NRSG367 Assessment 2 Reflection Report: Patient Safety in Nursing

This report is a reflection on two nursing clinical experiences, focusing on the application of the National Safety and Quality Health Service (NSQHS) Standards to enhance patient safety. The first experience involves a medication error where a patient exhibited an allergic reaction to penicillin. The report analyzes the incident using the 5R's reflection model, discussing the nurse's initial apprehension, the importance of accurate medical history documentation, and the need for adherence to medication administration protocols. The second experience centers on a communication error during clinical handover, where a patient's hypertension was not documented. The reflection examines the impact of this oversight, the importance of reassessing vital signs, and the role of effective communication in preventing adverse patient outcomes. The report emphasizes the importance of continuous learning, training, and adherence to NSQHS standards to improve nursing practice and ensure patient well-being.

Running head: NRSG367 ASSESSMENT 2 REFLECTION
1
NRSG367 ASSESSMENT 2 REFLECTION
Title page
Student Name:
Semester 2, 2019
Word count:

NRSG367 ASSESSMENT 2 REFLECTION 2
Introduction
Being front line health professionals, focusing on the serving unique needs
of human being and supporting their wellbeing by providing the best possible care is the
prime function of nurses. The common practice in this field requires not only scientific
knowledge but also interpersonal skills, effective communication skills, technological
abilities and empathetic (Desborough et al., 2016). In this context, professionals cannot
be termed as negligent since it will not only breach the duty of care but also question
patients safety (Www.safetyandquality.gov.au, 2019). Hence, this paper aimed to reflect
on past nursing clinical experiences to improve practice and understanding relating to
patient safety.
Body:approximately 800 words +/- 10%
Industry standard 1: Medication Safety Standard
Medications are most frequently used in health care which further increase high
incidents of errors and questions safety of patients. In this case, the Australian
Commission on Safety and Quality in Health Care designed National Safety and
Quality Health Service Standards to prevent possible medication errors that cost lives
of more than a thousand patients (Www.safetyandquality.gov.au, 2019).

NRSG367 ASSESSMENT 2 REFLECTION 3
o Reporting : During my clinical placement, I have encountered a patient
who came to the emergency department due to throat infection which was
making him uncomfortable and he was agitated. To reduce his discomfort,
I administrated penicillin and then started taking medical history.
Immediately after 1 hour of administration, the patient started
exhibiting allergic reaction to the medication such as rashes, hives, and
itchy eyes. I contacted my supervisor and he injected anti histaminase.
o Responding: Initially, I was apprehensive and nervous while I examined
the allergic reaction of the patient. I contacted my supervisor regarding the
allergic reaction and reported the allergic reaction. He injected anti
histaminase.
o Reasoning: According to Romano et al. (2018), a significant number of
patients are allergic to the drug when their immune system
is hypersensitive. In this case, the immune system mistakenly reacts to
the drug as a harmful substance as if it is a viral or bacterial infection. This
is called type I hypersensitive reaction where IgE mediated release of
histamine was observed from mast cells which further caused an allergic
reaction (Trautmann & Wurpts, 2018).

NRSG367 ASSESSMENT 2 REFLECTION 4
o Relating: the patient was allergic to penicillin drug which already he had
experienced before. While he arrived in the emergency, as a nurse, it was
my responsibility to document the medical history of the patient and then
administrate possible medication for reducing the discomfort according to
NSQHS standard 4 (Www.safetyandquality.gov.au, 2019). However, for
reducing discomfort I administrated medication first then took medication
history which resulted in an allergic reaction in patients and patient
exhibited reactions such as rashes, hives and itchy eyes.
o Reconstructing: From the above incident, it can be concluded that being
a professional it is my responsibility to document the medical history and
administrate medication. However, while I was empathetic, I failed to
document history and unaware of reaction which further affected my
clinical practice. In the future, in order to improve future practice, it is
crucial to involve in the training and workshops and incorporate “7 rights”
of medication administration (Smeulers et al., 2015). Moreover, I will seek
the assistance of my supervisor to guide me with in appropriate nursing
practice according to the National Safety and Quality Health Service
Standard 4 which ensure appropriate medication administration.
Industry standard 2: Communicating for Safety Standard

NRSG367 ASSESSMENT 2 REFLECTION 5
While transferring professional’s responsibility it is crucial for professionals to
document each relevant information of the patient and handover to another professional
(van Sluisveld et al. 2015). For safe transfer of patient care effective handover
between two professionals is crucial which aimed to achieve effective communication
during patient care (Wainwright & Wright, 2016). However, during the transfer of
responsibility, high incidents of errors are common. One such incident is provided
below.
o Reporting: during my clinical placement, I have encountered a situation
where I was appointed to take care of a patient with diabetes. During
clinical handover, my coworker gave me all the details of the patient in the
form of a document which showed no sign of hypertension. However, after
lunch when I checked her vital signs, I saw her blood pressure was 140/80
and the patient said she had mild hypertension but it increased last
night, my coworker failed to document it. The lunch she had must have
salt which increased her blood pressure. I contacted my supervisor
regarding it and the supervisor immediately instructed me to give her beta-
blocker.
o Responding: Initially, I was apprehensive and nervous while I examined
the vital signs of the patient as no documentation of hypertension were
observed but patient vital status exhibited hypertension. I contacted my

