Medication errors
I was just reading a report from the National Patient Safety Agency entitled ‘Safety in Doses’ (See link below). This report gives a review of medication errors reported to them during 2007. The majority of these involve general medical settings although 9% of them (6551) happened within mental health services. Luckily, 96% of all incidents are not serious, in that nobody got hurt – however there were 100 cases of death and severe harm.
In mental health and learning disabilities settings the most common problems are caused by omission of anti-convulsant medications, generally, omission of medications is a serious problem. Incidents involving methadone and clozapine were also frequently seen. A big problem is found in the interface between primary and secondary care settings. Given the complexity of modern mental health care provision the number of such interfaces and the potential for confusion is greatly increased.
I can remember a couple of incidents from practice in which medication was administered incorrectly. Fortunately neither case caused any harm to anyone but I will never forget the feeling of absolute horror when I realised what had happened.
Less fortunate were the patients being cared for by these Nurses practising at Heartlands Hospital in Birmingham – I can remember reading about this truly dreadful incident. It is very easy to understand the anger felt by the widow of of one of the patients killed.
How many of us can say that we have never made a mistake when working with drugs?
Those of you who are a little older will remember the ‘drugs assessment’ that every student nurse had to pass. This involved studying the contents of a drug trolley, learning the nature and purpose of every drug as well as it’s usual dosage and most common side effects. It was a tough test to pass!
I just wonder if we need something like this now?
I guess a lot of people will say that nurses are often working in stressful situations, there isn’t always the level of staffing & resources needed to do things as well as we would like. I certainly don’t think that all errors are down to nurses lacking knowledge.
What others think? Do you as qualified staff feel that students are as well prepared as they ought to be? – what about students, are you ready to take responsibility for administering medication? Also, if there are errors being made then why do you think this happens?
I would really love to hear from people.
Link to National Patient Safety Agency report
Photo at top of blog from Flickr creative commons by Charles Williams (click on picture)
PS On an unrelated note I had an email from the RCN asking that I draw your attention to the RCN election website – there are two links below for your attention
www.rcn.org.uk/generalelection
http://www.facebook.com/pages/Nursing-counts/268071293877?v=wall
Akmal Shaikh
Akmal Shaikh RIP
Despite a clear history of mental health problems in the period leading up to his arrrest and conviction for drug smuggling, British citizen Akmal Shaikh was executed in China this morning.
Anyone with any experience of working with people who have mental health problems will easily identify elements of mental illness in descriptions of Mr Shaikhs behaviour. It seems clear to me that there is a very obvious history of mental health problems and it is puzzling that the Chinese Government is still insisting that there is no such history.
People with problems such as those experienced by Mr Shaikh often do not have a firm grasp of reality and would be very vulnerable to manipulation by unscrupulous individuals. The likely influence of such factors appears to have been completely ignored by the authorities in China.
I hope that mental health nurses worldwide will join me in condemnation of this dreadful action -- please take a moment to click on the links below.
Reprieve Youtube video
Amnesty International reaction
Happy Christmas & Merry New Year!
Seasons greetings from everyone at the Mental Health Nurse Lecturers Tea Party
This blog is now one year old – thanks to everyone who has contributed, commented & most importantly read it over the past 12 months – see you in the new year.
Registered Nurse Plumber?
I have noted with interest over the years that nurses (and I am one) have had an attitude of “I can do that. Give me that job” and indeed nurses have expanded their role quite considerably. When accused of trying to be ‘mini doctors’ nurses have responded ‘no we are maxi nurses’. We have clearly demonstrated that we are capable of so much.
So…with the latest MHA nurses can (after appropriate hoop jumping) can be the responsible clinician or the approved mental health professional, posts previously filled solely by doctors and social workers.
Surely nurses (and the Act) are missing the point?
The greatest strength of any team revolves around the idiosyncrasies that each individual brings to the table but now, oh no, we are removing this uniqueness to leave one ‘new’ professional that simply changes hats to fit the job in hand.
I am strongly in favour of social workers retaining their role – it is after all a vital position to ensure that the medical model does not dominate. I remember as a newly qualified nurse being impressed by a social worker refusing to ‘sign off’ a detention after two doctors had recommended it – this social worker exerted his own standards and whilst I disagreed with him, I thought that he was doing a splendid job that he was trained to do. He was able to step away from the medical needs and look at the social needs in a wider context.
