Healthcare Policy And Quality Essay Example for Free

Healthcare Policy And Quality Essay The essay will examine the management of medicines policy on standards in medication errors by nurses in the hospital environment, the guidelines that nurses must follow when giving medication in order to avoid medication errors. A definition for medication error will be given. Further issues to be discussed include; why medication error happens, approaches aimed at minimising medication error and the importance of teamwork , a brief reflection and a conclusion based on the findings will be given. The use of medication process involves different health care professionals as a result , medication error can take place relating to a series of steps in the drug delivery process, and includes the process of prescribing, dispensing, transcribing and administration (Chua et al. , 2009 ; Zhan et al., 2006), thereby making room for error to take place. Subsequent to prescribing errors, the administration of medication errors is the most frequent type as they are more likely to reach the patients and the greater chance of causing patient harm (Chua et al.,2009). The legislation of medicines applies to prescribing, supply, storage and administration and it is important to have knowledge of and adhere to this legislation (Nursing Midwifery Council (NMC), 2008; Royal Pharmaceutical Society of Great Britain (RPSGB) (2009). The medicine management policy on standards in reporting medication errors, near misses and adverse drug reactions was located on the Local Trusts website and was easy to access. The Local trust is an acute, non-profit, health service. From the policy all staff involved in the prescribing , administration, dispensing and checking of medicine has the responsibility to ensure the policy is implemented and adhered to. In the local trust policy it states any member of staff can report a medication safety incident, near miss or adverse outcome. The local Trust Policy was reviewed in January 2012. The trust will also monitor all medication related incidents and an annual audit will be carried out to assess the effectiveness of the policy. The audit will be undertaken on a random selection of 30 cases of reported incidents. This Local Trust implemented the guidelines for the administration of medicines by the Nursing and Midwifery Council (NMC), 2008 which gives the information a prescription  chart must contain for safe and correct drug administration and gives clear principles for prescribing medicines. If the prescription is clear and accurate, errors are less likely to occur. The guidelines also states: In exercising your professional accountability in the best interests of your patients; as a registrant, you must know the therapeutic use of the medicine to be administered, its normal dosage,side effects, precautions and contraindications,be certain of the identity of the patient to whom the medicine is to be administered , be aware of the patients plan of care To appreciate medication mistakes and discuss policies for reducing and reporting medication errors, it is useful to understand the term ‘medication error’. The National Coordinating Council for Medication Error Reporting and Prevention states: a medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of health professional, patient or consumer (cited in Chua et al., 2009 p. 215). Different standards and policies are formed for varied circumstances and situations as well as routine moments (Unver, 2012). One such standard is the Standard for Medicine Management which replaces the Guidelines for the Administration of Medicines 2004, even though many of its principles remain relevant today (Nursing and Midwifery Council (NMC), 2008. This standard points out the various ways of managing medicine for nurses as they are required to take responsibility for their actions and omissions for any errors they make when giving any medicine (Copping, 2005). Usually, medical mistakes do not harm patients (Department of Health (DoH) (2004). Although, the National Patient Safety Agency (NPSA) (2009) gave a written account that in England, less than 1% of the key instance of harm or death in the National Health Institute (NHS) were directly linked to medication error; 155 medical instances gave rise to severe harm and 42 deaths. Standards in the NHS are used to make sure proces ses and procedures are carried out in a uniform and consistent manner to help professionals and patients ( Tzeng et al., 2013). Also , the same process should be carried out in the same way  wherever the site or location and under the same circumstance. This uniformity removes errors from personal judgement and panic decisions during situations which could ultimately lead to the death of people under various circumstances ( Fore et al., 2012). The administration of medication is likely to be based on errors in nursing as under normal circumstances, nurses are involved in the administration process and they spend 40% of their time giving it (Wright, 2013; Unver et al., 2012). Hence some studies have reported high error rates, indicating that nurses are putting patients in danger, when such errors would cause a low or minor risk to the patient (Wright, 2013). It is of great value to establish the cause of errors so that solutions can be