NRSG367 ASSESSMENT 2 REFLECTION 6
supervisor regarding hypertension and reported the discrepancy in clinical
handover. He instructed me to give her a beta-blocker.
o Relating: Campbell et al. (2016), suggested that consuming salt increases
the sodium in the bloodstream and reduce the capability of the kidney to
eliminate the water. The high blood pressure is due to the extra fluid and
strain of the blood vessels leading to the kidney. Moreover, diabetes and
hypertension are interrelated as diabetes already affect the kidney and
consume of salt increases the fluid retention in the body. Consequently
patient experience hypersensitivity. The beta blocker
o Reasoning: The patient was mild hypertensive and her hypertension
was visible previous night. However, while it is the responsibility of the
nurse to monitor health status to check all information of clinical handover,
my coworker failed to document it according to NSQHS standard 6
(Www.safetyandquality.gov.au, 2019). It was my responsibility to reassess
vital status and then alter the diet of the patient. Consuming diet
containing salt increases the vital signs and affected her wellbeing.
o Reasoning: From the above incident, it can be concluded that being a
professional it is my responsibility to reassess vital signs to identify
changes in the health status which is different from the clinical handover.
However, I was unaware of hypertension and failed to assess the vital
signs before lunch and discrepancy in clinical handover which affected my
clinical practice. In future, in order to improve future practice, I would
involve myself in the training and workshops regarding proper

NRSG367 ASSESSMENT 2 REFLECTION 7
documentation and I will seek help from my supervisor regarding me
inappropriate nursing practice according to National Safety and
Quality Health Service Standard 6 which ensure appropriate clinical
handover. Beta blocker blocks the effects of the hormone epinephrine
and facilitate slow pumping of heart (Wiysonge et al., 2017).
o Reconstructing: From the above incident, it can be concluded that being
a professional it is my responsibility to reassess vital signs to identify
changes in the health status which is different from the clinical handover.
However, I was unaware of hypertension and failed to assess the vital
signs before lunch and discrepancy in clinical handover which affected my
clinical practice. In future, in order to improve future practice, I would
involve myself in the training and workshops regarding proper
documentation and I will seek help from my supervisor regarding me
inappropriate nursing practice according to National Safety and
Quality Health Service Standard 6 which ensures appropriate clinical
handover.

NRSG367 ASSESSMENT 2 REFLECTION 8
Conclusion
Thus, to conclude it can be said that serving the unique needs of human being
and supporting their wellbeing is the prime function of nurses. To provide best possible
care to the patients according to National Safety and Quality Health Service Standards,
every nurse were required to involve themselves in training and workshop as well as
reflective practice to ensure safety and quality to the patients.

NRSG367 ASSESSMENT 2 REFLECTION 9
References
Campbell, N. R., Correa‐Rotter, R., Cappuccio, F. P., Webster, J., Lackland, D. T.,
Neal, B., & MacGregor, G. A. (2015). Proposed nomenclature for salt intake and
for reductions in dietary salt. The Journal of Clinical Hypertension, 17(4), 247-
251.
Desborough, J., Bagheri, N., Banfield, M., Mills, J., Phillips, C., & Korda, R. (2016). The
impact of general practice nursing care on patient satisfaction and enablement in
Australia: A mixed methods study. International journal of nursing studies, 64,
108-119.
Romano, A., Valluzzi, R. L., Caruso, C., Maggioletti, M., Quaratino, D., & Gaeta, F.
(2018). Cross-reactivity and tolerability of cephalosporins in patients with IgE-
mediated hypersensitivity to penicillins. The Journal of Allergy and Clinical
Immunology: In Practice, 6(5), 1662-1672.
Smeulers, M., Verweij, L., Maaskant, J. M., de Boer, M., Krediet, C. P., van Dijkum, E.
J. N., & Vermeulen, H. (2015). Quality indicators for safe medication preparation
and administration: a systematic review. PLoS One, 10(4), e0122695.
Trautmann, A., & Wurpts, G. (2018). Penicillin allergy–recommendations for diagnostic
work up and patient management. Allergo Journal International, 27(4), 107-113.
van Sluisveld, N., Hesselink, G., van der Hoeven, J. G., Westert, G., Wollersheim, H., &
Zegers, M. (2015). Improving clinical handover between intensive care unit and

NRSG367 ASSESSMENT 2 REFLECTION 10
general ward professionals at intensive care unit discharge. Intensive care
medicine, 41(4), 589-604.
Wainwright, C., & Wright, K. M. (2016). Nursing clinical handover improvement
practices among acute inpatients in a tertiary hospital in Sydney: a best practice
implementation project. JBI database of systematic reviews and implementation
reports, 14(10), 263-275.
Wiysonge, C. S., Bradley, H. A., Volmink, J., Mayosi, B. M., & Opie, L. H. (2017). Beta ‐
blockers for hypertension. Cochrane database of systematic reviews, (1).
Www.safetyandquality.gov.au/ (2019). [online] Safetyandquality.gov.au. Available at:
https://www.safetyandquality.gov.au/sites/default/files/migrated/NSQHS-
Standards-Sept-2012.pdf [Accessed 22 Aug. 2019].