Station 1: communication

As a medical intern, you are completing your shift and need to hand over the care of a
patient, Mrs. X, to the incoming team. Mrs. X is a 75-year-old patient with heart failure and
has shown signs of clinical deterioration during your shift.
Write down an outline of handover report.
Handover Report for Mrs. X

Patient Information:name age

Diagnosis: Heart Failure

Summary of Current Condition:

Medical History and Relevant Information:

Medication’s list:

Investigations and Interventions During Shift:

Pending Actions/Considerations for Incoming Team:

Family/Patient Communication:

Any Changes in the Past Few Hours:

Patient's Demeanour and Mental Status:

General Plan for Next Few Hours:

Station 2: Medication Safety

Scenario: You are a medical intern working in a busy hospital. You are required to counsel Mrs. X, a
60-year-old patient with diabetes, on a new medication she has been prescribed. She seems
confused about the instructions and expresses concerns about potential side effects. Your task is to
educate her about the medication, ensuring her understanding and adherence while addressing her
concerns.

What are the 5 rights of medication administration?

Right patient

Right medication

Right dose

Right route

Right time
A 60 years old lady who was admitted for left sided hemiplegia due to ischemic infarct is discharged
today she is bed ridden at discharge. what advice will you give her family.

1. Counsel regarding bed sores (Air Mattress), change of posture.

2. Physiotherapy, psychological support if required

3. Compression stockings

4. NG feeding if inability to swallow, positioning prevention of aspiration pneumonia

5. Compliance to medications (Aspirin/ statins)

 18 years old girl presented to you with fit like activity while playing with her friends. Her mother
also gives similar history 6 month back. Considering her to be a case of epilepsy what advice will you
give her attendant on discharge?

1. Explain about Long term nature of disease.

2. Compliance on therapy
3. Avoid going to places.
Avoid swimming / driving etc.

4. Regular follow up
5. What to do when having a seizure (ABC Positioning)
6. Carry diagnostic / card bracelet, inform the treating physician in case of any illness about the
antiepileptic drugs to avoid interaction.
 Station 3: fall risk
Mr. X A 60 years old male admitted with acute exacerbation of COPD.
a) How would you assess his risk of fall?
b) If fall risk is high, what would you recommend

a)

Medical History

Mobility and Balance Assessment

Muscle Strength and Functional Assessment

Environmental Evaluation

Medication Review

Cognitive Assessment

History and Fear of Falling

Outcome and recommendation

b)

Bedside Precautions

Assistive Devices

Continuous Monitoring

Patient Education and Communication: Educate the patient and family/caregivers about the
increased fall risk and the importance of requesting assistance before moving or getting up.

Inform the patient about safety measures in place and the importance of following instructions.

Environment Modification:

Keep the patient's room clutter-free and maintain adequate lighting to reduce tripping hazards.

Install grab bars or handrails near the bed and in the bathroom if necessary.

Medication Review and Management:

Review medications and adjust dosages or schedules to minimize the impact of medications known
to cause dizziness or light headedness.

Multi-disciplinary Approach:

Engage the multidisciplinary team, including physiotherapists and occupational therapists, for a
comprehensive care plan to address fall risk.
The OPD clerk mistakenly entered Mr. Ahmad's details into the hospital system under the wrong
medical record number, associating his identity with another patient of a similar name and age. His
CXR showed R sided pleural effusion and medical team decided to perform diagnostic pleural tap.

Identify the potential errors

What can be done to mitigate such errors in future?

Potential Errors:

Patient Misidentification:

Diagnostic Test Based on Incorrect Data

Lack of Verification: There was a failure to adequately verify the patient's identity at different stages
of care, including during the admission process and prior to the diagnostic pleural tap.

Communication Breakdown

Mitigation Strategies for Future Errors:

Use of Multiple Identifiers: Implement a policy requiring the use of at least two unique patient
identifiers, such as name, date of birth, and a unique hospital identifier, at all stages of patient care.
This reduces the likelihood of patient misidentification.

Electronic Verification Systems: Consider the use of electronic systems that can automatically cross-
check patient data with the correct medical records. Electronic identification systems can help
prevent manual data entry errors.

Staff Training and Education: Provide ongoing training and education to hospital staff, emphasizing
the critical importance of patient identification. Ensure that all staff members understand the
potential consequences of identification errors.

Standardized Procedures: Establish standardized procedures and checklists for verifying patient
identity at various points in the care process, from admission to diagnostic procedures. These
checklists should be consistently followed to minimize errors.

Double-Check Protocols: Implement a double-check protocol for high-risk procedures, such as

diagnostic taps or surgeries. This involves an additional verification step by a second healthcare
provider to ensure that the correct patient is involved in the procedure.

Reporting and Accountability

Swiss Cheese Model Scenario

In a hospital, a patient was admitted for a gastrointestinal procedure and was labelled NPO (Nil Per
Os) for fasting before the procedure. The patient, diagnosed with diabetes, required insulin for
glycaemic control. However, a sequence of errors led to the administration of insulin despite the
patient being on NPO status.

How can such errors be prevented?

Enhanced physician education and reminders regarding adjusting insulin orders during NPO status.

Pharmacist's double-check protocols to ensure prescription alignment with the patient's clinical
status.

Nurse's validation and verification of all medications against the patient's status before
administration.

Patient education on the impact of fasting on insulin dosing and the necessity to communicate any
discrepancies.
A patient, Mr. Jackson, was admitted to the hospital for an abdominal surgery and was placed on
NPO status in preparation for the procedure. Mr. Jackson has a history of epilepsy and requires
antiepileptic medication. A series of errors led to Mr. Jackson not receiving his antiepileptic
medication during the NPO period, increasing the risk of a seizure due to missed doses.

How can such errors be prevented?

Improved protocols for prescribing, dispensing, and administering medications, particularly critical
medications like antiepileptics, during NPO status.

Enhanced cross-checking systems to ensure necessary medications are ordered, dispensed, and
administered as appropriate.

Patient and family education emphasizing the importance of antiepileptic adherence and explaining
the temporary withholding during NPO status.