Nursing Clinical Experience: Reflection on Safety and Quality

This essay reflects on critical clinical nursing experiences in the context of National Safety and Quality Health Service Standards (NSQHS). The first reflection discusses a near medication error involving a patient with liver cirrhosis, emphasizing the importance of reviewing patient medication history and consulting with doctors before administering drugs. The experience highlights the role of nurses in preventing adverse health outcomes and the need for proper documentation using systems like CPOE and EMR. The second reflection analyzes a clinical handover situation in the cardiac department where incomplete information could have led to dietary errors for a patient with congestive heart failure. This underscores the significance of thorough, face-to-face or written handovers to ensure patient safety and prevent misunderstandings. The essay concludes by reinforcing the importance of adhering to NSQHS standards to minimize medical errors and improve patient care.

Running head: NURSING EXPERIENCE
Nursing Experience
Name of the Student
Name of the University
Author Note

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Reflection 1:
One clinical nursing experience of mine which is relevant to the standards of National
Safety and Quality Health Service Standards (NSQHS) (2012) is medication safety.
According to Australian Commission on Safety and Quality in Health Care (2012), medicines
are widely accepted of treatment in healthcare. However, medicines are related to with
massive medical errors and this error is associated with increase in the adverse health
outcomes of the patients along with the increase in the overall healthcare cost.
During my clinical placement in the emergency department, I encountered an event of
medication error. The patient was suffering from high fever. I was a trainee nurse and I was
asked to go for a round in the emergency ward to check the health status of the patients.
While on the round, I spotted that one patient who was admitted with leg ulcer was suffering
from high level with temperature 39 degree Centigrade. Recording the condition, I
immediately notified my reporting registered nurse that patient (patient A) is having high
fever I think he immediately needs a dosage of paracetamol. When my registered nurses
asked me what is the dosage I think is preferable for him, I immediately replied high
paracetamol dosage for immediate relief from the fever, which is arising from inflammation
or wound infection due to leg ulcer. However, my registered nurse highlighted that high
dosage of paracetamol is detrimental for Patient A as he is also a patient for liver cirrhosis.
According to Imani et al. (2014) paracetamol is safe for the patients with severe liver disease
but a lower dosage of paracetamol (2gm/day) is suggested for the long-term use. My
registered nurse under whom I was working also helped me to understand that before
prescribing any medication to the patient; it is the duty of the nursing professional to consult

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with the reporting doctor while accessing the patient medication history in detail. This helped
to reduce the chances of medication error.
This clinical experience helped to understand the importance of the maintaining a
detailed medicine history of the patient and at the same time saved me from conducting a
medication error. The NSQHS highlighted that it is the duty of the clinical workforce to
document and review patient’s medication history. This helps to avoid the episodes of
medication error and adverse health outcomes. In order to increase the access of the patient’s
medication history, Radley et al. (2013) highlighted that importance of the computerized
physician’s order entry system (CPOE) and proper documentation of the patient information
in the electronic medical records (EMR).
Reflection 2:
One clinical nursing experience of mine relevant to the national safety and quality
service standard is the clinical handover. Clinical safety handover refers to the procedure
where professional responsibility of one person in all aspects for the patient transfer to
another person or professional group on a temporary (Anderson et al., 2015). It is an essential
part has impact on the health care centers.
When I was posted to the cardiac department of the royal hospital of Australia, I
encountered such clinical error due to the improper way of clinical handover. My fellow
coworker’s shift was about to end. She was taking care of a 52 years female patient who was
diagnosed with Congestive pulmonary heart failure. Approximately, 1 to 2 hours after shift
time she came to me and told me about the patient and severity level of the disease. She

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requested me that I should take care of the patient since her shift is about to end and nobody
is in the in charge of the patient. She was unable to leave and her mother was sick so she had
to go immediately after shift time. Considering the situation, I took the responsibility of the
patient, and she gave me the sharp details of the patients enough for taking care of the patient
at night. After providing the details of the patient, she left and I was alone. However, she did
not offer me any chart of diet that what to contribute to the patient. Therefore, when I went to
the room of the patient, she was in sitting position, talking to her family members. Assuming
that she was hungry, I was about to give her salty snacks containing sodium. However, my
registered nurse under whom I was working helped me to understand the importance of
clinical handover. In clinical setting, it was my duty to properly understand the responsibility
and take the responsibility in front of the patient and family members.
The clinical experience saved me to understand the importance of clinical handover
such as it should be faced to face or via written orders in order to avoid any misunderstanding
(Manias et al., 2016). This helps to prevent the Current handover processes are highly diverse
in Australia and may be unreliable process where clinical handover considered as the high-
risk area for the safety of the patient (Sujan et al., 2015). Therefore, the proper documentation
of clinical handover reduces the chances of any medical errors.

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References
Anderson, J., Malone, L., Shanahan, K., & Manning, J. (2015). Nursing bedside clinical
handover–an integrated review of issues and tools. Journal of Clinical Nursing, 24(5-
6), 662-671.
Australian Commission on Safety and Quality in Health Care (2012). National Safety and
Quality Health Service Standards (NSQHS). Access date: 5th September. Retrieved
from: https://www.safetyandquality.gov.au/wp-content/uploads/2011/09/NSQHS-
Standards-Sept-2012.pdf
Imani, F., Motavaf, M., Safari, S., & Alavian, S. M. (2014). The therapeutic use of analgesics
in patients with liver cirrhosis: a literature review and evidence-based
recommendations. Hepatitis monthly, 14(10).
Manias, E., Geddes, F., Watson, B., Jones, D., & Della, P. (2016). Perspectives of clinical
handover processes: a multi‐site survey across different health professionals. Journal
of clinical nursing, 25(1-2), 80-91.
Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., &
Bradshaw, B. (2013). Reduction in medication errors in hospitals due to adoption of
computerized provider order entry systems. Journal of the American Medical
Informatics Association, 20(3), 470-476.
Sujan, M. A., Chessum, P., Rudd, M., Fitton, L., Inada-Kim, M., Cooke, M. W., & Spurgeon,
P. (2015). Managing competing organizational priorities in clinical handover across

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organizational boundaries. Journal of health services research & policy, 20(1_suppl),
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