Nursing Assignment for Inappropriate Skills

1. Blood transfusion is an important therapeutic tool, which could be used to treat different health problems. There have been countless efforts made to ensure the quality of the transfusion process but in many cases, the security fails (Nuttall et al.2015). The blood and its components are used as a foundation to treat many transplants and diseases. In the given case study, there was no fault of the doctors and supervisors, but the junior staffs not having sufficient knowledge about the transfusion process did the actual mistake (Flood& Higbie 2016).  When the medical officer went to collect the FPP products, then at first he should have noted the label contents whether the blood product taken by him are correct or not. He made another mistake while signing the laboratory register where he did not check the details of the patient. The nurse sent the patient service assistant when she did not find the related papers of FPP. It is unknown whether the PSA had any talk with the laboratory staff or not, but he came to the nurse and said that the paperwork is not needed. This was the biggest blunder done by him due to his ignorance. Moreover, when the nurse checked the blood group of FPP, it was ‘O’ group and that of a patient was ‘A.' She did not understand the underlying difference between these two groups and thought that ‘O’ was the universal donor so it could be administered to the patient (Laws et al. 2013). According to standard 1 in “Nursing competency standard in Australia” provided by Nursing and Midwifery Board of Australia, “Nurses have to practice in accordance with legislation affecting nursing practice and health care” (Nursing & Council, 2005). The nurses did not undertake legislative action to stop the misconduct. Thus, the patient received the wrong blood transfusion and had to face the further consequence due to irresponsibility and lack of skill of the nursing staff.

2. As per the report of Australian Bureau, it has been noted that there have been many cases of failed blood transfusion process. The authority has set up guidelines for carrying out the blood transfusion in the correct manner but still the patients have to suffer because of the lack of knowledge and inappropriate skills of the nursing staff (Nuttall et al., 2013). I have chosen this topic because I think on a personal note; many steps could be taken to avoid such incidents. To make a thorough study on this topic, many factors should be taken into consideration. The nursing profession is considered important in blood transfusion process because it could impart proper skills to their junior who assist the patient so that they could work effectively (Jacob et al., 2016). The 2^nd standard in “Nursing competency standard in Australia” highlights that “nurses should practice in accordance with the nursing profession’s codes of ethics and standard”. The health care providers did not attempt to complete the procedures in an ethical way, as they ignored the step of documentation, which is a major ethical issue that reflected in a major mistake in blood transfusion (Nursing & Council, 2005). To ensure, that process of blood transfusion is done properly; I would try to improve the consistency of the transfusion practice. I would also check the integration for the quality management of such transfusion process so that it is done effectively. I would also aim to increase the awareness among the consumers so that the transfusion related complications are decreased. I would also check that these practices are conserved within a limited resource (Smith et al.,2014).

3. In the given case study, the administration of the incorrect blood products was due to the ignorance of the staffs and medical officer and lack of communication between the laboratory staff and the patient service assistant. Communication is a very important tool in the nursing process because many people are involved in the treatment process of the patient, so effective communication should prevail among the staffs to avoid any major risk. The patient was given the wrong FPP because of the lack of communication between the laboratory and PSA. Also, the nursing staff should be given proper education on all the relevant medical terms so that they could be able to guide the patient even in the absence of the supervisor. According to standard 6 in “Nursing competency standards in Australia, it has been depicted that nurses should “plan nursing care in consultation with individuals/groups, significant others and the interdisciplinary healthcare team” (Nursing & Council, 2005). This standard highlights the importance of teamwork in these kinds of situation. In the case study, if the staff had known the difference between the blood groups and administering FPP, then the patient would not have ended up having the wrong blood transfusion. Further, the incorrect identification of the FPP product was the major cause of this incident. Since the PSA did not have that much education about nursing and effective communication, so he committed this mistake. According to standard 3 and 4 in “Nursing competency standard in Australia”, “nurses practice within an evidence-based framework” and should “participate in ongoing professional development of self and others”. Thus, staffs need continuous education(Nursing & Council, 2005). If the medical officer had noted the label contents at the time, would have checked the details of the patient before signing the register, and would have then this incident would have not occurred (Fastman & Kaplan 2014). The errors of the staffs and communication failure between the medical officer and the laboratory staff had contributed to the morbidity of the patient who was supposed to get the blood transfusion for his fractured neck of the femur. 

