Medication Management by Freshly Graduate Nurse - Reflective Writing

This reflective writing discusses the challenges faced by newly graduate nurses in medication management and how to overcome them. It covers topics such as medication errors, documentation, clinical handovers, and more. The author emphasizes the importance of evidence-based research, proper assessment of patient history, and using technologies for monitoring and documentation. The article also highlights the significance of collaboration with other healthcare professionals and patient education.

Running head: MEDICATION MANAGEMENT BY FRESHLY GRADUATE NURSE
MEDICATION MANAGEMENT BY FRESHLY GRADUATE NURSE
Name of the Student
Name of the university
Author’s note

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MEDICATION MANAGEMENT BY FRESHLY GRADUATE NURSE (REFLECTIVE
WRITING)
Medication management can be defined, as a patient specific care to optimize effective,
safe and suitable drug therapy. A patient is provided with care, with the collaborative action of a
multidisciplinary team. Registered nurses (RNs) are one of the important members of the
multidisciplinary team that influence a safer management of medications. As a new graduate
nurse I have received elementary knowledge about medication management through our entire
nursing program, yet I have faced with several new challenges while making a transition from
the university ambience to a clinical setting (Cheragi et al., 2013). As a nurse I should be able to
apply my knowledge about the patient and the medications. The process of nursing is not a very
linear process. A continuous assessment is being done at all the stages of the medication
management (Mirbahaet al., 2015). Newly graduate nurses are inexperienced; hence, it can be
difficult for them to monitor the medication protocol of a patient.
Apart from the types of drugs that have to be delivered, the correct method of drug
administration also plays a pivotal role in patient's safety. Nurses play a very significant
responsibility in the prevention of the medication errors. Most of the time, this is caused due to
the clinical personnel failing to do his duty correctly (Cheragi et al., 2013). Some of the common
medication errors that can, be caused by the registered nurses are omissions, administering
wrong drugs or wrong dosage of drugs, improper methods of delivery and wrong prescriptions. It
has to be noted that the work load, the responsibilities in a proper clinical setting is far more than
the student workload, exams, and placements, which can be some of the main causes of
medication errors (Keers et al., 2013). Newly graduated nurses are encountered with problems
like lack of pharmacological information, lack of monitoring of the pre- administered drugs. I

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have come across one of my peers, who forgot to find out history of the adverse drug reaction in
a concerned patient.
When a nurse is undergoing training, the last thing that they are concerned is about the
documentations. there are few things that has to be kept in mind while charting for a patient-
Proper documentation of the drug administration and the doses, records of any discontinued
medications, records about drug allergy (Campbell et al., 2012)(if any).
I have grown and have developed skills through my personal experience placement so
that I can think, collect and foster a safe medication management. The correct procedures of safe
medication administration involve maintenance of an electronic medical record. In my nursing
course I have learned that liquid medications are measured by standard measuring containers.
Notably, while splitting the tablets, it should be ensured that the medications are scored by the
manufacturer and the medication is splitted evenly. According to Campbell et al., (2012), it is
important to carry out the some assessments before the application of certain medications. I have
learnt that it is necessary to monitor the heart rate before the administration of antidysrhythmic
medications. The duty of a nurse does not end with this. It is necessary to monitor the response
of the patients to the medications, especially when we are applying the medications for the first
time. In my learning career I have also learned about the importance of recording the site of
injections. For high alert medications, it is essential to double check the doses. The Australian
commission on safety and quality in health care (ACSQH) has developed medical charts in order
to standardize the medication management and increase medication safety. There are separate
medication charts for the paedriatics, aged care and more. I have always tried to keep an eye on
these charts in order to develop my pharmacological skills.

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The NSQHS safety standard 4 for the medication errors in nursing ensures that the nurses
safely administer medications to the patients. In order to meet the standard, the frame work
proposes that it is essential to document the medication allergies and previous anaphylactic
reactions (Flanigan, 2016).
I have faced problems related to the administration of the intravenous medicines. In
accordance with my problem I would like to share that Ohasi et al., (2014) have proposed that
Intravenous application of medications involve a lot of complexities and preparations. The
reports by Campbell et al., (2012), shows severe patient harm related to intravenous medications.
It was found that most of the intravenous errors are due to the wrong intravenous rates, wrong
volume and mixtures and drug incompatibility, previously I faced challenges in the preparation
of the intravenous medications. Later on I have learned to check the medication standards
provided in the Australian Injectable drugs handbook (AIDH).
I should mention that the problems I encountered regarding the IV, during my learning
career were much different from those in the actual clinical setting. In order to ensure a safe
management of medications, a nurse should undergo extensive research to practice evidence
based practice and should have an avid knowledge of pharmacology, pharmacokinetics (Kim &
Bates, 2013). From the problems, I have realized that it is very important for a nurse to have a
foundational knowledge regarding human growth and development, physiology, human
anatomy, nutrition and more. Surprisingly, the mathematical skills will probably help one out in
the dosage calculations (Ohasi et al., 2014). According to the NMBA standard of nursing, nurses
should indulge in critical thinking and clinical judgment while planning the drug dosage
(Flanigan, 2016).

