Nursing Presence: Former Nursing Present Transition

Goal three by the National Patient Safety Goal for 2014 is to use medicines safely. Many errors occur regularly with medications which is why communication is so important with the doctors, nurses and patients. One process that Joint Commission requires in accredited HCO’s is medication reconciliation “creating the most accurate list possible off all medications a patient is taking, including drug name, dosage, frequency, and route, and comparing that list against the physician’s admission, transfer, and/or discharge orders with the goal of providing correct medications to the patients at all transition points within the hospital (Finkelman & Kenner, 2012, p. 388)”. Ensuring medication reconciliation to the patient, health providers and any new consults that are

Each year, roughly 1.5 million adverse drug events (ADEs) occur in acute and long-term care settings across America (Institute of Medicine [IOM], 2006). An ADE is succinctly defined as actual or potential patient harm resulting from a medication error. To expound further, while ADEs may result from oversights related to prescribing or dispensing, 26-32% of all erroneous drug interventions occur during the nursing administration and monitoring phases (Anderson & Townsend, 2010). These mollifiable mishaps not only create a formidable financial burden for health care systems, they also carry the potential of imposing irreversible physiological impairment to patients and their families. In an effort to ameliorate cost inflation, undue detriment, and the potential for litigation, a multifactorial approach must be taken to improve patient outcomes. Key components in allaying drug-related errors from a nursing perspective include: implementing safety and quality measures, understanding the roles and responsibilities of the nurse, embracing technological safeguards, incorporating interdisciplinary collaborative efforts, and continued emphasis upon quality control.

Transitioning from an licensed practical nurse to a registered nurse is of the hardest things I have ever done. Twelve years ago I took my boards and became a licensed practical nurse. Going to school to become an LPN was difficult, but I was not a mother and I did not work full time as I do now. Getting to know the students I attend school with has made me realize that each student’s role transition is different, with unique outlooks and emotional roller coasters. In the following paragraphs I will preview licensed practical nurse to registered nurse role comparisons, my change in

The purpose of this paper is to bring forth awareness when it comes to patients and medication errors and further educates health care professionals on the importance of communication especially during transition of care. According to Williams and Ashrcoft (2013) “ An estimated median of 19.1 % of total opportunities for error in hospitals.” Although not all medication errors occur during transition it is the time most prevalent for these errors to occur. As per Johnson, Guirguis, and Grace (2015) “An estimated 60% of all medication errors occur during transition of care. The National Transitions of Care Coalition defines a transition of care as the movement of patients between healthcare locations, providers, or different levels of care within the same location as their conditions and care needs change, [and] frequently involves multiple persons, including the patient, the family member or other caregiver(s), nurse(s), social worker(s), case manager(s), pharmacist(s), physician(s), and other providers.”

An underlining principle that forms all nursing practice is respect for the inherent dignity, worth, unique attributes, and human rights of all individuals. (Jimenez-Lopez, Roales-Nieto, Seco, Preciado, 2016) Nurses are to always treat all patients with dignity. For example, closing doors before you start providing patient care. It’s also essential as a nurse to respect patients regardless of their background, race, culture, value system, or spiritual belief. (Jimenez-Lopez, et al., 2016)

In Era II, mind-body has a direct correlation to situations regarding anxiety for instance. If a patient is anxious, naturally the heart rate will be elevated. With deep breathing and conscious thought, heart rate will decrease. I see this almost daily.

Through this course, Professional Presence and Influence we, the students/learners, are academically guided to get to know how our professional presence affects our nursing practice. The Kiersey Temperament II Personality Sorter identified traits about myself and how my personality affects my professional presence. Learning about a mindful practice allowed me understand that being mindful can influence my presence. Finally, my environment can, and does, influence my presence and my practice as well as the healing of patients. This is especially emphasized in an optimal healing environment as described by Samueli.

