Type: Written assessment

Due date: 28th April at 5:00 pm (Brisbane Time), Week 7

Weighting: 40%

Length: 1500 words (± 10%)

Unit Coordinator: Danielle Le Lagadec

Returned by: 18th May (Week 10)

Learning Outcomes Assessed

• Explain the principles of quality use of medicines (QUM) relevant to nursing practice;

• Describe the pharmacodynamics and pharmacokinetics of particular drugs; and

• Demonstrate accountability in relation to the safe administration of medications.

Aim

The aim of this assessment is to enhance your recognition of medication errors and to embed your knowledge of the quality use of medications. The assessment also aims to assist you apply your knowledge regarding the pharmacokinetics and pharmacodynamics of analgesics.

Instructions

Assessment 1 involved compiling an essay in response to two (2) topics with questions linked to the case study.

Please follow the steps below to complete your assessment task:

Step 1: Read the case study.

Step 2: Use the case study to complete the two (2) topics listed below addressing the questions. You are required to attempt both topics.

Topic 1: Medication error (700 words)

There was a significant medication-related error that occurred, leading to a poor outcome for this patient. Write a short essay addressing the following:

    a.     Describe the medication-related error that occurred and outline two (2) factors that contributed to the error.

    b.     Identify and discuss at least 2 (two) of these failings and/or poor practices that occurred in this case study.

    c.     How can these failings and/or poor practices that you have identified, be addressed so that the risk of this medication error occurring again can be minimised?

    d.     Refer to the NSQHS (2nd Edition) Standard 4 - Medication Safety. Choose one action from the NSQHS Standard 4 - Medication Safety list below and discuss how this could be used by the nurse caring for Mr Snell to prevent this type of            medication error occurring again.

                o     Partnering with consumers: Action 4.3

                o     Medication reconciliation: Action 4.6

                o     Information for patients: Action 4.11

                o     High risk medications: Action 4.15

Topic 2: Understanding Pharmacokinetics and Pharmacodynamics (800 words)

Before you administer medications to your patient, you require adequate knowledge of the medication. Having an understanding of the pharmacokinetics (what the body does to the drug) and the pharmacodynamics (what the drug does to the body) is essential to ensure safe and effective administration of medications.

    1. Discuss the pharmacokinetics (Absorption, Distribution, Metabolism, Excretion) of morphine sulphate.

        Include in your response:

            • Absorption:

                        • Name four methods (routes) of administering morphine sulphate

                        • When (time, in hours or minutes) is the drug’s peak of action and duration of action for each administration route?

                        • Explain why the peak of action and duration of action differs between administering routes.

            • Distribution:

                        • How is morphine sulphate distributed in the body?

             • Metabolism:

                        • Discuss how morphine sulphate is metabolised and what is meant by its half-life.

             • Excretion:

                        • How is morphine sulphate excreted from the body? Briefly discuss the organ responsible for the excretion of morphine sulphate.

2. Pharmacodynamics:

        • How morphine sulphate achieves its analgesic effect,

        • Briefly describe morphine’s mechanism of action.

        • Discuss two significant adverse effects of morphine sulphate.

        • Discuss the nursing considerations required when administering morphine sulphate to a patient.

Literature and references

In this assessment use at least 10 contemporary references (≤ 5 years for journal articles and credible websites, ≤ 10 years for textbooks) to support your discussion. You may also use seminal scholarly literature where relevant. Suitable references include peer-reviewed journal articles as well as textbooks and credible websites. When sourcing information, consider the 5 elements of a quality reference: currency, authority, relevance, objectivity, and coverage. Grey literature sourced from the internet must be from reputable websites such as from government, university, or peak national bodies: for example, the Australian College of Nursing.

Requirements

• Use a conventional and legible font, such as Times New Roman 12 or Arial 11 font, with 2.0 line spacing and 2.54cm page margins (standard pre-set margin in Microsoft Word).

• Include page numbers on each page in a footer.

• Write in the third-person perspective.

• Use formal academic language.

• Use the seventh edition (7th ed) American Psychological Association (APA) referencing style. The CQUniversity Academic Learning Centre has an online APA Referencing Style Guide.

• The word count is considered from the first word of topic 1 to the last word of topic 2. The word count excludes the reference list but includes in-text references and direct quotations.

• The following format is to be used to present your submission (include topic headings):

            • First page: cover page (must include: student name, student number, unit code, unit name, term date and year, name of the unit coordinators, the due date for submission, and actual word count).

            • Next page:

                    i. Topic 1: Medication error

                    ii. Topic 2: Understanding pharmacokinetics and pharmacodynamics

            • Last page: Reference list.

• Do not include an introduction or a conclusion.

• Please include short topic headings.

Resources

• Please use credible sources (e.g. journal articles, books) to reference your argument. The quality and credibility of your sources are important.

• We recommend that you access your discipline-specific library guide: MIMS Online; Nursing Resource Guide; Midwifery Resource Guide.

