death of the
patient. This article has focused entirely on the emotional distress the
care staff to through and its impact on their psyche. Although, I
believe along with increasing flexibility in the practice protocol,
there is need for regular psychological screening and
psychotherapeutic support for the staff of ICU to help them cope
with the trauma effectively (Fridh, 2014).
Reconstructing This activity has given me ample opportunity to explore the issue of
death and dying in the ICU setting. This article helped me
understand the reality of the bereavement stress that I will have to
eventually undergo in my future Practice. Along with understanding
the need for advocating our right to a more flexible protocol for ICU
and psychocounseling, I have also understood the need for personal
development. I will be taking the assistance of my supervisor to
engage in soft skill development courses and workshops to improve
my coping strategies and professional competence
(Parshuram & Dryden-Palmer, 2018).

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References:
Donnelly, S. M., & Psirides, A. (2015). Relatives’ and staff’s experience of patients dying in
ICU. QJM: An International Journal of Medicine, 108(12), 935-942.
Echeverría, C. B., Goic, A. G., Herrera, C. C., Quintana, C. V., Rojas, A. O., Ruiz-Esquide,
G., ... &Vacarezza, R. Y. (2015). Some current threats to confidentiality in
medicine. Revistamedica de Chile, 143(3), 358-366.
Fridh, I. (2014). Caring for the dying patient in the ICU–the past, the present and the
future. Intensive and Critical Care Nursing, 30(6), 306-311.
Garrouste-Orgeas, M., Flaatten, H., & Moreno, R. (2016). Understanding medical errors and
adverse events in ICU patients. Intensive care medicine, 42(1), 107-109.
Garrouste-Orgeas, M., Perrin, M., Soufir, L., Vesin, A., Blot, F., Maxime, V., ... & Azoulay,
E. (2015). The Iatroref study: medical errors are associated with symptoms of
depression in ICU staff but not burnout or safety culture. Intensive care
medicine, 41(2), 273-284.
Gold, M., Philip, J., McIver, S., & Komesaroff, P. A. (2009). Between a rock and a hard
place: exploring the conflict between respecting the privacy of patients and informing
their carers. Internal medicine journal, 39(9), 582-587.
Health.gov.au (2018). Department of Health | 6.3 Confidentiality and the law. Department of
health. [online]. Retrieved from
http://www.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-

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pubs-front11-fa-toc~drugtreat-pubs-front11-fa-secb~drugtreat-pubs-front11-fa-secb-
6~drugtreat-pubs-front11-fa-secb-6-3. [Accessed on 19th Oct]
Health.nsw.gov.au. (2018). Patient Privacy. NSW Government. [online] Available at:
https://www.health.nsw.gov.au/patients/privacy/Pages/default.aspx [Accessed 19th
Oct. 2018].
Keiffer, S., Marcum, G., Harrison, S., Teske, D. W., & Simsic, J. M. (2015). Reduction of
medication errors in a pediatric cardiothoracic intensive care unit. Journal of nursing
care quality, 30(3), 212-219.
Nuckols, T. K., Smith-Spangler, C., Morton, S. C., Asch, S. M., Patel, V. M., Anderson, L.
J., ... & Shekelle, P. G. (2014). The effectiveness of computerized order entry at
reducing preventable adverse drug events and medication errors in hospital settings: a
systematic review and meta-analysis. Systematic reviews, 3(1), 56.
Parshuram, C., & Dryden-Palmer, K. (2018). Practice in Pediatric Intensive Care: Death and
Dying. Pediatric Critical Care Medicine, 19(8S), S1-S3.
Ryan, L., & Seymour, J. (2013). DEATH AND DYING IN INTENSIVE CARE:
EMOTIONAL LABOUR OF NURSES. End of Life Journal, 3(2).
Tracy, M. F., Allen, J., Davis, T. M., Barden, C., Olff, C., & McCarthy, M. (2013). Patient
Safety Issues in Critical Care. AACN advanced critical care, 24(4), 376-377.
Wilson, L. S., Pillay, D., Kelly, B. D., & Casey, P. (2015). Mental health professionals and
information sharing: carer perspectives. Irish Journal of Medical Science
(1971-), 184(4), 781-790.

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