Quality Improvement of safety improvements

Answer

1. Safe Medication Administration

   Agenda and Outcomes

   • The goals of this in-service training involves;
     1. To discuss common medication errors
     2. The quality improvement plan
     3. Role nurses should play to minimize errors in medication

   The most common medication errors include prescription errors, administration errors, dispensing errors and monitoring errors.

    Prescription errors occur due to prescription decisions or prescription handwriting.

    The prescription mistake include incorrect drug selection, incorrect route of administration selection, wrong dosage forms, drugs to which patients are allergic, and wrong patient errors.

   Administration errors include wrong dose, missing dose, drug overdose, and wrong timing.

   Dispensing errors include wrong labeling of drugs and dispensing of drugs to wrong patients. Monitoring errors include inadequate patient assessment to the response of the drug therapy.

   Common Medication Errors

   • Medication errors are the most common health mistakes that affect patient safety and care ( W.H.O, 2016).

   About 6.7% of hospital admissions are caused by medication administration errors, leading to high mortality rates, lengthy hospital stays and high medical costs.

   The commonest types of medication errors are wrong dosage and infusion rate. Both of these factors are caused by lack of pharmacological knowledge among nurses.

   Causes of medication errors

   • Poor communication
   • Patient related issues
   • Technical failures
   • Inadequate policies

   The causes of medication errors include;

   1.Staff shortages

   2. Many distractions and interruptions

   3.Poorly designed safety protocols on medications

   4.Failure in the adherence to policies and guidelines

   5. Look alike and/or sound alike drugs

   Quality improvement plan

   • The proposed plan is to adopt Total Quality Management(TQM).
   • This is to address issues related to medication administration errors.
   • Integrating Six Sigma with TQM

   Total Quality Management approach  is an approach of management for continuously and consistently improving the products’ quality and other processes in order to improve patient safety.

   Integrating TQM with Six Sigma approach will improve process of medication through detailed analysis of data.

   • This approach will also be efficient in improving handwritten behaviors and decreasing errors related to administration of wrong dosage.

   The improvement ways of behaviors like improving handwritten prescriptions and decreasing the level of medication errors to less than the global standards are key factors to increasing patient safety.

   Purpose of the in-service session

   • The nurses role to improve quality In medication provision are to;
     • Ensure the five rights of medication are followed ( Tshiamo et al., 2015)
     • Follow proper medication reconciliation procedures
     • Properly document everything
   • Nurses should ensure correct medication is prescribed for the correct patient, via a correct route in the correct dosage and time.
   • They should also follow the Medication Administration Record( MAR) for verification.
   • To prevent errors caused by carelessness, the nurses should double-check or triple-check procedures before administering drugs

   The Need to Address  Medication Administration Errors

   • To reduce patient morbidities and mortality caused by medication errors.
   • To painting a negative image on the healthcare facility
   • The main aim of the need to address medication errors is usually to enhance patient safety and reduce the morbidity and mortality rates that are caused by careless administration of medications.
   • Additionally, medication errors may dent the overall picture of the health institution, therefore making the general public lose trust in the healthcare services, as they will be deemed unsafe and dangerous to human safety.

   Purpose of the in-service session

   • Ensure proper storage of medication
   • Consider having the drug guide with them every time.

   The nurses are critical to the success of the improvement plan because, beginning with them, the proper drug administration will improve patient safety and reduce the morbidity and mortality rates that are caused by medication errors. Therefore, proper storage of medication is a critical responsibility of the nurses to ensure the drug is safe for consumption.

   Also, to avoid errors due to guesswork and carelessness, the drug guide should be followed every single time.

   Audience Role and Importance

   • Early preparation of medication administration by nurses to  reduce distraction
   • Following the eight rights of medication (Wu, 2019).
   • Performing hand hygiene

   The role of nurses to reduce errors related to medication include early preparation of nurses in the health facilities to avoid distractions that may hinder their maximum concentration.

   The eight rights of medication which include right patient, right medication, right dosage, right route, right time, right documentation, right reason and right response should be followed strictly by the nurses in order to minimize medication errors.

   • Provision of patient education
   • Completion of vital signs and focused assessment
   • Checking for any precautions. This is done on the rooms.

   Patients also have a part to play in ensuring the right medication is administered and errors minimized.

   When the patient is adequately educated on the safe ways to use drugs, some errors might be noticed and prevented before they occur.

   Monitoring vital signs before and after administering drugs may help the nurse with important information about drug reactions and adverse effects that may be caused by the drug.

   Any precautions should be checked before administering any drug to the patient

    

    

Answer

Chirality- Isolation of Limonene from Citrus Fruits

INTRODUCTION

The purpose of this experiment is two-fold: (i) to obtain Limonene from citrus fruits through steam distillation and (ii) to analyze the optical rotation and enantiomeric excess (optical purity) of the fruits using polarimetry.

Limonene belongs to a class of aromatic compounds, mainly terpenoids in composition and characterized by several isoprene repeat units (Ludwiczuk, Skalicka-Woźniak & Georgiev, 2017). These include monoterpenes which comprise 2 isoprene units, sesquiterpenes with three isoprene units, diterpenes containing 4 isoprene units and triterpenes with 6 isoprene units (Asia, Nicholas, Segui & Ballivian, 2020).

Limonene is extracted by steam distillation, as aromatics are thermally decomposable under high temperatures (Valderrama & Ruiz, 2017). Subsequently, polarimetry is deployed to determine the chirality of the limonene. Chirality is the “direction of rotation” of the substance (Telo, 2016). Additionally, chirality confirms optical activity and the presence of a chiral center, a carbon attached to four other groups (Weldegirma, 2016; Telo, 2016). Polarimetry is a necessary tool for establishing optical purity through measurement of enantiomeric excess (ee), or optical purity.

Findings from the experiment show the specific rotation to be about “half of the literature value” (Asia, Nicholas, Segui & Ballivian, 2020). Many studies associate this outcome with a high concentration of limonene in the samples being investigated. Similarly, the optical rotation of the sample was found to be 11 (Asia, Nicholas, Segui & Ballivian, 2020). The ee was found to be 11.34%, one possibility for this result could be that our sample was not pure, therefore accounting for the low percentage. A percentage of 100% means a pure enantiomer (Weldegirma, 2016).

Figure 1: Schematic Diagram for Extraction of Limonene

Source: Asia, Nicholas, Segui & Ballivian (2020)

Figure 2: Schematic Diagram for Polarimetry

Source: Asia, Nicholas, Segui & Ballivian (2020)

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