Nurses, whilst we strive to be separated from it, are biased in the ways of the medical model -Face it.
What is wrong with being a nurse anyhow? I plumbed in a washing machine the other week but I am not asking to be registered as a nurse plumber. Leave the plumbing to the person who trained to be a plumber and who does it day in and day out and the plumber can leave me to nurse.
And another thing….following on from nurses saying “I can do that. Give me that job” there is the follow up call of “Hang on. Have you seen my workload? I’m not paid enough you know!”
Images from Flickr creative commons:
1. Plumber James #2 by MoToMo
2. Plumbing by basykes
3. Day 719 / 365 – Wrong Setting by JasonRogersFotographie
The value of human life
After reading Simon’s blog post last week I got thinking about why his ideas made me feel so uncomfortable. I can’t help agreeing with many of his points, but when you add them all up – well, I felt there is something in the middle of it that is a larger issue, and one that I think we in nursing need to get to grips with.
In trying to say how we feel about the value of human life – our own and others - it is hard to articulate it without using spiritual language – there’s nothing wrong with that, but if you are not coming from a spiritual perspective then an alternative is required.
Being human is, I feel anyway, more than just rights and responsibilities, and more than comparing ourselves to a ‘beloved pet’. Maybe it’s also about acknowledging how difficult – and in fact impossible – it would be to ‘press the button’ on another person’s life.
In this situation, the difficulty would not be for the person leaving, but for those left behind. What do we become once we have agreed to sign away another person’s life, even if they themselves ask us to do so? Does this mean that life is only worth something when we are intellectually and functionally 100%? What does this say about our relationships with other groups of vulnerable people?
To me, this discussion is not just about what a person loses when they have dementia, or another life-limiting and damaging condition, but about the culture which we live in, and which it is our responsibility to guide.
The ‘right’ to say you want to die in certain circumstances does open possibilities for foul play, as Simon suggests, but more importantly, I believe, it damages our sense of community, our cultural heritage and recognition of our inter-dependence. Individualism seems to be increasingly prioritised in our society and in nursing itself – the trio of autonomy, independence and intellectualism seem to be valued above other qualities with little argument.
To me this route ignores the reality that we are all strong and vulnerable in different respects and at different times, all have hidden or visible disabilities, all work better together than we do apart, and all are damaged when one (and who’s next?) chooses suicide or euthanasia.
Instead, we should be campaigning for inclusion and for investment in sensitive provision of excellent standards of care. For those who need it now, and for those who are planning ahead, we shouldn’t be assuming that lack of intellectual ability makes us less of a person, and thinking about how to ‘jump before we are pushed’.
How can we recognise and celebrate the individual differences that make us all who we are, in different parts of our lives, as part of a caring supportive and accepting community with mutual interests at heart?
(all images from Picapp - click image for info re source etc)
Thoughts on assisted suicide?
The Royal College of Nursing (RCN) recently carried out a survey on assisted suicide. It was only open to their members, quite rightly as it will inform the policy of the RCN, but this restriction will result in a flaw in their research.
It is right that we have this debate – but it will only be worthwhile if we involve much broader opinion. There have been legal arguments in court about what will happen to people who assist suicide abroad. Is it right that terminally ill people have to travel abroad to get relief from a life that is painful and miserable?
Gordon Brown has come out against assisted suicide, but is it right that MP’s legislate for their own private convictions or should they only be allowed to represent the wishes of their constituents?
I have long held the belief that I should have the right to die with dignity and free from pain. No one has ever objected to people making the choice to end the lives of much loved pets but to help a person that we love to end their lives is illegal.
The most used argument against relies heavily on the premise that the right to die could be abused. Relatives may pressure people to die in order to inherit, or people may feel guilty for being a burden. I believe that effective regulation would prevent this.
If I were to get a diagnosis of dementia I would worry more about the pain inflicted on my wife (who would have to witness my suffering) than I would worry about dying myself. Furthermore the cost of nursing care, with no hope of recovery, would seriously impact on her quality of life.
These are my personal views and do not reflect any Institutional views and I very much look forward to hearing from you your opinions.
