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The incident I will be reflecting on is about an experience I had during my placement at

an aged care facility. During my placements, I was posted with a registered nurse. It
was a very busy evening shift and there was no enrolled nurse on duty. Only one
registered nurse was posted for the entire facility (four different units). I accompanied
the nurse for medication administration process (medication preparation, administration
and documentation). I observed how efficiently she followed the eight rights of
medication administration to maintain the safety of the residents at the facility. Other
healthcare staff members disturbed her many times as she was the overall in charge of
the facility and despite of having the busy shift and interruptions by other health care
workers, the registered nurse was able to give medication without any error. She
followed all the eight rights of medication administration for each and every resident
very patiently. She was rushing to different four units to supervise the other healthcare
team members also. Although she was very focussed but the interruptions from other
staff members and switching between the various tasks due to staff shortage can lead
to serious medication errors.

Feelings:
First of all, I was very much surprised to see the electronic medical record (I care
system), as this was the first time I saw administration of medication in such a
systematic way. Furthermore, I was even more surprised to see the actual practice of
the nurse and the way she followed eight rights of medication preparation,
administration and documentation for all the residents in order to maintain the safety of
patient and her own practice. Realising the fact that the registered nurse was so
focussed even though other co-workers frequently interrupted her during the procedure
also amazed me but at the same time I was annoyed with repetitive interference by the
other health care members for every single task and also I was worried about the
possible medication errors that could happen due to this interference by the various
members of the health care team. After the incidence, I realised the fact there was staff
shortage in the evening shift, which made me even more upset because it is one of the
main cause behind many medical errors.

Evaluation:
On evaluation, I realised that this observation has both positive and negative aspects,
which has resulted in increased understanding of medication administration process
and exploring the potential causes of medication errors so that it can be avoided.
The positive side is that I now have better understanding of eight rights of giving
medication by actually observing the process. Safety of the patients or consumer of
health care services is the prime focus of a healthcare professional. The medication
errors are one of the most common types of medical error that jeopardise the safety of
patient (Bifftu, Dachew, Tiruneh & Beshah, 2016). Therefore it is very important for me
as a nurse to have sound knowledge of rights of medication administration along with
skills to perform the procedure to maintain the safety of the consumers.
On the other hand, the interruptions from other health care members can result in
human errors (Schroers, 2018; Getnet & Bifftu, 2017; Johnson et al., 2017). Distractions
during the preparation process of the medication may trigger medication errors due to
lack of attention from nurses (Duruk, Zencir & Eşer, 2015). Apart from frequent
disturbances, cognitive load or busy shifts can also be one major cause of medication
errors which needs to be given due consideration (Thomas, Donohue-Porter & Stein
Fishbein, 2017).

Analysis:
During the whole procedure, I observed the nurse carefully. The pre packed
medications from the pharmacy along with electronic medical records assisted her to
follow the rights of medication conveniently. It is very easy and convenient for the
nurses to use the “I care software” in order to do medication administration. In fact the
software gives the prompts also in case there is any error in administration or
documentation. The pre-packed medicines and Webster packaging makes the whole
process very easy and also reduce the chances of any human error if everything is
done very carefully without much disturbances. Every detail of the resident and
medicine is clearly mentioned over the packing and placed in separate boxes according
to resident room number and name to minimise the chances of any medication error.
However, I am also aware that at times busy shifts and uncontrolled interruptions during
medication preparation, administration and documentation can result in medication
errors.
The primary focus of the registered nurse is to maintain the safety and comfort of the
patients and to act in their best interests (Nursing and Midwifery Board of Australia,
2016). In this incidence, I feel that the registered nurse did not fulfilled her responsibility
as she did not tried to minimise the interruptions from other staff members which could
have contributed to human errors causing harm to the patients. She could have
instructed the health care team members to not disturb her during the process unless
and until there is an emergency.

Conclusion:
From this experience, I am now more mindful of importance of being focussed and
following the rights of medication administration and also stressing more on reducing
the human errors. It can be concluded that following all the rights of medication is
extremely important (Smeulers et al., 2015). But at the same time there is need to
minimise the human interruptions during the process. The registered nurse could have
been more mindful about instructing the other healthcare team members to not disturb
the staff while doing administration of medication unless there is an emergency or
unavoidable situation that cannot be delayed. Although she was efficient to do all the
work alone but there ere always chances of human errors. Therefore she could have
asked for extra staff from the management team to help her.

Action plan:
In future, if I am in such situation while administering medication I plan to be more
vigilant. Firstly, I will prioritise my work according to the shift load and focus on one task
at a time unless there is an emergency to avoid any human error. Secondly, I will try my
best to avoid medication errors due to human interruptions by awareness and educating
staff regarding the possible negative outcomes that can result due to medication errors
and how it can affect the residents as well as the registered nurse. Thirdly, I will also
inform the management team of the facility about the shortage of staff, which can be a
potential cause of medication error during busy shifts. Lastly, as a registered nurse, I
will use the prompts such as flyers, posters and signs to warn the health care
professionals, patients/residents and visitors not to disturb nursing professionals for
safety purposes during the medication rounds (Westbrook et al., 2017).
Most importantly, I will also continue to conduct regular reflective professional practise,
with the help of continuing model recommended by Gibbs (1988) to improve my skills
and knowledge to be a good registered nurse.