(2020) highlight that significant numbers of service-users have been harmed during

healthcare and as such identify patient safety as a priority in healthcare. Further, the

Nursing and Midwifery Council (NMC) (reference) stipulate ‘Improving Safety and

Quality of Care’ as one of their platforms, stating that Nursing Associates must

identify risks and take appropriate action to prioritise service-users’ needs.

Reference portrays a person-centred approach as a key element necessary for the

delivery of safe care. This assignment aims to reflect on an episode of care where I

have contributed to safe, person-centred care. I have used Gibbs reflective cycle to

aid structure and logical flow throughout (reference).

Description (Appendix 1)

Thoughts and Feelings

The episode made me feel eager to learn as I had not been involved in many

medication rounds. I also felt pleased that I was able to assist Ms A and felt my

approach was person-centred. I did however feel rushed and distracted due to the

busy clinical environment.

Evaluation

At all times I was under direct supervision which made me feel that I was delivering

safe care. As a student it is vital that I am supervised at all times to ensure optimal

learning and safe care (reference).. Furthermore, I felt that by wearing the red bibs

and informing the nurse in charge that we were completing the medication round, we

were less likely to be disturbed which contributed to a safer environment for

preparing and administering medications (reference).. I also completed the

necessary safety checks detailed in the 5 R’s (appendix 2) such as ensuring correct

patient identification (Reference).

medication round because of distractions (reference)..

Analysis

Medication errors are identified as common adverse safety incidents resulting in

preventable harm to patients (reference). It is paramount that healthcare

professionals adopt approaches to ensure safe practice in relation to medicines

management. The 5 R’s provides a simple, systematic framework for healthcare

professionals to work through during medication administration (ref). Using the 5 R’s

framework is outlined in the trust’s medicines management policy. Practising in

accordance to policies is an important element conducive to safe care as such

policies are based on the latest available evidence. (reference argues that practice

guided by robust evidence contributes to safe care. During the episode I used the 5

R’s as a framework and spoke through this with my supervisor. One way I

demonstrated this was by ensuring I had the correct patient by checking Ms A’s

wristband. However, (reference) states that this is not a sufficient safety check as

there have been reports of service-users wearing wristbands with incorrect

information which could lead to incorrect medication being administered. Therefore it

is always necessary to ask the service-user to confirm their details. Involving service-

users’ in their care like this is also important in making them feel valued and

contributes to person-centred care (reference).

During the medication round my practice supervisor and I wore bibs reading ‘Do not

disturb’ in an attempt to minimise distractions from the task at hand. Adopting such

measures is outlined in the literature as a protective measure conducive to reducing

errors during medication rounds (reference). This protective measure was

Subsequently, other tasks could be delegated to members of the team in minimising

distractions; a key factor often present in medication errors (reference). Team

communication and delegation is recognised as an important element of patient

safety because it ensures that aspects of patient care are not overlooked reference)..

However, despite these measures I found the clinical environment to be very

distracting. It was short staffed; call bells needed answering and the phone kept

ringing. I found it difficult to concentrate in such circumstances which led me to

consider how this could potentially impact on correctly calculating drug doses.

Reference states that busy environments pose risks in relation to medication errors.

The NMC emphasise nursing associates’ duty of care in recognising risk, including

adequate staffing levels, and escalating any concerns that may impact the needs

and safety of service-users (reference). Escalating concerns enable measures to be

put in place to prevent harm and improve patient care (reference).. Further, it creates

a culture of openness and candour; an important element for improving safe, person-

centred care (reference). On reflection, I should have voiced my concerns to my

practice supervisor as part of ensuring a safe clinical environment.

It is also important to recognise and work within my scope of practice (reference).

and only perform tasks in line with my professional knowledge, skills and

competence (reference. Throughout the medication round, I was directly supervised

by my practice supervisor which contributed to the delivery of safe care as I was able

to clarify queries with her prior to completing tasks. This led me to consider that in

my future role I may not always be under direct supervision, however to ensure safe

care I must always work within my scope of practice and approach a registered

nurse or appropriate professional if I am unsure of something.

such nursing associates must put the service-users first to ensure person-centred

care. Person-centred care involves taking into account individual needs, preferences

and values and is a key partner in delivering safe care reference. Within this episode

I took time to discuss Ms A’s medication with her to ensure she understood; research

reference (2020) suggests that lack of understanding is a common factor influencing

service-users’ decisions not to take their medication, which could pose risks to their

health and safety (reference). In this case, the administration of enoxaparin is vital in

the prevention of thrombosis (reference);thus by listening to Mrs A’s concerns

surrounding her medication and explaining the benefits I contributed to safe, person-

centred care. I also recognised that Ms A may not wear her compression stockings

as they caused her discomfort and, in partnership with Ms A, devised a plan for her

own moisturiser to be bought into hospital. Reference states that service-user’s

being part of their care and involved in decisions is central to achieving person-

centred care as this makes them feel valued and motivated. Furthermore, by

adopting a person-centred approach I contributed to safe care as wearing

compression stockings is important in preventing thrombosis (reference)..

Action Plan and Conclusion

This has been an invaluable learning experience relating to safe, person-centred

care. Patient safety is a fundamental priority within healthcare. This episode has

taught me many ways in which I can contribute to safe, person-centred care on a

daily basis; following evidence-based guidelines, frequent communication within the

team including delegation, recognising and working within my scope of practice and

seeking appropriate support when necessary, and escalating concerns. In future I

when I feel safe, person-centred care is not being optimally achieved.

Appendix 1

During my placement on a gynaecology ward I was involved, under direct

supervision of my practice supervisor, in assisting with a medication round. It was a

very busy shift and prior to beginning the medication round my practice supervisor

informed the nurse in charge that she and myself were about to complete the

medication round. My practice supervisor and I then put on red medication bibs

which are designed to minimise interruption whilst completing medication rounds.

Under direct supervision by my practice supervisor I prepared to administer a

subcutaneous injection of Enoxaparin for a service-user. The service-user, Ms A,

had undergone a hysterectomy and was on prophylactic Enoxaparin to reduce the

risk of post-surgical thrombosis. I completed safety checks including checking Ms A’s

wristband against the medication chart, and checking the subsequent 5 R’s of

medication administration with my practice supervisor. As part of gaining informed

consent I asked Ms A if she was aware of the reason why she had been prescribed

Enoxaparin. Ms A appeared unsure and concerned. I then sat down next to Ms A

and discussed the risk of thrombosis following surgery and reasons why, and how

enoxaparin acts as a blood thinner to reduce the risk of clots developing. I also took

the time to discuss with Ms A other, non-medicinal ways that she could reduce the

risk of any blood clots developing once she was at home. Ms A informed me that the

doctor had encouraged her to wear her compression stockings at night and to

mobilise as much as possible. Ms A said that she did not like wearing the stockings

as they cause her skin to go dry. I discussed the use of emollients and Ms A said

she does use moisturiser but only a specific one that she has at home. I encouraged
Ms A to use her moisturiser on her legs to alleviate the dry skin when wearing the

stockings. I offered to contact her next of kin to ask them to bring her moisturisers

into hospital for her. Ms A thanked me and said she felt more positive about adopting

such measures. I was however aware of how busy the ward was and found it difficult

to give my full attention to Ms A as I was aware that my practice supervisor needed

to continue with the medication round.

Appendix 2