Photos fromFlickr creative commons (Click images)
‘One day later’ : by Bolshakov
‘Solo la muerte puede salvarte de este mundo : Rodrigo Basaure
A losing battle?
British Royal marine with captured Opium - from Flickr commons - see also below
I was just reading this story from the BBC about a suggestion that the Scottish cannabis crop (worth an estimated £100 million) may now be bigger than the Scottish vegetable crop.
This comes in the same week that we had the story about the sacked Government drugs adviser. As usual then, plenty of stories about drugs.
Just ask a CPN
Of course, if I wanted stories about drugs then I would need to go no further than my own students in practice or my clinical colleagues. Any of these people would be able to reel off hair raising stories about drugs in the communities around us -- often we hear about the effects of these substances and their widespread availability (ok, far more often we hear about legal drugs i.e. alcohol)
Not so long back a local CPN told me that in their particular area they may as well stop asking ‘do you take drugs of any sort’ -- in favour of asking ’what do you take?’ When I was last a CPN it was pretty obvious that in some parts of town it was probably more convenient to buy Crack Cocaine or Cannabis than it was to buy, say -- five portions of fruit & veg a day!
Crime
How much crime is all of this promoting?
A litle example -- Not so long back my daughter was in Church with her Nan -- whilst the service was in progress she noticed a man going around collecting unattended handbags. As soon as he had gathered enough he ran from the church. ‘Money for drugs’ was the assumption of the (mainly elderly) theft victims -- it may not have been, but would you bet against them being right?
As well as a great deal of petty crime there is a colossal amount of organised crime -- both here as well as in poorer countries. There is a suggestion that Mexico is close to buckling under the strain of fighting the drugs war as well as other Latin American nations (See link) (also this)
How many members of our armed forces have been killed or injured in Afghanistan by weapons and explosives partly funded by illegal drugs?
What do you think?
I can’t help thinking that eventually we are going to have to face the fact that the we need to look at this -- where is the war on drugs heading? -- are we just here to pick up the pieces?
I don’t have the answers of course but I wonder, what would you as Mental Health Nurses do?
Is my assessment over pessimistic? -- or are the streets of our major cities awash with illegal drugs?
Do you think that we need more of the same -- or some degree of legalised supply of drugs?
I think that Mental Health nurses are ideally placed to comment given our knowledge of what is going on.
Get back with your comments if you get a minute -- feel free to do so anonymously if you want.
NB Photo at top of post from Flickr commons also on Helmandblog
Time article ‘Drugs in Portugal’
Half way through my first placement
This is the second guest post from Kate Hopley (first post here) who recently commenced a course here at BCU. Kate has also started a BCU mental health nurse student area on Facebook
I am now more than half way through my first placement, and I have had many new experiences since writing my last entry. I have been involved in all of the day to day nursing duties: meds round; ward round; helping residents to wash and dress; assisting residents with eating meals; completing all the relevant paperwork and, most enjoyably, getting to know each of the residents by spending time with them.
A difficult time
I had a difficult couple of days a week or so ago, in the midst of several deaths. Over the week following the deaths I noticed how stories of those who had died were told over and over again in the staff room, alongside stories of other deaths which had been experienced. I reflected that the communal processing of grief was important for nurses, because fitting our experiences together and telling and re-telling them led to an acceptance of death and to moving on. We knew that we had done our very best to care for our patients during their stay at the unit, and in the end I felt honoured to have cared for them at the end of their lives, and no longer sad.
Advocacy
Another subject which struck me forcefully over the past weeks is the need for nurses to act as advocates for people suffering with dementia, and especially for those who are in the stages of the disease where they may have lost the ability to communicate verbally. Most of the residents at my placement are not able to choose from a menu prepared to their liking – they rely upon the nursing staff to make informed choices on their behalf to ensure that they eat a varied and balanced diet. Many of the residents cannot walk about unaided, and so cannot choose whether to sit in a sunny window or right next to the television or who to sit by. Nursing staff must consider what they know of the person’s history alongside non-verbal clues as to what mood or preferences are being expressed on that day, and then make an informed choice.
A good environment?
