CASE STUDY
You are a new graduate nurse working in a general medical ward on an evening shift. It is 1730hrs and you receive a new admission from the Emergency Department. Mr Nguyen is a 74 year old male who was admitted with generalised malaise, polydipsia and polyuria. He is a newly diagnosed type 2 diabetic whose blood glucose level on presentation to the ED was 23 mmol/L. He had a normal acid base balance and no ketones present in the urine. Mr Nguyen was commenced on 8 units of Actrapid insulin QID and Lantus insulin 14 units Nocte via subcutaneous injection. You review Mr Nguyen’s medication chart and realise he is due for 8 units of Actrapid insulin. You measure his BGL prior to administration and it is 14 mmol/L
You go to the medication preparation room with another registered nurse to prepare insulin but realise there are no more insulin syringes left in stock. Your colleague then tells you to use a tuberculin syringe instead as they are the same (she explains that the only difference is it is marked as cc rather than units as it is an American made syringe). You draw up 0.8cc of Actrapid insulin and have it double checked with your colleague as per the 6 rights. You administer the subcutaneous injection to Mr Nguyen.

Half an hour later you approach Mr Nguyen to prepare him for dinner and find he is unrousable to speech and pain response. You immediately role him in the left lateral position and call the rapid response team. When the team arrives they review Mr Nguyen and his notes, they ask what medication you have recently administered and you inform them you administered 0.8 cc of Actrapid insulin. The medical team leader of the rapid response team informs you that although the syringes are very similar, the units are not equivalent and that the patient has actually received 80 units of insulin instead of 8units. The team administer 1mg of Glucagon IV and 50% dextrose (50ml) IV as the BGL was un-recordable on the blood glucose monitor.

Mr Nguyen’s level of consciousness begins to improve and he is transferred to the high dependency unit for BGL monitoring overnight.

Questions:
Q1. In 250 words, identify and discuss the relevant Australian Nursing and Midwifery Accreditation Council (ANMC) competency standards that are breached in this case.

Q2. As a Registered Nurse, prior to administering any medication, what key information related to the pharmacology of the medication should you have a comprehensive knowledge of? (250 words)

Q3. The following morning you are on a day shift, the Nurse Unit Manager asks you into the office. She informs you that the adverse drug administration has been logged on the hospital incident management system (IMS) and that you are required to write a report and also be interviewed by the RCA (Route Cause Analysis) team. You are feeling very apprehensive about writing the report and meeting the RCA team regarding this incident. In 250 words, what are the main points you will cover in the report? What resources or support services can you identify to assist you in this situation?

references max 5 years old