put in place to reduce medication error rates. Although there are medication policies, adherence to these policies are low (Kim and Bates, 2012). Prior to medication administration, the following checks should be done : ‘right medication, in the right dose, to the right person, by the right route, at the right time’ (Kim and Bates, 2012) . Despite the guideline established in the administration of medicines using the ‘five rights’, nurses may conduct in a way and give inaccurate assurance that the practice is safe ( Unver et al., 2012). Non-adherence to the five rights of medicine administration were observed by Kim and Bates (2012), the observations show that for : wrong dose (1.8%), wrong medicine (13%), wrong time (7.1%), wrong person (5.2%) and wrong route (1.8%). An observation of potential error in the administration of medicine was made during a recent clinical placement in an elderly ward of a local trust. The ward has 30 beds and medicines were supplied in bulk to the ward, though more specific medicines were provided as single items on receiving a prescription by the pharmacy department. In addition, medication orders were written by doctors directly onto the patients medication chart without transcribing.The medication was given by nurses by referring to the medication chart. In view of human error, it was noted that the registered nurses on duty worked over 12 hours a day and Tzeng et al., (2013) noted that taking everything into account nurses function is significantly greater when working a regular 8hour shift compared to over 12hours shift. Further circumstances that contributed to medical errors by nurses include;  tiredness which can affect concentration (Copping , 2005), being distracted or interrupted (Wright,2013; Fore 2013), loss of concentration and a belief about limited drug calculation and numeracy skills among nurses ( Ramjan 2011). In addition, Leape et al., (1995) reported other types of medication errors: short of knowledge of the drug, information about the patient, in breach of the rule, slip and memory lapses, transcription errors, faulty drug identity checking, not interacting with other services, not checking the dose, insufficient monitoring , drug stocking and delivery problems Unver et al., (2012) also noted that medication error can also be as a result of systematic factors like heavy workload ; for example, a study carried out by Karadeniz and Cakmakci , (2002) in Turkey reported nurses fatigue was the primary cause of medication errors. Another factor is insufficient training . It has been wel l-known that newly qualified nurses lack of skills in clinical settings affects the occurrence of medication errors. A patients circumstance, that is complex health conditions), doctor issue (multiple orders, illegible handwriting) and nurse aspect (personal neglect, newly qualified staff, not familiar with medication and patient) . The avoidance of medication errors is extremely imperative for patient safety (Unver, et al., 2012). In the early 2000s Pape et al., (2005) was the first to initiate the use of aviations sterile cockpit code which has gained awareness in the health care to cut down on distraction during clinical tasks. The process included the use of vests and signs. The words Do Not Disturb positioned in the medication vicinity were used as prompts to reduce distraction. Members of staff were also asked not to disrupt or distract the nurse doing the medication round of the ward. As a result , Papes (2003) study found 63% fewer distraction when using a firm checklist set of rules. Similarly, a study by Federwisch (2008) reported a 50% decrease in the number of staff interruptions, an increase of 50% in the standardisation of medication administration, 15% progress in the time vital to administer medications and 18% increase in on-time medication delivery when nurses wore yellow sashes during medicat ion administration. On the whole, to lessen medication errors, the collaboration among doctors,  pharmacists and nurses is necessary ( DoH, 2004). Doctors must know their shortcoming and recognize their interconnection with other health care professionals (Pedersen et al., 2007), in particular nurse prescribers who help to ease the work of junior doctors. Verification by another nurse is essential as double checking by other nurses in adherence to the ‘five rights’ of medicine administration can help reduce an error (DoH, 2004). Subsequently, pharmacists can lessen the chance of errors by being in attendance on the ward drug rounds and chipping in their drug knowledge (DoH, 2004). Moreover, everyone in the health care team can help reduce medical errors by keeping a reflective journal (Tzeng et al., 2013 ) as a practical self-help tool, though there is a not enough of empirical study to support its valuable effects (Fore, 2013). According to Fore (2013), health professionals can reflect by one or more of the subsequent methods: welcoming feedback from colleagues about strengths and weaknesses; checks on critical incidents to find out what went wrong , why it went wrong and how to avoid a recurrence of an error; use of a diary for self evaluation and recognize knowledge gaps. It is generally accepted that system factors presents itself with medication errors in health care, nurses are the health professionals