I have also spent some time reflecting on the physical and sensory state of the healthcare environment for those who are inpatients with dementia. If the rooms are moved around every day this may be confusing for the person with dementia; if different and unfamiliar staff help residents to wash each morning this may be confusing and frightening; if someone starts to offer food on a spoon without first explaining what they are going to do this could be frightening. If music is played or interesting sensory objects are available and nursing staff spend time talking to or sitting with the residents, then this creates a space for the residents to engage with the world around them and to express themselves. I have spent a lot of time getting to know the residents better, and over time I have learned to understand what they are saying to me better, and finding that it is indeed possible to have a conversation, one side of which consists solely of an array of meaningful facial expressions and gestures.
I am absolutely loving my placement and I will be really sad to leave. Every day something happens that puts smile on my face, and every interactive response from a resident, be it a belly laugh or simply the raising of an eyebrow, makes placement feel nothing like a job at all, and everything like a satisfying vocation.
Kate
Hope for Mental Health Reforms – a US perspective
Todays guest post is from Nicole White from the USA.
The bailout that was signed by former President Bush in October 2008 opened up a new door to health reforms by requiring that group insurance companies require equal coverage for both mental and physical illnesses. This was a milestone in health insurance policies that had previously required higher deductibles and co-pays for various mental illnesses such as autism and alcohol addiction. This has been a political issue for years now, as so many members of Congress suffer from different types of mental illnesses or have family members with mental illnesses; the subsequent rise in the number of soldiers coming back from Iraq with mental health issues has also been a pressing matter for Congress to debate upon.
The mental health debate has been years in the making, with many prominent political figures in the forefront of such a large piece of legislation. The twenty-first century has brought with it a slew of mental health disorders, ranging from those which are unavoidable (autism) to those which we need a multitude of drugs for (schizophrenia). It is unclear as to whether or not some of these diseases are a result of modern society and the fast-paced way in which we run through life, but regardless of this fact, it remains integral that we find a way to combat these illnesses in a way we can afford to. Many scientists have additionally attributed many forms of mental illness to “graying” parts of the brain which require just as much care and treatment as any other debilitating disease; this bill offers sufferers of various mental illnesses to have a chance to assimilate back into society by being able to afford their treatments.
Dependencies and alcoholism are some of the major killers in today’s society, ranging from overdosing to alcohol-infused rampages. By providing the proper care for these illnesses, many companies will increase their employee productivity and overall well-being through increased health coverage.
This bill represents more than just lower costs for sufferers, it offers a new way of life for those of us who are surrounded by these sufferers. Alcoholism affects every realm of a user’s life, from work to school to their home life, and left untreated can transform into a monster which is practically incapable of control. By catching this type of disease earlier on and providing the proper care, we as a society may be able to curtail this increased amount of mental illnesses which is plaguing the country.
Marines at Hue City, Vietnam, February,1968
The fact that many young soldiers are returning home has also caused many politicians to speak out for this legislation; this new generation of soldiers has been left with severe mental scars from Iraq and without proper counseling, they may be released to early back into society. Our country experienced similar amounts of post-traumatic stress after Vietnam, which resulted in many ex-army members killing themselves at home or committing random acts of violence. While the Iraq War is still more supported than Vietnam ever was, thereby allowing the soldiers to assimilate back into society easier, these soldiers are still young men who will be plagued by haunting memories of death for many months (even years) after returning home. This bill has been a long while in the making and proves to revamp our entire health care system by putting mental debilitations on the same par as the physical.
All images from flickr creative commons – see below for attribution
1. Stars and stripes clarabell
2. At rest: Rob
3. Marines at Hue City, Vietnam, February,1968 : bobster855
4. A Funeral Flag, American Veteran Soldier, The Red, White, and Blue, Stars and Stripes, Patriotic, Memorial Day 2009, Cemetery: BL1961
A Mental Health Nurse?
Grand designs?
I thought it would be a good idea to identify the role of the mental health nurse. Occasionally when people find out I’m a mental health nurse, they say, ‘mental health nurses – all they do is sit around talking all day. This, and the general lack of knowledge about the role of the mental health nurse spurred me to start writing. However, I’d dug myself a bigger hole than initially planned. It was a bit like that programme ‘Grand Designs’, my expectation of the job was significantly underestimated and the overall time, cost and obstacles were greater than I’d initially considered. Its complexity was also a reason for writing this piece.
