[00:00:00] This is the All One Nurse Podcast, where we are bridging the gap between the stethoscope and the soul and getting back to the human side of healthcare.
[00:00:15] Powered by Riverside According to the American Nurse Journal, did you know that in the US 2000 to 9000 people die annually due to medication errors? And additionally, birth drug events lead to approximately 1.3 million emergency department visits and 350,000 hospitalizations each year.
[00:01:01] And welcome to this week's episode of the All One Nurse Podcast, where I'm your host, Nurse Chanel Tompkins, and I am so excited that you are tuning in to another episode with me. I'm going to be talking about safe medication administration and assessments, and these assessments include admission assessments, head to toe assessments, and I'm even going to talk about the importance of discharge instructions because that leads to adverse drug events that have patients coming back into the hospital setting. So it's just as important of how we receive patients, take care of them, and how we discharge them and let them continue on in the community so that they don't have to come back. If you've been tuning in to Nurse Converse, a nursing podcast presented by Nurse.org, which I originated on thank you Nurse Converse and my nursing community who voted for me. Okay, staying on topic. If you've been tuning in or if you've already a part of the Nurse Converse podcast community, then you have heard Redonda Vaught's latest episode with nurse Maddie Ortez and she talks about the State Board of Nursing and their primary responsibility, which is public safety. And one thing we worry about as nurses is our license, right? We always want to protect our license. We don't want to lose our license. And so I encourage you to go check out that episode with Redonda as she shares advice for nurses before a Board of Nursing investigation.
[00:02:44] And honestly, just listening into her, I believe I would have went in just as naive and thinking, okay, do I or do I not need legal aid? And just to give you a little history, Redonda Vault is the nurse that overrode some steps with medication administration that resulted in harm to a patient back in 2017. And I really encourage you to go listen to that episode. She does not dive into the investigation itself or her trial, but she dropped some good gems about the Board of Nursing investigation and some things that we just do not know as a nursing community and things that were not talk to us in nursing school. So go check that out. Diving right into safe medication administration if you have not already. Go ahead and click that subscribe button and share this episode with a friend, with a nursing student, with a nursing intern, or with someone who just needs to know more about their role in the healthcare community. Because patients are the reason why we do what we do. And patients, if you're tuning in, you need to be informed as well on what the expectation is when you're in the hospital setting. So getting right into it, I encourage you to open up your hearts and your minds as always to receive this wonderful information that I am about to share.
[00:04:12] Safe Patient Administration Just piggybacking off of the Medication safety article in American Nurse Journal. It talks about how nurses play a crucial role in ensuring medication safety by following best practices and in 2023, the CDC reported that the most common types of adverse drug events are associated with allergic reactions, side effects over medication, medication errors and drug, drug, drug to drug interactions. The most problematic medications that lead to emergency adverse drug events include anticoagulants, which are blood thinners, diabetes medications, antibiotics and opioid analgesics. If you know your medications, you need to understand why your patients are taking them and whether the medication will do what it is supposed to do. So to backtrack, let's go back to what used to be the 5 rights which are now the 10 rights of safe medication administration. First we had the right patient, the right medication, the right dose, route and time. And now in addition to that we have the right documentation, the right patient education, patient's right to refuse the right assessment and the right evaluation, meaning monitoring the patient's response and making sure we're advocating for an adjustment if needed based off the right evaluation. Now going back to the right assessment, I it makes me think of am I going to get the desired outcome if I give this medication and that one right, that right assessment is going to be really the one thing that forces me to do everything else.
[00:06:03] So that means I have to actually do an assessment on my patient and get a baseline, which we're going to talk more about in our head to toe assessment. But it also makes me want to make sure that I understand why the patient is in my care, why the patient is hospitalized, why the patient is being prescribed this medication, whether it is a home medication or a newly prescribed medication. So desired outcome a good example of this and I always tell the nurses this when when I'm assisting with education in the hospital setting, I think about desired outcome as you know, being a nurse with a background in cv. If I have a patient that comes in and with CHF exacerbation, which is congested Heart failure and they're in fluid overlo. Then their by mouth Lasix is not enough. Right. That 40 milligrams of Lasix twice a day is not enough. And so the doctor prescribes IV Lasix, IV push, 80 milligrams twice a day. So initial, initial, initially, initially, this medication is working well for the patient. If they got good renal function and they're diuresing, they're putting, they're getting this fluid off, they're breathing better, they're not as short of breath with exertion, and so they're doing better. But now during their stay, after the second, second or third day, as I'm looking at my 10 rights of medication administration, the right assessment, when I assess my patient, I think, am I going to get the desired outcome for giving this 80mg of IV Lasix, their output has decreased significantly. Now their blood pressure's running low 100, their urine output has dropped significantly and they're not as edematous. They're breathing a lot better. If I give them this 80 milligrams of Lasix IV push, will I get the desired outcome?