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Another thing that most of the new nurses are encountered with the catheter related medication
errors (Kim & Bates, 2013). Most of the errors that are caused by nursing students are related to
intravenous tubing. Like any other fresh students, I am faced with problems related to the
catheter tubes. Reports related to tube catheter misconnection involve a number of devices, such
as peripheral intravenous, central venous, peritoneal dialysis).
According to Alsulami et al.,(2012), a nurse should be able to support and advocate
patient education regarding the adherence to medication regime. I have tried my best to have a
transparent knowledge regarding pathophysiology and pharmacology, so that I am able to deliver
a proper instructions and knowledge to the patient.
One of the important aspects of becoming a successful nurse is self regulation.
Medication error can arise due to improper documentation and reporting of the health care errors.
Verbal, written or other forms of communication for recording the near misses are one of the
crucial initiatives from the side of nurses.
I have gained efficiency in preparing ISBAR, clinical handovers. Clinical handover plays a
major role in error prevention (Simonsen et al., 2014). A proper clinical handover are intended as
the handing over of responsibilities from one health care professional to the other. It helps in
mitigating the medication related errors. It helps the person in the next shift to get an overall idea
of the patient history and the undergoing medications. In my degree course I have gained
knowledge regarding the medication reconciliation of each and every patient. As stated by Haw
et al., (2014), medication reconciliation consists of three steps: - First is verification. I have
always learned to verify the medication history of the patients, including the current medications,

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herbal or alternative therapies and more. It is important to get it clarified from the physician
charge that all the doses are correct (Simonsen et al., 2014). The RN investigates, disseminate
and document any further changes. As a freshly graduate nursing student I may make medication
errors, but I should not deter to inform the higher authority regarding my mistake, as we know
that medication error can be as lethal as death (Alsulami et al., 2012).
An RN should be able to work together with the families, patients and the care providers
for ensuring comprehensive and accurate medications. It is required that all the medications of a
particular patient are reviewed in order to ensure that appropriate medications are added,
changed or stopped (Parry et al., 2015).
It is not that everyone should apply for a transition to practice, however they can motivate
a nurse to strive more in his professional practice. It is important for ensuring a consistent,
transparent and equitable process for the management of transition to practice nurses. This
transition to practice can be done in any clinical setting .It helps a nurse to develop her inter
professional skills.
I am well aware of the fact that medication error may lead to adverse drug reactions,
which can bring about life threatening conditions in patients. Since, a collaborative care is not
possible as long as I do not make any interaction with the other members of the collaborative
team, it is better that I consult with my peer and my senior nurses in case of complicated
situations. I should be able to work with the health care agencies for identifying the individual
risk factors and implement a proactive measure for decreasing the medication errors.

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Each of these challenges is problematic for a newly graduate nurse. Proper help and
guidance from the senior nurses and the peers can help the new nurses for a successful transition
in to a new working environment. In conclusion it can be said as a graduate nurse, I can manage
the medication challenges by practicing evidence based research work against pharmacology,
proper assessment of the patient history and the current conditions, including the vital signs.
Other things that I should keep in mind are proper clinical handovers, documentation, using
technologies for monitoring and documentation. The nursing frameworks will also help me to
overcome my fears.

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References
Alsulami, Z., Choonara, I., & Conroy, S. (2014). Paediatric nurses’ adherence to the double
checking process during medication administration in a children's hospital: an
observational study. Journal of advanced Nursing, 70(6), 1404-1413.
Campbell, R. L., Bellolio, M. F., Knutson, B. D., Bellamkonda, V. R., Fedko, M. G., Nestler, D.
M., & Hess, E. P. (2015). Epinephrine in anaphylaxis: higher risk of cardiovascular
complications and overdose after administration of intravenous bolus epinephrine
compared with intramuscular epinephrine. The Journal of Allergy and Clinical
Immunology: In Practice, 3(1), 76-80.
Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes
of medication errors from nurse's viewpoint. Iranian journal of nursing and midwifery
research, 18(3), 228.
Flanigan, K. (2016). NSQHS standard-patient identification. ACORN: The Journal of
Perioperative Nursing in Australia, 29(1), 23.
Haw, C., Stubbs, J., & Dickens, G. L. (2014). Barriers to the reporting of medication
administration errors and near misses: an interview study of nurses at a psychiatric
hospital. Journal of psychiatric and mental health nursing, 21(9), 797-805.
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Prevalence and nature of
medication administration errors in health care settings: a systematic review of direct
observational evidence. Annals of Pharmacotherapy, 47(2), 237-256.
Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to
guidelines. Journal of Clinical Nursing, 22(3-4), 590-598.

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Kim, J., & Bates, D. W. (2013). Medication administration errors by nurses: adherence to
guidelines. Journal of Clinical Nursing, 22(3-4), 590-598.
Mirbaha, F., Shalviri, G., Yazdizadeh, B., Gholami, K., & Majdzadeh, R. (2015). Perceived
barriers to reporting adverse drug events in hospitals: a qualitative study using theoretical
domains framework approach. Implementation Science, 10(1), 110.
Ohashi, K., Dalleur, O., Dykes, P. C., & Bates, D. W. (2014). Benefits and risks of using smart
pumps to reduce medication error rates: a systematic review. Drug safety, 37(12), 1011-
1020.
Parry, A. M., Barriball, K. L., & While, A. E. (2015). Factors contributing to Registered Nurse
medication administration error: A narrative review. International journal of nursing
studies, 52(1), 403-420.
Simonsen, B. O., Daehlin, G. K., Johansson, I., & Farup, P. G. (2014). Differences in medication
knowledge and risk of errors between graduating nursing students and working registered
nurses: comparative study. BMC health services research, 14(1), 580.
Weeks, K. W., Hutton, B. M., Young, S., Coben, D., Clochesy, J. M., & Pontin, D. (2013).
Safety in numbers 2: competency modelling and diagnostic error assessment in
medication dosage calculation problem-solving. Nurse education in practice, 13(2), e23-
e32.