You work on a neurology unit caring for Samantha Hill, a 35-year-old woman who was admitted after presenting with a severe headache, stiff neck, and fever. The results of her lumbar puncture are consistent with bacterial meningitis, and the strain is sensitive to gentamicin sulfate. You have to administer Gentamicin Sulphate 168mg IV q8h. Samantha weighs 68 kilograms and has normal renal function. The dose strikes you as being high for someone of her weight. To reduce medication errors, your facility has an ‘app’ on their tablet computers that checks the dosing of medications. Using the app, select gentamicin sulfate IV, enter Samantha’s weight and click on ‘calculate dose.’ The app proceeds to an error screen. One of your colleagues noticed the error screen and commented that he had the same problem earlier in his shift so he went online and found a different dose calculator.
- Would you use the other dose calculator offered by your colleague? Why or why not?
– It is important to know that as a practical nurse, professional practice is one of our responsibilities, as well as prioritizing patient safety and following the due process when giving care to the patient. In this scenario, when encountering an error using the facility’s medical equipment, which has raised concerns about its reliability, it is necessary to display self-awareness and seek assistance from another nurse in the unit. However, you have been recommended to use another source; the source’s credibility should be from a reputable healthcare organization or a known pharmacy. The calculator’s accuracy should also be verified, and it must provide an accurate dosing recommendation based on the patient’s weight. When using this online calculator, one should compare the dose calculated with the standard guidelines from the drug reference or clinical guidelines to ensure consistency and accuracy. Therefore, all safety precautions must be followed, and the pharmacist who sent the drugs and other specialists involved in the care term must be consulted.
- Would you give the dose and ignore your initial reaction that it seems high?
According to the information provided in the article “Nursing Rights of Medication Administration” (Martyn et al., 2019), nurses must prioritize patient safety, follow established rules, and best practices, including the “five rights” of medication administration. This includes verifying the patient’s identity, confirming the exact medicine, route, time, and dose, and considering patient-specific aspects like weight and renal function. Nurses should use accessible tools, such as medication administration applications or dosage calculators, to precisely calculate and verify drug doses. Ignoring initial concerns about potentially excessive doses of medication would be incompatible with nursing best practices and might compromise patient safety. Instead, nurses should advocate for patient well-being by requesting clarification from healthcare providers if there are any concerns about drug dosing to avoid errors and ensure safe administration (Martin et al., 2019).
- Where else could you check for the recommended dose?
- What is wrong with your colleague’s attempt to ‘fix’ the problem of the “app not working”? How would you communicate with your colleague? [AB1]
- What policy/guideline/practice should be considered to guide nursing actions in these types of situations
- What other resources or actions could assist your decision-making?
Reference
Martyn, J. A., Paliadelis, P., Perry, C., & Fothergill Bourbonnais, F. (2019). Nursing rights of medication administration. Nurse Education in Practice, 37, 109-114. https://doi.org/10.1016/j.nepr.2019.05.001
I will do these 2 questions 🙂 [AB1]