A team can be best defined as “a small number of people with complementary skills, committed to a common purpose, performance goals and approaches for which they hold themselves mutually accountable” (Katzenbach & Smith, 1993, p. 46). A healthcare organization can achieve success only when every member of the team works collaboratively as a unit and understands the context of the teamwork to the greatest degree possible. Intensive care unit is a high risk area of health care, which needs a high-functioning, cohesive, and coordinated team to deliver safe and effective care to the patients. Lack of efficient teamwork among and between the teams of caregivers could result in serious patient safety consequences (Borkowski, 2015). Moreover, there …show more content…
are many barriers that hinder the team’s performance. The main identified barriers are lack of management support, lack of resources, lack of leadership, and lack of training (Borkowski, 2015). Among these improper assignment of responsibilities and inadequate skills development training are the significant issues identified in the case of novice nurse. Firstly, there was no proper assignment of roles and responsibilities among the team members in intensive care unit (ICU).
Team coordination could be the best solution to prevent such medication errors. When Lawanda was assigned a duty in the ICU to give physician ordered medications to the patient, it would be the duty of other nurses in the team to check whether the things in medication drawer are properly arranged and also to recheck the appropriate medication before handing it over to Lawanda. This lack of coordination and improperly assigned duties among team members finally lead to death of the patient. The issue clearly shows that not Lawanda alone, but it is the team that is responsible for the medication error. Balanced participation and sharing responsibilities equally among the team members to achieve the tasks would help resolve this issue (Gordon, …show more content…
2002). Moreover, Lawanda was the only nurse who was assigned to take care of the 2 clients in the ICU. It was not correct to assign Lawanda too much responsibility who has only limited experience. An inter-professional teamwork is required to improve the quality of patient management in critical settings of high-risk areas like ICU. It always requires the presence of experienced specialists, physicians, and nurse practitioners to save the life of patients in life-threatening conditions. The most important barrier in teamwork here might be inappropriate ratio of workforce to workload. The error would not have occurred if an experienced senior nurse and a trained nurse assistant were there to help and guide Lawanda in ICU. The nurse supervisor has to reduce the workload by assigning the work equally among team members. Efficient teamwork usually reduces physical and mental stress resulting from the workload. The second significant issue was the inadequate skills development training to the team.
Every member of the team must possess three important complementary skills needed to perform his or her job which includes technical and functional, problem solving, and interpersonal skills (Katzenbach & Smith, 1993). It was before the completion of effective training program, Lawanda was assigned a stressful work. So, she did not possess adequate knowledge of necessary technical and functional skills, problem-solving, and interpersonal skills to handle the situation as she was a recent graduate and her training program was not finished at the time when she was assigned that
duty. Teamwork training should attempt to minimize the potential for error by training each team member to respond appropriately in acute situations. Lawanda without any considerable thought, in a haste to save the life did not respond properly to the situation which ultimately lead to a error. Implementation of practice guidelines, and policies by the management to educate and train the staff to work as a team when dealing with emergency situations would help resolve this issue. Furthermore, effective leadership would have improved the teamwork. The leader has to be influential and collaborative (Borkowski, 2015). It is the responsibility of the leader to implement strategies that strengthen the team through training, and ensure appropriate number and qualifications of team members are available.
...estions if not 100% sure of something or use a double checking system. When a nurse is administrating medication, they should use the ten rights of medication administration (right patient, right drug, right route, right time, right dose, right documentation, right action, right form, right response, and right to refuse). Nurses should always keep good hand hygiene and always wear appropriate clothing to prevent from the spread of disease. Good communication with patients and healthcare team members is also key to success. Keeping on the eye on the patient within an appropriate time is important. If the patient ever seems to be looking different than their usual self vitals should be taken immediately. Encouraging patients to ask questions if they are unaware of something can prevent errors as well. Nurses should make sure the patient is on the same page as they are.
In addition to having a specific objective assign and a clear role every team member should have the proper education that allows her to complete the assign task(s). Also an open and constant communication within team members is important, since the feedback from each other can help to the growth of knowledge of each of the team members as an individual, as well as it helps to resolve any issues or errors found within the interdisciplinary care model. Another important characteristic of a team member is the ability to be able to provide support to other team members even if this means taking on extra workload for a short-term period, while the other team member stabilizes herself and becomes available to take over the assignments left
Most undergraduate nursing students are not being properly educated on proper medication administration. Clinical instructors and registered nurses need to be updated on medication administration reporting, so students do not develop bad habits when they become registered nurses. Registered nurses must also continue their education on med error prevention to prevent future errors. Another significant problem with registered nurses was that they did not have positive attitudes when reporting an error. Once these negative attitudes were changed, more errors were reported (Harding & Petrick, 2008). The three main problems that cause medication errors...
In today’s health care organizations, fewer and fewer individuals are working as solo practitioners ; instead, health care is increasingly delivered through teamwork, and teams are a vital component in health care organizations(McConnell,2006). Bauer and Erdogen (2009) define a team as a “cohesive coalition of people working together to achieve mutual goals”. (p.213). According to McConnell (2006) , teams are united by a shared purpose , regardless of the team’s type, composition, degree of performance, or reason for being. In health care organizations, teams are utilized by leaders to address problems and perform tasks. McConnell (2006) states that teams can benefit the organization because they provide greater expertise, enhance morale, improve personnel retention, increase flexibility, and create synergy in the workplace..
Medication Errors one of the biggest issues happening in an acute care setting today . Although, Medications are given based on the five rights principles: the right patient, right medication, right route, right dose, and right time. Even with the five rights principles medication errors are still happening. However, some of the errors that are occurring are due to poor order transcriptions and documentation, drug interactions, proper drug name and not paying enough attention and environment factors.
