TEN MEDICATION RIGHTS OF ADMINISTRATION IN CEREVILLE MEDICAL CLINIC

An Action Research Presented to the Faculty of the Graduate School of Health Science, Management and Pedagogy Southwestern University

In Partial Fulfillment of the Requirements for the Course Master of Arts in Nursing and Master of Arts of Nursing major in Medical-Surgical

Agravante, Keane Jim T. Arnaiz, Darwin B. Lao, Lysette A. Paulin, Irish Ann L.

September 2010

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Southwestern University Cebu City

Graduate School of Health Science, Management and Pedagogy

TEN MEDICATION RIGHTS OF ADMINISTRATION IN CEREVILLE MEDICAL CLINIC

I.

Introduction / Problem Identification: A Physician is given the Right to Prescribe Medication, but the Nurse is given

the Right to Administer the Prescribed Medication -Anonymous This saying stated above is one of the few reasons why the researchers chose to touch the field of medication administration, especially the basic knowledge of the ten (10) rights of medication administration. This practice has already been done since the dawn of the knowledge in medicine. Furthermore, as time passes by, medications becomes more and more complex, in which at times if not used or administered properly may cause different adverse effects of even death. According to the research of the World Health Organization (2008), medication error, especially in administration, is one of the leading causes of death in all levels of hospital around the world. Globally according to Braun, Inc. (2001) there are almost 770,000 accounted adverse drug injuries and death. Furthermore, in the United States of America, according to Delaune et. Al (2008), there are 1.3 million accounted death or injuries, and it is increasing annually. In terms of such cases in Asia, there are no studies or surveys that has been done or recorded. Moreover, data for the Philippines, the Region XI and of the exposed municipality are not readily available to any data base from the government or private sector. The graduate school students of Southwestern University, enrolled in the courses of Master of Arts in Nursing and Master of Arts in Nursing major in MedicalSurgical, were exposed in the municipality of Sta. Cruz, Davao del Sur. As part of their graduate school studies for administration, leadership & management, human resource and research, they have to find nursing problems based on the area stated above, and provide an action research to help alleviate the problem. Furthermore, the group assigned in leadership & management chose the Health Care Institution

Page |2 named Cereville Medical Clinic. Cereville Medical Clinic is located in the heart of the municipality. It is a Level I health care institution, with a bed capacity of 25 (19 functional, 6 under repair). They have 17 health care providers (9 physicians, 4 nurses, 3 midwives, and 1 medical technologist) and 4 office staff (one in every department: pharmacy, medical records, human resource, and laboratory). Finally, with the use of observation and interview, the researchers are much concerned and focused on the awareness of the knowledge and the use of the ten (10) rights of medication administration of the members of the health care team, especially the nurses of Cereville Medical Clinic.

II. Problem Analysis: The researchers extensively interviewed the available members of the Health Care Team of Cereville Medical Center and comprehensively observed the research locale. They have expansively discussed the problems that are sighted in the locale, and have agreed that the problem they will address will be concentrated the topic of medication error, which is covered under the ten (10) rights of medication administration, if not used religiously. They also had observed that the following factors may be the cause of the problem: The Health Care Institution doesnt have any system of official record of any negligence or malpractice that any of the members of the health care team may commit, especially on medication error. The Health Care Institution doesnt have any clear patient identification system, as government policy (e.g. Philippine Health Insurance Co.); clients admitted in any Health Care Institution should have identification bands. The Health Care Institution combined their medication area, medication storage and pharmacy. Moreover, there is a presence of a sink on that area and there is no proper medication storage device to store volatile and sensitive medications. The Health Care Professionals of the institution is over confident that such problem will not arise due to the small bed capacity that the institution has. The nurses of the institution identifies their client by stating their name not by letting the client state their name; this has already deviated by the

Page |3 standards and basic procedure as presented by B. Kozier (2009) in her book Fundamentals of Nursing.

III. Formulating Hypothesis: The researchers formulated the following hypothesis in which it will be investigated in this study: The Health Care Institution will implement a recommended system of documenting and recording any negligence or malpractice of the members of the health care team (e.g. Incident Report, etc.) The Health Care Institution will implement the use of patients tag for their client identification system. The Health Care Institution will separate their medication preparation area medication storage and pharmacy. Furthermore, the institution will provide a medication storage device that may store volatile and sensitive medicines. The Health Care Professionals will be reiterated and use the ten (10) rights of medication administration, and somehow reconsider that even if the bed capacity is not that numerous, they will be cautious in identifying their clients, especially in administering medications.

IV. Experimentation and Action: As the formulation of the hypothesis was finalized, the researchers strived to formulate an action plan that will somehow improve the medication administration and the use of the ten (10) rights of medication administration for the Health Care Professionals of the Institution. Furthermore, the researchers would like to alleviate the awareness of knowing the ten (10) rights of medication administration for the Cereville Medical Clinic, this is to avoid any presence of incidence of medication error. Thus, the following statements are the plans that they have implemented: There shall be a compulsory implementation of documentation methods for any negligence or malpractice of the members of the health care team. One example that the researchers recommend is the use of the Incident Report