• For information on academic communication, please go to the Academic Learning Centre Moodle site. The Academic Communication section has many helpful resources including information for students with English as a second language.

• Submit a draft before the due date to review your Turnitin Similarity Score before making a final submission. Instructions are available here.

Submission

Submit your assessment via the unit Moodle site in Microsoft Word format only.

Marking Criteria

Refer to the marking rubric on the Moodle site for more detail on how marks will be assigned.

Case Study Summary

Setting

A busy 6 bed Orthopaedic ward at a private regional hospital.

Bed 46: Mr. Snell, a 78-year-old gentleman, underwent a spinal laminectomy of L3 and L4 two days previously. Mr. Snell has chronic back pain which he treats with Paracetamol 1g QID and heat packs. He also suffers from GORD for which he takes Esomeprazole 20mg daily and occasionally suffers from asthma which is treated with a Salbutamol puffer when needed. Mr. Snell experiences sleep Apnoea and usually utilises a CPap machine at night but has forgotten to bring it to the hospital. He dislikes morphine and stated that he’d prefer not to be given any because it causes him to hallucinate. Mr. Snell has no known allergies.

Post-surgery Mr. Snell has been prescribed the following, in addition to his regular medications:

        • oral paracetamol 1g QID,

        • oral ibuprofen 400mg TDS,

        • 100mcg fentanyl transdermal patch to be replaced every three days.

Bed 47: Mr. Smyth, a 72-year-old gentleman, underwent a total hip replacement surgery the previous day. Mr. Smyth is generally in good health. However, he has been diagnosed with hypertension and hypercholesterolaemia, which are well controlled with medications (Perindopril 4mg daily and Atorvastatin 20mg daily). Mr. Smyth has no known allergies.

Following his surgery, in addition to Mr. Smyth’s regular medications, the surgeon has prescribed:

        • oral paracetamol 1g QID,

        • oral ibuprofen 400mg TDS

        • subcutaneous morphine sulphate 5-10mg 6 hourly PRN, a maximum dose of 40mg / 24 hours

Situation

At 2230 the curtains are partially drawn around the beds as most patients are sleeping. The lights are dimmed. Mr. Smyth, in bed 47, buzzes and requests pain relief for 7/10 pain. RN Mary has just commenced her shift after being on ‘days off’ for four days. She checks Mr. Smyth’s medication chart and notes that his paracetamol was given at 2200 and that his previous dose of morphine was given at 0800 that morning. Considering the severity of his pain, RN Mary decides to give Mr. Smyth 10mg of morphine.

RN Mary writes up the morphine in the DD Book (controlled drug register) and asks junior RN Sarah, whose shift is just about to end, to witness the removal, preparation and administration of the morphine. They both go to the patient’s bedside to administer the drug but as most patients are asleep, they do not turn on the lights and speak softly as they briefly do their checks/rights. They omit to check the patient’s armband. Both RNs sign Mr. Smyth’s medication chart as drug given. As they leave the ward, RN Sarah suspects that they may have given the morphine to the patient in bed 46. However, she thinks she is probably mistaken, doubts herself, and additionally feels embarrassed and reluctant to question Mary as she is a senior RN. Since Sarah’s shift has ended and she is running late, she doesn’t investigate further and leaves the hospital without reporting her suspicions.

At 2330 RN Mary checks the patients - they are all sleeping soundly. She notes that Mr. Snell’s breathing is shallow and irregular but thinks that this may be normal for him as he suffers from sleep apnoea. At 0130 RN Mary monitors all patients’ vital signs and is alarmed to find that Mr. Snell is not breathing and had no detectable pulse. She activates the emergency call button. CPR is executed but the staff are unable to revive the patient. The patient is declared deceased at 0150.

The Investigation

This is an unexpected death and a coroner is required to undertake an investigation. The investigation reveals that Mr. Snell died from opioid toxicity due to an opioid overdose.

DISCLAIMER

This case discussed here is fictitious but is based on a coroner’s case in the public document.

This quiz is an open-book, timed online quiz. The quiz is available for 48 hours and you have two (2) hours to complete the quiz once you begin. You may only attempt the quiz once and, unless there are exceptional circumstances, you will not be able to resit the quiz if not completed within the required time frame.

As this is an open-book assessment, you can access resources throughout the quiz. While you may use unit resources and your own notes, we expect you to provide answers in your own words. Copying and pasting information will be considered a breach of academic integrity.

The assessment is worth 60 marks of which 20 marks are allocated to multiple choice questions, true/false questions and matching questions. The remaining 40 marks are short answer and case study questions. Marks may differ between questions. Please type your answers into the areas allocated for the answers. Marks may differ between questions. 

We expect that you complete this quiz independently and adhere to the conditions associated with undertaking an assessment. It means that you must ensure academic integrity and comply with the Student Academic Integrity Policy and Procedure. Acting honestly and with integrity means that you avoid behaviour that may breach academic honesty, such as plagiarism, collusion, cheating, and other forms of academic misconduct. If any academic misconduct is detected, it will be managed according to the policy and may result in penalties.