In the healthcare facility there are many things that can benefit from change. Bedside rounding with the inclusion of the entire care team would be a beneficial change to any healthcare facility. By doing bedside rounding it promotes patient and family involvement in the exchange of information and planning of their care. This also allows for the interdisciplinary team to be completely involved rather than picking up bits and pieces of information throughout the day from multiple different people. This is also a great opportunity for the patient and their family to ask questions with the entire care team available for answers.

Medication Reconciliation is defined by the Joint Commission as the process of checking and rechecking a patient’s current medication list to the patient’s orders. Within a MedRec program, three steps must be followed to ensure patients have the correct medications at admission and discharge: Verification, Clarification, and Reconciliation (Greenwald et al., 2010; Ruggiero et al,. 2015). MedRec should not occur once, but multiple times especially when a patient moves from department to department. The more a patient moves, the more liable they are for a medication error due to poor communication. MedRec is done for the simple reason of catching those medication errors and correcting them before they can do any harm (The Joint Commission, 2006). Medication errors effect nearly 1.5 million people who enter the hospital setting in the USA. At least every patient has one medication discrepancy between admission and discharge, which leads to rehospitalizations due to hospital-setting medication errors (Institute of Medicine as cited by Wilson et al,. 2015). With nurses at the forefront of a patient’s medication regime, pressure is put on them to provide the necessary education and safety to prevent medication related rehospitalizations. Included in the causes for medication errors is miscommunication between departments taking care of the same patient (Allison et al., 2015). Many medication errors are preventable by the implementation of electronic orders. The use of electronic

Administration of medication to a patient is an interdisciplinary concern. When dealing with medication, nurses are held with as much accountability as other members within the medical team. To uphold this standard, it is important for nurses to stay informed with new research to help provide better care to their patients. The nursing community also adheres to the “nursing process,” a guide that nurses utilize to achieve well-rounded care. Nurses can relate the nursing process not only to their plan of care, but also to different subjects to systematically analyze information. Applying the nursing process to this research created a connection that allows awareness of the

Extensive use of the word transition in nursing literature signals that it is a significant concept (Ralik, Visentin, Van Loon, 2006). It is essential for nurses to possess knowledge and understanding of transition. The purpose of this paper is to provide a comprehensive examination and explore the definitions and key elements of the concept of transition and show how gaining knowledge of transition can positively impact client care and the nursing profession. Understanding transition will help improve client care by teaching nurses how to assess for, and facilitate transition and develop health promotion initiatives. Ultimately, the goal is to have better outcomes for clients going through transition. Continued research and education

In addition to telephone and clinic follow-up, medication reconciliation has been identified as critical transition of care intervention. Gunadi et

In the Care About Your Care video discussion one of the transitional care implementations was a nurse visit after leaving the hospital. In the article, Transitional Care Interventions Prevent Hospital Readmissions for Adults with Chronic Illnesses, the author’s identified that same intervention of a nurse visit, but stipulated that the visit should be within three days of discharge and be performed by a registered nurse or advanced-practice nurse, along with other interventions such as, “care coordination by a nurse and communication between the primary care provider and the hospital” (Verhaegh, MacNeil-Vroomen, Eslami, Geerlings, Rooij & Buurman, 2014). During the nurse visit it would be beneficial to perform a drug reconciliation to reduce

According to the Institute for Healthcare Improvement, “Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician’s admission, transfer, and/or discharge orders” (Institute For Healthcare Improvement, n.d). This process includes three steps: collecting the medication history, ensuring that the medications and dosages are appropriate for the patient, and documenting the changes in the orders. This occurs when the patient is admitted, transferred and discharged from the hospital (Institute for Healthcare Improvement, 2011). The purpose is to avoid any duplications, incorrect

In my place of work, medication reconciliation is done by the ER nurses as soon as a patient is to be admitted into the unit. It is very critical to be very accurate when doing medication reconciliation. Accuracy with med reconciliation reduces errors in medication therapy after a patient is discharged, reduces cost of care,