Page |4 and an Incident Report File Case, which will be reported to the ethics committee of the institution. There shall be a creation of an Ethics Committee on who will deal on all the negligence and malpractice of the members of the health care team. The members of this committee are members of the health care team, and have good experience and judgment in dealing with negligence and malpractice. Furthermore, the committee shall provide a list of penalties for all the different kinds of negligence and malpractice of the institution, and it should be flexible enough for both members of the health care team and the clients. The Health Care Institution will provide the clients a patients tag or any similarities that will somehow be attached to the client upon admission until discharge. It shall be made out of something that could be conveniently located for inspection, but will not be easily detached to the body or may fadeout within a few days of use. The researchers highly suggest in removing the sink or better yet transferring the medicating area to a more convenient and less hazardous area of the clinic. Furthermore, a presence of a sink near the medicating area may increase the incidence of contamination of the available medication (Kozier, 2009). The researchers also propose that there should be an obvious separation between the pharmacy and the medicating area. Nonetheless, the pharmacy and the medication storage may be merged in to one facility, but there should be an obvious division of these two areas. This is to facilitate any future missed match of available medication for the admitted clients and the for sale medication for the outpatient department clients. The researchers also recommend that the institution should provide an exclusive medication storage device (e.g. specialized medication refrigerator) for their medications, especially the volatile and sensitive ones. The members of the health care team, especially the nurse, should undergo seminars that would reiterate and enhance their knowledge and skills in administering medications to their client. Furthermore, those seminar units may be also used for their renewal of their licenses as to be credited in their

Page |5 Continuing Education for Professionals, which is also mandatory as

implemented by the law (Venzon, 2010). It should be reminded that, they should have at least followed somehow to the near ideal or innovative ways in which the ten (10) rights of Medication Administration will still be followed and it should be a posted somewhere near the station in which it can be easily seen by all members of the Health Care Team. To stress out the ten (10) rights are the following Rights: Client, Drug, Dose, Time, Route, Refuse, Assessment, Documentation, Education, and Evaluation (Balita, 2010).

V.

Evaluation: The researchers believe that if the basics in the fundamentals of drug

administration, especially the ten (10) rights of medication administration, will be observed then it could have somehow alleviated the problem that was spotted in the health care institution. Additionally, the measures suggested by the researchers will be done, and then the health care institution will achieve good projection in their on-going accreditation and licensure from the government crediting agency. Furthermore, it presents that if the members of the health care team will pursue or have the initiative to review their fundamentals, especially in giving care to their clients, then they could have at least followed what is being prescribed and somehow alternatively applied it to their institution.

VI. Conclusions and Recommendations: The researchers agree that following basic protocols are very important in giving health care services, no matter what category is a health care institution is. Thus, they suggest that there should be a strict observation in following the recommendations above, since it is part of the protocol that is being set in the laws stated for hospital licensure and insurance accreditation. Furthermore, the members of the health care team of the institution may have known the protocols, but have not adjusted and implemented it to the institution. Since, upon the researchers visit to the institution, and they are still having renovations, and plans

Page |6 were set to revise the system, such plans are in accordance to the suggestion that the researchers made. The researchers agree that the institution will pass the licensure and accreditation with flying colors. Additionally, the following are the conclusions and recommendations made by the researchers based on the formulated hypothesis: The Health Care Institution reviewed its institutional protocol and suggested that they will strengthen their own documentation records especially of the staff negligence and malpractice actions. Furthermore, they have applied the Incident Report in their protocol, and will be implemented upon the day of the government inspection for their licensure and accreditation. The Health Care Institution also implement the use of patients tag for their client identification system. Furthermore, the members of the health care team also reiterated that whenever they will administer medications they will ask what is the name of the client which they will reconfirm it with the use of the client identification band that is placed on the wrist of the client. The Health Care Institution revised their medication preparation room. They have revised it in a way that the sink will be removed from the area in which it will not contaminate the medications. Furthermore, the institution also has acquired a medication storage device in which it will somehow maintain the medication in its prescribed storage setting. A bulletin reminder of the ten (10) rights of medication administration was posted on the side of the medication preparation room for them to be reminded on the use of such rights in administering medications to their clients. Furthermore, if the institution will not somehow follow the researchers suggestion, then their chance of having the renewal of licenses and accreditation from the government will not be approved. Thus, better yet follow the recommended action plan that was suggested to alleviate the problem and reach the goal upon inspection of the authorities.

Page |7 Reference: Manuscript Sources: Balita, C., et. Al. (2010). The Ultimate Learning Guide to Nursing Review. Manila: Trimega Printing House & Co. Berman, A., et. Al. (2009). Fundamentals of Nursing: Concepts, Process and Practice. Singapore: Pearson Education, Inc. Cuevas, F., et. Al. (2007). Public Health Nursing in the Philippines 10th Edition. Philippines: National League of Philippine Government Nurses Delaune, S., et. Al. (2008). Fundamentals of Nursing: Standards and Practice, 3rd Edition. San Diego, California: Thomson and Delmar Learning, Inc. Henderson V. (1966). The Nature of Nursing. New York: Macmillan Publishing Maglaya, A. (2005) Nursing Practice in the Community 4th Edition. Marikina City: Argonauta Corp. Roper, N., et. Al. (2001). The Roper-Logan-Tierney Model of Nursing: Based on Activities of Living. Edinburgh: Elsevier Health Sciences. Taylor, C., et. Al. (2008). Fundamentals of Nursing: the Art and Science of Nursing Care. Philadelphia: Lippincott, Williams and Wilkins Venzon, L., et. Al. (2010). Professional Nursing in the Philippines 10th Edition. Philippines: C&E Publishing House, Inc. Electronic Sources: Braun Service Philippines, Incorporated Department of Health, Philippines Google Books Philippine Health Insurance Corporation Proquest Scribid World Health Organization