Reading around
Reading around the subject and looking at roles identified by others I had difficulty distinguishing between role and skill. I came to realise that both come hand in hand. A nurse colleague said to me ‘anyone can fulfil a role but it is the quality of skill that determines the standard of the role delivered’. I like this statement and hope to deliver a learning environment where students develop both. I see ‘role’ as those laid out in a job description usually outlined from a top down approach. In my view ‘skill’ defines the quality of the care and the interventions most appreciated by patients, carers, family and friends. I want to be nursed by a person who cares enough to offer me a personal approach.
So, back to the point. What is the role (and skill) of the mental health nurse?
Paperwork – lots of it!
Bureaucracy! Never ending and it seems forever increasing, it is argued the amount of paperwork detracts from the time nurses have to actually deliver direct patient care but is now the norm. Arguably, too much time is spent on filling in data when it is unclear that anyone really looks at the information (Gowodo and Nolan, 2008). Nevertheless, if you’re a mental health nurse, paperwork is a daily expectation. In conjunction with paperwork runs the Care Programme Approach (CPA) framework. The CPA is HUGE! And does involve more paperwork. The CPA requires the skill to work with the service user, family and carers where appropriate, equally within a multidisciplinary team. If used well, it can promote recovery and independence. Care plans, patient care reviews, involvement of carers and promotion of independence are all parts of the CPA. We’re encouraged to write care plans with patients and carers. Involving service users and carers in CPA is a skill that needs more attention by nurses as we are there to advocate and create an environment that allows for independent thinking and self development by the service user. I feel healthcare workers as a whole are yet to fully embrace this concept as it involves positive risk taking and allowing the individual to have choices we don’t agree with.
A power balance?
Shifting the power balance between service user and professional also has its own struggles, some patients appreciate formal health service offered and some professionals may struggle to give up some of their power. I personally feel a positive mental health approach manages to strike a balance between all. I often say a skill of a mental health nurse is knowing when not to take action or when not to take control in the right context. All people should have the right to learn by making their own right and wrong choices.
Nurses have distinguished their unique contribution to individual care in terms of empathy, being non-judgemental, allowing time, providing support and promoting positive links with friends and family. I see these as skills rather than roles, although I have seen ‘have a non-judgemental attitude’ in a job description. The difficulties with these skills as pointed out by Gowodo and Nolan (2008) is that they are almost impossible to quantify, to evidence. It is difficult to produce evidence that demonstrates the level of skill and care delivered by the nurse and also that this work is being done and continues to be an important aspect enhancing patient care and recovery. Having said that, these skills are the pinnacle of good nursing practice and have a lasting impact in the memory of service users.
The role of the mental health nurse is ever increasing. With the focus on specialised teams, mental health nurses have become specialised in their own right, adapting and developing skills specific to their area of practice. For example, assertive outreach, home treatment, early intervention, primary care, eating disorders, mother and baby to name but a few of the specific areas a mental health nurse can work and will require an individual approach as a team and towards service users. One benefit is that teams have immediate access to specialist skills, expertise and experience to provide a comprehensive and specialised package of care to that particular client group (Department of Health, 2009). The downside of this perhaps is the employability of the mental health nurse as they become more skilled in say eating disorders with a significant loss of experience in other areas.
OK – it is nearly impossible to define!
It is almost impossible to define the role of the mental health nurse and I am becoming increasingly aware that many people have attempted this task dedicating much more time and thought than I have. It’s actually much bigger than I ever anticipated and almost impossible to quantify. I am aware there are many roles and skills that I have not identified within this blog, mostly because at this rate I would be writing a book not a blog. If it has highlighted one thing it is that the skills of a mental health nurse should not be identified as a one shoe fits all approach. Although, having said that, the areas I have identified are relevant to all. I’m confused! If anyone can highlight any work specific to this I’d be interested to hear and appreciate any feedback.
(PS This is worth a look – Phil Barker talks about Mental Health Nursing You will need Windows Media Player : Film is taken from this website which is also well worth checking out)
Photos from Flickr creative commons.
1. Construction of our house – Framing : by Lee Coursey
2. Juggling bean bags : madaboutasia