Critical Analysis of a Clinical Scenario – Health System Example

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"Critical Analysis of a Clinical Scenario" is a great example of a paper on the health system. Paramedics and other medical practitioners experience different challenges during the treating process that in some cases have a serious negative impact on the patient life. Several cases like administering the wrong medication, confusion due to medicine similarity, wrong diagnosis leading to wrong prescription, failure to understand properly the patient medical history, and giving wrong dosage quantity are some of the common problems experienced by the paramedics. However, in this cases, the essay is a critical overview or analysis of a paramedic response situation attending to a 55-year-old patient experiencing heart failure and the paramedic in charge due to the medicine look-alike mistakenly pushes 4 milligrams of intravenous norepinephrine instead of the intended lookalike vial of 1 milligram of bumetanide (Bumex® ).

The response is critical since the patient immediately develops supraventricular tachycardia, becomes hypertensive, and deteriorates into ventricular fibrillation. Resuscitative efforts are unsuccessful; the patient is pronounced dead on arrival at the ED. According to (Hoyle, Davis, Putman, Trytko & Fales, 2012) the errors in dosage and medication processes occur in one out of 2.3 medication processes in a pediatric hospital.

Unfortunately, the research on the occurrence of such errors is not well documented and that leads to low awareness. In this scenario, the paramedic has made several mistakes by failing to adhere to the necessary safety protocols. The first mistake is failing to double-check the medication he/she is administering. This is because he/ she mistakenly pushes 4 milligrams of intravenous norepinephrine instead of the intended lookalike vial of 1 milligram of bumetanide (Bumex® ).

A simple recheck of the required medication would have taken less than one minute but save the life of the patient. The second obvious mistake is failure to understand or ask for the medical history of the patient before starting the resuscitation process. The resuscitation process is governed by different laws depending on the state and in most cases the patients are expected to carry along the Do not resuscitate (DNR) Order which restricts paramedics from administering certain medications considered dangerous. The (DNR) Form instructs the medical practitioner to forego practices such as assisted ventilation case, endotracheal intubation, defibrillation, chest compression, and cardiotonic drugs that are to be administered to the patient.

The form is basically designed to be used in pre controlled hospital environment such as: while the patient is still at his home, in the long term care facility, during patient transportation to or from the health care facilities, or any other location outside the recognized hospital (Tadros, Long & Davis, 2010). The last mistake which is the most common amongst the medical experts is in the dosage and am surprised the paramedic doesn’ t realize the mistake at that point.

Logically it is reasonable to confuse the lookalike in the external packaging appearance and as an expert, he should at least notice the quantity which the medicine he is administering require is four times more than the quantity we expect. He should at least have noted that 1 milligram of bumetanide (Bumex® ) is what was required and measuring 4 milligrams of intravenous norepinephrine already shows a mistake in quantity. The errors experienced during the treatment process in some cases are regarded as human errors.

This is because the participating paramedic, in this case, has a hand in the error that can be avoided. However several factors have not made it easy for errors that are regarded as human or system errors to be completely avoided (BRADY, MALONE & FLEMING, 2009). The first limitation is the complexity of the health care system increases the chances of errors. The technologies involved, the powerful drugs administered to patients make error recovery very difficult, and in other instances, the intensive care needed to complicate the process. The second cause of possible human or system factors is the cognitive aspect in regard to the thinking style of the medical practitioners.

Many things happening in a paramedic's mind as he/she watches the fluctuation of the patient's condition can lead his thinking into a pitfall and affect his identification and error sensing ability. In some places, the doctors or the paramedics have earlier undergone sleep deprivation which possibly leads to stress and fatigue, and that results in a serious drop in the expected quality. The third human factor is the inconsistency in the training the medical experts are exposed to prior to engaging in the direct practice.

At the same time distraction during the working process can lead to medical errors experienced. There is the level of teamwork needed and the paramedic obviously was never alone on the site. If there was possible laxity in communication quality during the execution process or the supposed team members involved in issues irrelevant to the process that can easily cause the paramedic to experience a given level of distraction. The last aspect is the situational awareness being lost by the medical expert due to the situational stress which leads to the expert losing the focus needed to offer the desired quality. Patient safety should be a key issue that every medical practitioner should give priority to during the treatment process.

Though the human is liable to errors, precautionary measures can help improve the safety of the patient and the success of the treatment process. According to (Smith, Burkle & Archer, 2011) the safety process is necessary for protecting both the patients and the paramedic.