that frequently encounter and report medications error ( Roughead and Semple 2008). On the contrary, a study by Unver et al ,(2012) points out, more than half of nurses do not give an account of some medication errors as they are frightened of their colleagues reactions. As a result , it is important to foster a culture that is less fixed on laying guilt to promote communication and error reporting. The need to reduce medication error is a continuing process of quality improvement (Unver et al.,2012). Ac cording to Sanders (2005) , to establish risk is the first act to undertake, as any other strategy to reduce risk may be inappropriate. This can be made by means of using tools such as audit ( Montesi and Lechi, 2009). The World Health Organisations (WHO) (2009) framework for the classification of problem, process and outcomes of patient safety events is a practical base for a framework to learn the circumstances surrounding medication error. In spite of information of under-reporting of medication errors, especially by physicians, (Franklin et al., 2007) incident reporting can produce an awareness into the errors that happen and make easy identification of contributing factors (Malpass et al., 1999a). Moreover, a  UK Government white paper, put forward standardisation of audit as part of professional health care (Montesi and Lechi, 2009). The National Institute for Heatlh and Clinical Excellence(NICE) (2002), defined clinical audit as : a quality improvement process that seeks to improve patient care through systematic review of care against explicit criteria and the implementation of change ( cited in Montesi and Lechi, 2009, p. 3). Clinical audit is a learning tool , which encourages high- quality care and should be implemented regularly and it offers an organised framework for inspecting and judging the work of health care professionals ( Montesi and Lechi, 2009; NICE, 2002). Audit is also a way of measuring and monitoring practice across a well- set of agreed standards and finding mismatches in the written word and actual practice. Similarly, detecting medication errors can also be through a chart review, reporting of incident, monitoring of patients, direct observation and computer monitoring (Montesi and Lechi, 2009). The only technique used for identifying errors of administration of medications is by direct observation ( Montesi and Lechi, 2009). This is done under the observation of a trained nurse by noting the similarity or dissimilarity between what is done in the administration and the original physician orders. In addition to direct observation, reporting systems is another process obtained from pro cedures in high-reliability organisation. On the other hand, reports given to legal services can cause confusion and bring about a connotation of blame (( Montesi and Lechi, 2009). Incident of reporting was first used in the UK by the Royal College of Anaesthetists. According to Montesi and Lechi ( 2009), there are two safety-oriented levels of reports. First, incident reporting where it is required that a the details recorded are concise, legible and a true version of events are recorded and sent to the central organisation , which supplies regular statistical reports and raising concerns about quality improvement. Secondly, voluntary reporting . This process is anonymous, confidential and blame- free.The benefits of voluntary reporting include; the detection of active and hidden system failures, evidence of significant processes and the distribution of a culture of safety ( Stump, 2000). Other methods include; patient monitoring, by interviewing, satisfaction surveys and focus groups. Through this, patients can learn about medication errors. With reference the Local Trust Policy, patients now receive an individualised medicine patient  information leaflet (PIL) detailing their in-patient and discharge medicine by advising them about any possible side effects and dosage information, contact details should more information be required. During placement, it was essential that the five rights is followed during a medication round with the nurses. It became fully aware that the five Rs is the most thorough way to prevent medication error arising. This policy has helped me establish how and why using the correct procedure helps to minimise administration errors from happening. Not all but most of the nurses at the placement adhered to the guidelines that the policy set out. In conclusion, the essay demonstrated that medication administration errors are still a continual problem that is related to practice in nursing . Nurses are mainly involved in medication administration. They also have an exceptional role of identifying and stopping errors that occur in the various stages. Encouraging patient safety should have a number of approaches that involve more than direct care nursing staff. Another basic cause, is human- factor, therefore a professional education with individuals and system focuses on patient safety matter is essential. Lastly, health professionals accountable for the prescribing, dispensing and administration of medicines must work collectively as team members in the ward environment . The essay also demonstrated how the problem of medication administration error can be dealt with by the National Health Service.