[00:08:00] I will not thinking about that one. Right? That right assessment during safe medication administration, am I going to get the desired outcome for giving this medication? Is going to make me go back and research, okay, what is this medication? What does my patient have? Why is my patient taking this medication? I strongly encourage you to assess your patient, get a baseline assessment on them and understand what medications you are giving. And just because it's being prescribed doesn't mean that it is safe for the patient.
[00:08:37] One way to look at it is, yes, as a nurse, you may have more than what you should have on your med surg unit. But then as a prescriber, as a physician, that provider may have his or her list of patients may be just as long. So you have to think about those things. In conclusion, the desired outcome forces you to know something about your patient rather than just going in to give medication. And while I'm at it, let's talk about scanning medications and your patient for their name and date of birth. Every time we do that because we want to make sure it's the right patient, use the right things to identify your patient. And as a patient, they should be asking you for your name and date of birth. And I've heard that nurses are taking patient labels and putting them on a sheet of paper and scanning the sheet of paper as their label, going about room to room, administering medications.
[00:09:35] This should not be, it is not safe and as a patient, I encourage you to understand that a nurse should scan your armband, ask you for your name and date of birth every time they administer medications to you to make sure that they actually have the right patient with the right medication. Especially when we're talking about most of the time the unit is short staffed. This is not the time to be cutting corners with my meds. So I just want to point that out there. And with scanning medication, just going back to redundant vault, you know, that is a hard safety stop for protecting for one your patient because we're talking about their life and their well being and also to your license, which you worked very hard for and nobody took nclex for your license but you. And if your license is on the line, it's only going to affect you. The hospital will keep going, healthcare will keep going and you will be stuck finding another career in the worst case scenario. But God forbid, that's why we're here and that's why we're talking about this now. You will see people cut corners, especially as new nurses, nursing students, you may see other individuals cut corners. I strongly discourage you from doing that because we know it happens. And it's not only new nurses who make mistakes. Some of the biggest sentinel events are from seasoned nurses. And the reason why could be because they are very comfortable with cutting corners and it doesn't matter until it matters or they fail to keep up with evidence based practice. But either way, I don't want it to matter when it's just when it's me as the patient or my family member. But I want it to matter every time I'm passing medications, where every time meds are passed, jumping right into assessments, assess, assess and assess some more. And with that we're going to talk about admission assessments, head to toe assessments and I'm including discharge assessments because that is just as important to prevent patients from being readmitted into the hospital and not only for reimbursement purposes, but because of patient safety, because they're coming back because something transpired. Right? We know that the first group of nurses to assess is our wonderful ER nurses. And I've got to get a compassionate ER nurse on here so that we can really pick their brain and learn more about their FL and advice that they have for a lot of the new nurses that love ER or think they love ER and want to go into the ER setting, but with ER life I can't speak much on it, but I do take my hat off to them because they are the receive all of the hospital, right. They receive every patient and they get to deem who is worthy of being admitted. So a lot of their safe practice is going to be triaging and prioritizing patient care. Their assessment skills should be a one. I'm just going to put that out there. It should be a one. They don't admit patients per se, but they're questioning their health and history. Health history of the patient, their medical history of the patient, their current complaints, all those things matter, right? So triage is very big part of the er. And luckily for the nurses who are inpatient, whether it's icu, med surg or med surg, step down, your patients have been screened, you know what they are potentially admitted with and you have an idea of your patient's status. But also you have to admit them, right? You have to do that admission assessment and that is a step of safe patient practice because that's where you get to make sure that all of their history is correct. The biggest thing on there, there's social determinants of health that is documented and case manager or social workers help with a lot of, including the patient's home life, financial status, things like that.
[00:14:00] But on admission assessment, the biggest thing, and it's going to go back to the first topic that I just talked about is medications that, medication reconciliation, med rec. That is very important. It's so important because that med rec is going to include the patient's home meds or any meds that was on that list from previous hospitalizations that need to be updated or flagged for removal. Right?