Paramedics in some cases get exposed to different external conditions that may cost them their lives. However to avoid a scenario explained above, the paramedics should ensure that they double-check on the right medications before administering them. Secondly, paramedics are expected to understand the medical history of the patient in question. Such information can be retrieved from the conversation with the patient, conversation with the patient close relations, or from the record kept in the hospital he/she frequented. This is because people react differently to a different medication and in some cases, some medical condition calls for restriction of certain medical procedures.

For example, the inter-state varying rules governing the Do not resuscitate (DNR) Order which restrict paramedics from administering certain medications considered dangerous (Tierney & Kauts, 2014). The third recommendation is the understanding of the dosage quantity (Stultz & Nahata, 2014). Medicine is only good when measured in the right quantity otherwise the quantity mistake in most cases leads to more bad than good. Medicine abuse results in too many reported deaths and paramedics, therefore, have to be knowledgeable on the quantity of medicine to give to the patients.

The quantity normally varies depending on the age of the patient, type of disease, and the patient's condition. At the same time, the paramedics need to verify the measuring material, especially where medicine is in liquid form. Paramedics need to be psychologically prepared to deal with situations of medication errors and this can help protect them from reaction out of fear. Therefore line supervisors and managers of such paramedics need to encourage them to report immediately in case of occurrences of that nature so that quick response can be made.

In addition to that, reporting helps in research work when a solution to such problems is needed. Due to the sensitivity of the medication process, the medication procedure should be enhanced by the people involved being vigilant and exercise proper communication during the process (Quick, 2013). Therefore paramedics need to be encouraged as much as possible to report medication errors and near misses positively without fear of reprisal from the managers to allow for lesson learn and progress made in finding the ways of reducing such errors. Finally, medical experts need frequent training aimed at enhancing the quality of the service they offer.

Proper training and frequent improvement through field experience earn through working under an experienced expert can help improve starters to be aware of the safety procedures and possible error awareness (Kristensen, Mainz & Bartels, 2009). In conclusion cases of wrong medical prescription and wrong dosage are common in the medical field and there is no need for panic. It is, therefore, necessary for the medical experts to respond as quickly as possible, giving details of the error experienced so that the right step is taken to suppress the effect of such errors and maintain the quality of the services delivered.

The more the treatment process becomes more complex, the more the practitioners need tighter control to minimize the risk through reducing the drug errors and near-miss scenarios. This should be a global concern solved by sharing information and creating awareness rather than leaving it as the responsibility of the patient and health professionals. At the same time policies, rules and processes can be frequently accessed and adjustments made that guide the practitioners toward total quality practice.

References

BRADY, A., MALONE, A., & FLEMING, S. (2009). A literature review of the individual and systems factors that contribute to medication errors in nursing practice. Journal of Nursing Management, 17(6), 679-697. doi:10.1111/j.1365-2834.2009.00995.x

Hoyle, J., Davis, A., Putman, K., Trytko, J., & Fales, W. (2012). Medication Dosing Errors in Pediatric Patients Treated by Emergency Medical Services. Prehospital Emergency Care, 16(1), 59-66. doi:10.3109/10903127.2011.614043.

Kristensen, S., Mainz, J., & Bartels, P. (2009). Selection of indicators for continuous monitoring of patient safety: recommendations of the project 'safety improvement for patients in Europe'. International Journal for Quality in Health Care, 21(3), 169-175. doi:10.1093/intqhc/mzp015

Quick, O. (2013). Patient Safety, Law Policy and Practice * Improving Health Care Safety and Quality: Reluctant Regulators. Medical Law Review, 22(1), 137-143. doi:10.1093/medlaw/fwt018

Smith, E., Burkle, F., & Archer, F. (2011). Fear, Familiarity, and the Perception of Risk: A Quantitative Analysis of Disaster-Specific Concerns of Paramedics. Disaster Medicine and Public Health Preparedness, 5(01), 46-53. doi:10.1001/dmp.10-v4n2-hre10008

Stultz, J., & Nahata, M. (2014). Appropriateness of commercially available and partially customized medication dosing alerts among pediatric patients. Journal of the American Medical Informatics Association, 21(e1), e35-e42. Doi: 10.1136/amiajnl-2013-001725

Tadros, A., Long, M., & Davis, S. (2010). 2: Liquid Pediatric Medication Dosing Cups Are Inaccurate. Annals of Emergency Medicine, 56(3), S1-S2. doi:10.1016/j.annemergmed.2010.06.028.

Tierney, E., & Kauts, V. (2014). Do Not Resuscitate (DNR) Policies in the ICU: The Time Has Come for Openness and Change. Bahrain Medical Bulletin, 36(2), 65-68. Doi: 10.12816/0004477

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