Voltaires Candide as an Attack on Optimism Essay -- Candide essays

Voltaire's Attack on Optimism in Candide      Ã‚   Leibnitz emphasized, in his Discours de Metaphysique (Discourse on Metaphysics) (1686) the role of a benevolent creator. He called the constituent components of the universe monads, and while the philosophy of monads is of little concern to readers of Candide, the conclusion which Leibnitz drew from these monads is crucial to an understanding of optimism.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Leibnitz argued that all of these monads were linked in a complex chain of cause and effect and that this linking had been done by a divine creator as he created the harmonious universe. Since he was benevolent, omnipotent, and omniscient, he logically would create the best of all possible worlds. Hence, everything that happens in the universe is part of this greater plan, and thus must be for the best. Humans cannot appreciate how the evils encountered in every day life contribute to the best of universes and universal harmony, but they do, nonetheless.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Optimism was attractive to many because it answered a profound philosophical question that mankind had been grappling with since the beginning of faith: if God is omnipotent and benevolent, then why is there so much evil in the world? Optimism provides an easy way out of this philosophical dilemma: God has made everything for the best, and even though one might experience personal misfortune, God (via your misfortune) is still helping the greater good.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Voltaire's experiences led him to dismiss the idea that this is the best of all possible worlds. Examining the death and destruction, both man-made and natural (including the Lisbon earthquake) Voltaire concluded that everything was not for the best. Bad things do ha... ...e respond, in closing, to his friend the Optimist?    "That is very well put, said Candide, but we must cultivate our garden" (75).    Works Cited and Consulted: Bottiglia, William. "Candide's Garden." Voltaire: A Collection of Critical Essays. New Jersey: Prentice-Hall, Inc., 1968. Durant, Will, Ariel Durant. The Story of Civilization: Part IX: The Age of Voltaire. New York: Simon and Schuster, 1965. Frautschi, R.L. Barron's Simplified Approach to Voltaire: Candide. New York: Barron's Educational Series, Inc., 1968. Lowers, James K, ed. "Cliff Notes on Voltaire's Candide". Lincoln: Cliff Notes, Inc. 1995. Richter, Peyton. Voltaire. Boston: Twayne Publishers, 1980. Voltaire's Candide and the Critics. California: Wadsworth Publishing Company, Inc., 1996. Voltaire. Candide. New York: Viking Publishers, 1998.   

In the 15th Century the idea of schooling began Essay

It is used during the process of ‘streaming’ within school subjects. For example pupils who the teacher feels is good or poor at a certain subject, will be taught in a high or low ability group, this has criticisms at it encourages pupils to think of themselves as having fixed educational ability. A pupil can also be given a label from their behaviour, such as ‘trouble maker’ or ‘thick’, either at home or school. This can damage a child’s self esteem or make them rebel, which leads to them believing the label they have been given, this is called the ‘Self-fulfilling prophecy. For what ever reason they were given the label, they find it hard to be looked at without the label, so end up behaving in a way that fits to their given label. Working class not only have had inequalities in the past but also still do today. Although there are more opportunities in the education system, home life also plays large impact on how well a child does achidemically at school. Douglas (1964) conducted a study on middle and working class children through primary and secondary school. He found that children of a similar measured ability at age 7 varied a great deal in their educational achievement by the time they were 11. He claimed that the greatest influence on attainment was parental attitudes in the working class. He measured this by the number of times these parents visited the school, family size, early child-rearing practises, health and the quality of the child’s school. Working class children are more likely to have a part time job whilst at school and likely to leave education at 16. The Plowden Report (1967) noticed in working class households there was an absence of books, educational toys, lack of finance, lack of motivation, no parent support of due to own experiences or as a need to work long hours. This has been described as Material and Cultural deprivation. Jackson and Marsden (1962) published a study, ‘Education and the working class’. It showed that working class children tend to be slower in learning how to read and write, they start school at a disadvantage and this normal continues throughout. Marxists would say that this is because there are less opportunities for some classes and that the education system just helps to reproduce the existing class structure, e. g. , the ruling class (upper and middle class) and the workers (the working class), thus conflict and inequalities will continue. Success at school depends heavily on language, for reading, writing, speaking and understanding. Bernstein argues that ‘there is a relationship between language use and social class, and that the language used by the middle class is a better instrument for success at school than the language used by the working class’, (Browne 2005). In his view there are two different language codes: Â  The restricted code- This language is used by both classes, but is more characteristic of the working-class people. It is used everyday amongst friends and family, which is informal and simple (such as slang). Bernstein argues that lower-class-working people are mainly limited to this form of language use. Â  The elaborated code- This is mainly used by the middle-class, and is