4. If I had given the chance of handling such situation in future, then I would try to bring in many alternatives, which could ensure the safety of the patient (Milkins et al., 2013). According to standard 7 in “Nursing competency standard in Australia”, “nurses should provide comprehensive, safe and effective evidence-based nursing care to achieve identified individual/group health outcomes”. Based on this professional standard I would shape my nursing practice (Nursing & Council, 2005). Initially, I would make an identification of the patient as to what type of transfusion procedure he requires. Then I would make the thorough assessment of the patient by checking all the components prescribed to him and would know the specific requirements needed by the patient (Doughty, 2016).  Once, the identification of the patient is done, and then comes the identification of the sample to be transfused. I would accept the sample only after checking the name and group of the blood component. Then I would keep the check on the handover and communication that the correct sample is handed over to the responsible authority with proper communication by the delivering staff. “Nurses collaborate with the interdisciplinary health care team to provide comprehensive nursing care”, as highlighted in standard 10 of “Nursing competency standard in Australia”. For good co-operation, communication is very important (Nursing & Council, 2005). Then the transfusion checklist would be checked with proper care as what samples has been given to what patient and whether the medical officers have filled the correct details. The most important thing to be checked by the nursing staff is to keep the check on the timing of the transfusion and its products. The blood products are very sensitive, and its quality may diminish if kept out of its storage for a very long time. I will always prioritize ethical work and proper documentation to reduce mistakes. It is because, according to standard 2 in “Nursing competency standard in Australia”, “nurses should practice within a professional and ethical nursing framework”. I will try to reflect my knowledge based on evidences through a valid and ethical framework. So, these alternatives must be followed by the nursing professionals to avoid any hazard (Spahn  & Goodnough 2013).

References

Doughty, H. A. (2016). Transfusion guidelines: mind the gap. Anaesthesia,71(7), 743-747.

Fastman, B. R., & Kaplan, H. S. (2014). Transfusion-Related Hazards. InPatient Safety (pp. 161-178). Springer New York.

Flood, L. S., & Higbie, J. (2016). A comparative assessment of nursing students' cognitive knowledge of blood transfusion using lecture and simulation. Nurse education in practice, 16(1), 8-13.

Jacob, E. R., McKenna, L., & D’Amore, A. (2016). Role expectations of different levels of nurse on graduation: A mixed methods approach.Collegian.

Laws, T. A., & Goudas, L. (2013). Transfusion errors in the operating room: A systematic review. ACORN: The Journal of Perioperative Nursing in Australia, 26(3), 10.

Milkins, C., Berryman, J., Cantwell, C., Elliott, C., Haggas, R., Jones, J., ... & Win, N. (2013). Guidelines for pre?transfusion compatibility procedures in blood transfusion laboratories. Transfusion Medicine, 23(1), 3-35.

Nursing, A., & Council, M. (2005). National Competency Standards for the Registered Nurse [electronic Resource]. Australian Nursing and Midwifery Council.

Nuttall, G. A., Abenstein, J. P., Stubbs, J. R., Santrach, P., Ereth, M. H., Johnson, P. M., ... & Oliver, W. C. (2013, April). Computerized Bar Code–Based Blood Identification Systems and Near-Miss Transfusion Episodes and Transfusion Errors. In Mayo Clinic Proceedings (Vol. 88, No. 4, pp. 354-359). Elsevier.

Nuttall, G. A., Stubbs, J. R., & Oliver Jr, W. C. (2014). Transfusion errors: causes, incidence, and strategies for prevention. Current Opinion in Anesthesiology, 27(6), 657-659.

Smith, A., Gray, A., Atherton, I., Pirie, E., & Jepson, R. (2014). Does time matter? An investigation of knowledge and attitudes following blood transfusion training. Nurse education in practice, 14(2), 176-182.

Spahn, D. R., & Goodnough, L. T. (2013). Alternatives to blood transfusion.The Lancet, 381(9880), 1855-1865.

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