[00:14:29] And this is so important and hopefully your organization has an electronic medical record that can connect with the pharmacy. Like I don't know all the ins and outs. I'm not informatics, but getting a correct list is very important. And a good example of this is what if Mima, 80 year old lady who just had a GI bleed a month ago and then she comes into the hospital, we do her admission assessment and we do not flag her aspirin to be removed off of her med rec because she's no longer taking the aspirin, right? And so this aspirin is on her med rec, she makes it through her stay for whatever reason she's in the hospital for and then upon discharge, guess what? The aspirin is on that list and it's listed to be continued. Now it's neither here or there. That could be between the provider, between the nurse. Like we can argue who should have did what.
[00:15:31] But as a nurse I truly believe, and I know that Nurses are like that last stop or a big part of that safety chain for safe patient care.
[00:15:45] And that is why I'm encouraging you as a nurse, if you're a nurse listening in today and you're in doing assessments as a part of your workflow, make sure that you, if you're doing that admission assessment, pay attention to detail with it, especially that med rec so that it can be up to date as possible throughout that patient's. And going back to Meemaw, say she goes home and it says to continue her aspirin. And she's like, oh, they want me to start back taking my aspirin. And then she starts to take it and then she comes back with a GI bleed. And it's like that could have been prevented if someone paid attention to detail.
[00:16:28] So that med rec on their admission assessment is one important piece for safe practice for patients.
[00:16:36] Now jumping into head to toe assessment, I cannot imagine taking care of a patient and I have not touched them like using my stethoscope. Doing a head to toe assessment is like nursing 101. That is that part of non maleficence doing no harm. I am going to look that patient over because I at least want a baseline status for my patient. I want to know what that, what that patient baseline is for me when I come in and start taking care of that patient. So I want to lay hands on my patient as soon as possible. I want to see, I want to see my patient before I relieve the other nurse of their duties to go home. Right?
[00:17:20] Because I want to hold them accountable for what I see. And I want to know that, hey, we saw this together, we saw this patient together and they were still at work. Whatever baseline that we were, you, I should have been expecting expecting based off their handoff report.
[00:17:38] But with head to toe assessment, I think the main thing is use a stethoscope. Use a stethoscope, talk to your patient, your head to toe assessment, not only what you feel, but what you hear the patient saying. Because a lot of times they give you more insight on what's going on with them, the more dialogue that you create with the patient.
[00:17:58] You'll also be able to make a good decision on whether or not a medication may be safe for a patient because of what they disclose to you and what other treatment may be needed for the patient because of what you obtained from the patient during your conversation with that patient. And I've even found abscesses and we've already had infectious disease on board. And I'm like, let me Just remove this bandage. And of course I gotta press on it. And I press on it, pus comes out. And I'm like, oh, let me call the doctor back. I think we have their source of infection that nobody saw up under the patient's breast, right? And so head to toe assessment, pay attention to detail.
[00:18:43] Just concluding on the head to toe assessment. Because I can go all day about it.
[00:18:48] Do it on your patients. Do it. And the more you do it, the more natural it is, the faster you're going to be at it. And you will have done most of it as you're entering your patient's room because you're used to it, right? The last thing under assess, assess, assess and assess some more is in addition to admission assessment, head to toe assessment is discharge instructions.
[00:19:14] Now you may have a discharge nurse who rounds and does discharges. That is great. And it's also when you have someone who pays attention to detail upon discharge for that patient because you just have those nurses who are just very attentive. And I just love them. I love them like myself. But it's so important to pay attention to your discharge instructions to make sure that the patient has what they need. Make sure that you anticipate the patient's needs upon discharge so that they don't come back in to the hospital setting with another issue. Start anticipating your patient needs. And this is just going on into the realm of holistic care. So safe practice is really just looking at the whole patient and with discharge instructions, making sure that again, the med rec is correct, making sure that the patient is able to get their medications. A lot of hospitals may have programs where they do meds to bed prescription programs where the prescriptions may be at a lower price, whatever may, where it may be.
[00:20:24] But make sure you advocate and just create dialogue so that you can understand how to better advocate for your patients. And you know, a lot of one of the biggest issues is upon discharge day is they want to discharge the patient, but there was an oversight on home medical equipment that's needed, AKA home oxygen. Right. Or other needs. And so as the nurse, you have that ability to advocate and to really anticipate the patient's needs so that when the patient does get home that they will be able to stay home and continue to heal and progress versus a patient gets discharged and they come right back into the ED because they're short of breath because they needed home oxygen. So we just have to be mindful of things. Or we discharge patients and they're unable to take their medications for the evening. Or for the next day or two, and they end up back in the hospital. So we have to be mindful that we are anticipating the patient's needs and that their needs are met beyond discharge. That's part of safe patient practice. I would always say when I was working on a unit, even now, if I go visit on a unit, go round, every patient is my patient. If that patient falls, if something happens to that patient and it's something that we could have prevented, we have all failed the patient. So if you're watching that nurse scan that patient label on their computer on wheels and not go into the room, we're all failing that patient.