spoken in a formal context, with explanation if required. It has a much wider vocabulary than the restricted code, and is the language that would be found in textbooks, essays and examinations. Bernstein has argued that as the language used in schools by teachers and in textbooks is the elaborated code, working class children are disadvantaged. They may find it hard to understand the elaborate language used in school, therefore their work will suffer. Unlike middle class children who are used to the language so will find the work easier. Differences have been found amongst the achievements of people from different ethnic backgrounds, possible reasons for this could be the differences in their cultural backgrounds, language barriers and understanding or suffering from racism. If English were not the first language for someone this would give him or her a large disadvantage in the understanding of the language, which would affect their work in most areas. Suffering from racism in or out of school would cause the pupil upset, which could affect their schoolwork. Many Pakistani, Bangladeshi and African Caribbean children have large families and are working class, so are likely so have deprived social conditions. These groups mentioned appear to have a below average reading ability and tend to get fewer and poorer GCSE results than white or Indian pupils. It can be seen on the below table they are the overall lowest achieving ethnic groups. Students that achieved 5 or more GCSE grades A*-C (%) Race Group 1989 1998 2002 Indian N/a 54 60 White 30 47 52 Bangladeshi N/a 33 41 Pakistani N/a 29 40 Black 18 29 36. (Department for Education and skills, 2004: in Livesley et al, 2005) From the data above it is clear that black children are the lowest achievers. In the past racist remarks have been made claiming that problem was they had lower levels of inherited intelligence. Which is untrue, in 1985 the Swann Report found that ‘there was no significant difference between the IQs of black and white children’, (Thompson et al, 1982). Black boys are often given labels such as ‘unruly’ and ‘difficult to control’, due to how the teacher has interpreted them by their dress, manner or speech, and find them challenging. They are more often to be given detention than other pupils, and often feel unfairly treated, then respond in accordance with their label, self-fulfilling prophecy. Although they do not achieve well at school, the number of black women staying in education past the age of 16 is increasing, which may be influenced by the many future career opportunities available today. Kamala Nehaul (Parenting, Schooling and Caribbean Heritage Pupils’ 1999) has noted how black parents ‘valued education for the enhanced life chances it offered’. She also mentioned the encouragement and commitment from parents, talking about the school day and providing provisions needed for their child to study. Indian children do well within the education system, there is a strong emphasis on self-improvement through education within this culture. Many of these children have professional backgrounds, so have good role models and supportive parents and they also have material advantages. Differences in the achievement between gender, race and class will continue to be compared, though surely the person should be treated as an individual. Post-modern thinkers such as Elkind (1998), suggest ‘a key characteristic here is the idea of difference and, in a sense, the fragment of identities. In other words, students want to be recognised and treated as unique individuals rather than as groups’, (Livesey et al, 2005). Although a students background may effect their achievement, as evidence suggests, it must be remembered that everyone is an individual with their own abilities, no matter what race, class or gender they are, have the potential to achieve in education. A girl, black or white from a working class background may not have had any opportunities for a good career after education 50 years ago, due to inequalities in the system, but this is not the case today. Overall the educational achievements for all groups of people have improved. There will always be some people in all of the groups mentioned previously, that ‘fail’ in education, as a result of ‘self-gratification’ and ‘now culture’, they are more focused on ‘living for the moment’, and not thinking about how their actions during their education can effect their future life.

Reforming the NSA to Restore U.S. Credibility - 922 Words

Introduction On June 6, 2013, The Guardian published a story about the National Security Agencys (NSA) secret Internet surveillance program, PRISM (Greenwald and MacAskill 2013). The story was based on documents leaked by one of the most successful whistle-blowers in American history, former NSA contractor Edward Snowden. The documents that Snowden has released up to this time have shown the NSA to be heavily engaged in the collection of personal Internet activity, bulk collection of telephone metadata, and other forms of surveillance that have brought U.S. intelligence practices into question. Claiming its actions are related to the War on Terror, the NSA has insisted that these programs are legal, have not been abused, and are vital to preventing terror attacks. The leaked programs have not only created domestic furor, but also put U.S. diplomatic relations with its allies in jeopardy. With the overthrow of the Ukrainian government creating tension between the U.S. and Russia, Snow dens asylum in Russia is a political and diplomatic blow to U.S. prestige and moral authority. And with the threat of further Snowden leaks looming, future U.S. intelligence operations may hinge on the willingness of Washington to alter its policies. Benefits of the Programs The potential benefits of the NSAs surveillance programs have been described by the Obama administration as vital to the War on Terror. The two programs that have received the most attention are the collection