Working in the health care setting, teamwork and collaboration are used frequently to insure that everything runs correctly and efficiently. According to qsen.org, teamwork and collaboration consists of functioning effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. While assessing the patient a nurse can come into contact and work with many different individuals. These can include other nurses, doctors, therapists, and family
Every day there is a constant trust adhered to many different people in the profession of Nursing—the decision of what will help patients in terms of medicine, and the confidence to make these decisions. One false act or one slight misdiagnoses of medication to a patient could be the prime factor in whether the patient lives or dies. Nurses in hospitals across the country are spread thin, and thus makes the probability of mistakes higher. If a medicinal dose is off by even one decimal a patient could die, so the only real answer is for nurses to not be afraid to ask for assistance, always follow procedure and voice opinion is they feel something is wrong.
Medication errors made by medical staff bring about consequences of epidemic proportions. Medical staff includes everyone from providers (medical doctors, nurse practitioners and physician assistants) to pharmacists to nurses (registered and practical). Medication errors account for almost 98,000 deaths in the United States yearly (Tzeng, Yin, & Schneider, 2013). This number only reflects the United States, a small percentage in actuality when looking at the whole world. Medical personnel must take responsibility for their actions and with this responsibility comes accountability in their duties of medication administration. Nurses play a major role in medication error prevention and education and this role distinguishes them as reporters of errors.
Furthermore, short staffing affects the quality direct care each patient receives. The National Coordinating Council for Medication Error Reporting and Prevention (2012) states an estimated 98,000 individuals die every year from medical errors in the United States. One out of many significant tasks nurses do within their scope of practice is medication administration. Research shows a relationship between short staffing on medication errors: the longer the hours nurses work, the higher the chances of medication errors (Garnett, 2008). (include definition of medication error) Administering medications requires knowledge of patient rights, pharmacological information on the drug, adverse effects, proper dosage calculations, and hospital protocols. When nurses are assigned more patients, they are pressured to give due medications on time. Sometimes due to hunger or fatigue, nurses give the wrong medication to the wrong patient (Frith, Anderson, Tseng, & Fong, 2012).
It is another extremely hectic Monday in the Emergency Department. The waiting room is building up fast with many new walk-in patients. Fire Rescue trucks are calling one after the next with several medical and trauma cases. The hospital supervisor is calling to inform the Charge Nurse of the Emergency Department that the Operating Room has several cases that need beds and will supersede the Emergency Department admits. Patient through put will now be further delayed. This is just one example of a typical Monday and why Teamwork and Collaboration are vital components to run an efficient nursing unit, especially in the Emergency Department. When a common goal is created to foster teamwork, health care professionals working cohesively together
...nform the previous shift nurse who has made a mistake and conducted the medication error. Along with informing the co-worker, a right decision would be following the chain of command and report to the next person in authority at the hospital.
Physicians ultimately decide what dose and drug will benefit the patient and restore them back to health. Held by the standards set by The College of Physicians and Surgeons, Physicians must abide by the Health Professions Act. Physicians are responsible to prescribe the right medication and right dosage. It is thought that physicians and other prescribers are ultimately to blame for medication errors. Although malpractices do occur among physicians, nurses are responsible to have a thorough understanding of the medications one administers to their patients. A nurse does not just simply do what they are told and administer drugs without having a thorough understanding and background knowledge. Nurses are to know the purpose of each drug they administer, the therapeutic effects, side effects which can be harmless or injurious, and adverse effects which is a severe negative response to the drug (2009). In reference to the previously mentioned scenario, the physician’s handwriting was careless and illegible. Although the Physician demonstrated lack of clarity, the nurse noticed the hastily written sentence signed by the physician and continued to administer the drug as she had routinely done the past couple days. Nurse’s should have a strong pharmaceutical knowledge background and be aware of the potential harm a medication could cause. In the process of medication administration, registered nurses are responsible to “determine that each medication order is clear, accurate, current and complete. Medications should be withheld when a medication order is incomplete, illegible, ambiguous or inappropriate; with concerns being clarified with the prescriber (CNO, 2015)”. The critical care nurse demonstrated ineffective communication, which was shown by failing to ask the physician for clarification. Another instance of miscommunication is during medication
In the article by the American Nurses Association (2012), “Position statement: Care coordination and registered nurses’ essential role”, teamwork was defined as a partnership with health care providers, patients, and families to provide health care needs. An example would be, when an elderly patient presents to the emergency room with confusion, the health care team will do what is necessary to diagnosis this patient. The Certified Nurse Assistant may take the patients vital signs, the Registered Nurse will obtain the urine specimen to assess for a urinary tract infection (UTI), and the physician will determine if it is an UTI, what antibiotic, and treatment will be needed.
For the incident I do notice that there are other contributing factors for this error to take place such as there were no guidelines on administration of high alert medication. In order to have proper understanding on high alert medication, a guideline is indeed crucial to assist the nurses administering safe treatment. High alert medication is known to have the highest risk of medication administration that is been carried out by nurses. Besides that based on the incident the nurse had stated that she assume the no ‘5’ was ‘2’ and this is due to poor handwriting by the doctor. If only the hospital had a Electronic prescribing (E-prescribing) system, than this incident surly could have been prevented.
I was also responsible for monitoring medication orders and reviewing patient profiles to ensure that the proper drugs and dosages were prescribed and that the pharmacy technician had prepared them properly. In many instances there were mistakes made in the preparation phase and sometimes even before, with incorrect dosages or drugs being prescribed and prepared, which could result in serious adverse effects for the patient. A clinical pharmacist’s role, however, is to make sure that these mistakes never reach the