[00:22:12] I'm sorry, I just had to say that. I hope that resonated. Now, I really wanted to talk about effective communication with an interdisciplinary approach. I don't have time today to finish talking about that, to even go into it. So let's just wrap up and I will see you again here in two weeks, 6am on Friday, May 16th. Happy Nurses Week Nurses Week is May 6th through May 12th, so be sure to show your appreciation to a nurse. You can show your appreciation to me by sharing this episode and making sure that you're a subscriber. So go ahead and click subscribe subscribe so that you can tune in and I'll see you again May 16th.
[00:23:06] Coming up on the All One Nurse podcast, I have Dr. Felicia Harris, who is a functional medicine nurse practitioner and she helps Black women with autoimmune conditions find answers, get relief and live the life they love again. Which is so awesome. I cannot wait to interview her and learn about her professional journey, her personal insights, patient perspective and her educational insights. And of course, we got to end with her call to action and her advice for new nurses. I also have Rachel Dumas. Let me tell you about Ms. Rachel because she's probably going to have us in tears. The month of April is Maternal Health Month, and Rachel is a very busy person, but she is transforming maternal health care. She is the founder of A Light After Nine, a nonprofit dedicated to supporting moms, birthers and families navigating infertility, pregnancy loss and maternal health challenges.
[00:24:13] Rachel will tell us more about her her journey of enduring eight miscarriages and one stillbirth.
[00:24:23] Oof. That's I can't even imagine. I cannot imagine. I've experienced pregnancy loss myself. And you are welcome to go to the Rapid Response RN Podcast with Sarah Lorenzini where we talk about ectopic pregnancy, where I actually experienced a ruptured fallopian tube that resulted in pregnancy loss. So you know, one thing I want women to know is that you're not alone as a woman. And if you are in a relationship, I want you to know that your spouse, your significant other experiences the loss too in their own way. Even though it's your body, it is still a shared experience.
[00:25:12] And I'm going to leave it there because that is just a very sensitive and maybe triggering topic. But tune in, tune in, Stay connected.
[00:25:26] One thing that I want to address on some upcoming episodes is what does professionalism look like? Who are you? Beyond the title Nurse and understanding Delegation in Nursing, I think these are some awesome topics for my nursing students, my new nurses. I always want you to think on those things which are going to get you where you need to be. Complaining, doubting, worrying, stressing over everything is not going to get you to where you need to be. You can join me on all One Nurse weekly meetups on Thursdays at 8pm Central Time where we take 40 minutes of just talking about a win a barrier and whatever topic that we are diving into because of our previous weekly meetup. So you help guide the the discussion and I am just a support system. This is free mentorship. You can get it. You can get to the weekly meetup via Zoom on Patreon. So you have to go to Patreon and find all one Nurse. Become a free subscriber, go to the chat and there you will find the Zoom information. I will log in at exactly 8pm because I want to use all of that time. Okay so I will log into the Zoom at exactly 8pm Now I hope I left you feeling inspired, feeling encouraged to do the right thing in regards to safe practice as a nurse. Whether you are coming into the nursing field or you've been working in nursing for a while and you may have been taking shortcuts. Just did it last night. But it's never too late to stop, repent and let's move forward so that we are doing the right things by our patients. Speaking of my seasoned nurses, if you are a nurse who is very passionate about your role, your specialty, and you would like to share your expertise and how you care for your patients, your patient population to inspire and educate new nurses and encourage them, then reach out to me at chanel all1nurse.com is my email address Chanel S-H E N E L
[email protected] and let me know and we will let God do the rest. Okay?
[00:28:19] I'm so glad that we had this opportunity to be together on this episode. I hope that I left you with some. Something you can find me on all one nurse, on TikTok, on Facebook, on Instagram, just type in all one nurse. I'm also on LinkedIn.
[00:28:37] I'm gonna say that again. Linked in.
[00:28:40] I'm on YouTube, which you may be watching, and you can see my hair doing whatever is. Where else am I? I think that's it.
[00:28:49] I think I named all the places. So until next time, let your light shine and I look forward to connecting with you.
[00:28:58] Bye.
