You must use this form to record five written reflective accounts on your CPD and/or practice-related feedback

and/or an event or experience in your practice and how this relates to the Code. Please fill in a page for each
of your reflective accounts, making sure you do not include any information that might identify a specific
patient, service user, colleague or other individuals. Please refer to our guidance on preserving anonymity in
the section on non-identifiable information in How to revalidate with the NMC.

Reflective account: Community-Agency Nurse

What was the nature of the CPD activity and/or practice-related feedback
and/or event or experience in your practice?

Near miss incident. As an agency nurse I was given a list of patients to visit during my shift,
Among the patients were couples who were both on insulin and with similar surnames, I
took Mrs X folder and started administering the insulin for Mr X, I double checked the
prescription chart and follow the 5 rights.
 Right patient
 Right time
 Right dose
 Right route
 Right drug
I realised that I was about to administer the insulin to the wrong patient. As a community
nurse we visit patients in their houses and sometimes may encourage who are unable to
communicate with you for various reasons, we need to be extra vigilant when giving
medication by following the 5 rights

What did you learn from the CPD activity and/or feedback and/or event or
experience in your practice?

Reflecting back, I think it’s a good practice to let all nurses visiting to be aware of patients
who live in sane address so as to avoid unnecessary drug errors.

How did you change or improve your practice as a result?

I came to learn that triple-checking that you're giving the right medication to your patient.
Giving the wrong medication is a problem in and of itself, not to mention that it could
trigger allergies, cause bad side effects, prompt unnecessary symptoms, and have grave
results. Having the right knowledge of the 5 Rs has actually improved my confidence and
vigilance in drug administration.
How is this relevant to the Code?
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote
professionalism and trust

This is relevant to the following themes

 Practicing effectively – this experience is about communicating clearly, and taking
steps to ensure people understand what is being asked of them.
 Preserving safety – I took steps to reduce as far as possible any potential for harm,
neglect or abuse associated with my practice by introducing a new risk assessment