Introduction
Registered Nurse (RN) Syd and Enrolled Nurse (EN) Kay are administering medications to Mrs ZX, a 93-year-old resident in the hospital wing of an aged care facility who takes multiple regular and PRN medications and has a recent history of falls. Without documentation or a medical order, RN Syd adds multivitamins and an iron tablet to Mrs ZX’s medications. When Mrs ZX refuses to take them, RN Syd instructs EN Kay to crush and mix the medications with yoghurt without the patient’s knowledge and continues the medication round.
Later that day, Mrs ZX develops confusion, weakness, and nausea. The following morning, EN Kay informs Nurse Manager Jamie that the medications were crushed and administered together. An investigation reveals multiple breaches in medication administration, including undocumented supplements and inappropriate delegation. RN Syd states she believed the supplements would benefit Mrs ZX and felt pressured to complete the medication round, assuming EN Kay could manage the task.
In New Zealand, as in many other countries, nurses are authorized to prescribe and dispense medications based on their competence and the scope of their responsibilities. However, to ensure patient safety, nurses should be completely aware of their responsibilities and the rules governing the prescription of medications (Suresh, 2018). Therefore, it is essential to consider the case of Mrs. ZX for compliance with legal and ethical rules, namely the Guidelines for Nurses on the Administration of Medicine, Competencies for Registered Nurses and Scope of Practice, Health Practitioners Competence Assurance Act 2003 and Medicines Care Guides for Residential Aged Care, Code of Conduct, 2012 and Code of Ethics, 2019 and Duty of Care.
Guidelines for Nurses on the Administration of Medicines
It is essential to note that the scenario addresses specific issues outlined in the 2019 Guidelines for Nurses on the Administration of Medicines. Therefore, the scenario demonstrates a violation of the rules regarding the use of medications without consent. This occurred when Sid added two multivitamins and an iron tablet to Ms. ZX’s medication without her consent. Accordingly, such actions by a healthcare professional contradict the principles of informed consent outlined in the Guidelines for Nurses on the Administration of Medicines (New Zealand Nurses Organization, 2019). This is because the guidelines state that nurses should obtain informed consent from patients before administering any medication.
Moreover, when administering new drugs, the nurses needed to enter them into Ms. ZX’s overall medication record. In accordance with the Guidelines for Nurses on the Administration of Medicines, the medication chart must contain a clear and accurate record of all medications administered, including name, dose, route, frequency, and reason for administration (New Zealand Nurses Organization, 2019). Meanwhile, Sid did not comply with the five rights that must be considered when administering medications.
In line with the Guidelines for Nurses on the Administration of Medicines, medicines should be prescribed to the right patient, according to the right needs, in the correct dose, and administered in the right way at the right time. The Guidelines for Nurses on the Administration of Medicines require nurses to respect these rights to ensure safe and effective administration of medication (New Zealand Nurses Organization, 2019). Furthermore, delegating the administration of medications to Nurse Kay, which may not be within her scope of practice, also constitutes a violation of the law. The Guidelines for Nurses on the Administration of Medicines indicate that nurses are expected to delegate tasks based on the competence and scope of practice of the person receiving the delegation.
Additionally, despite the medical staff knowing that the patient was receiving many medications and had health problems, they did not monitor her condition after the new medications. Consequently, Ms. ZX was not monitored for possible side effects after administering the crushed medication. However, the Guidelines for Nurses on the Administration of Medicines require that nurses provide such supervision as an additional safeguard for patient safety (New Zealand Nurses Organization, 2019). Hence, the nurses violated the Guidelines for Nurses on the Administration of Medicines, which caused problems with the patient’s health.
Competencies for Registered Nurses and Scope of Practice
The Competencies for Registered Nurses and Scope of Practice is intended to establish and ensure standards of practice for registered nurses in New Zealand. The scenario shows Syd breaking several rules regarding medication administration. Firstly, Syd violated the regimen for administering new medications and changing care planning, even though she had sufficient authority. Accordingly, Syd introduced two new medications, namely a multivitamin and iron tablets, to Ms. ZX’s medication regimen. However, the nurse needed to review the notes and documentation to understand the patient’s response to the various medications. Syd also violated the rules by failing to consult with the patient’s family and provide a reasonable explanation for the need for new medications.
Secondly, Syd breached his competence to administer the medication by delegating it to Kay. Furthermore, the nurse gave the patient the drug in a covert form after Mrs. Z refused to take it. However, the Competencies for Registered Nurses and Scope of Practice state that crushing and mixing medications can change their pharmacological properties and increase the risk of adverse drug reactions (Nursing Council of New Zealand, 2016).
The nurses were also negligent because they did not seek medical advice or consult with other colleagues to find an alternative solution, despite the patient’s refusal. Additionally, Syd neglected professional accountability by failing to follow the healthcare facility’s procedures for medication administration. Therefore, the nurse’s actions violated several of the competencies outlined in the Competencies for Registered Nurses and Scope of Practice (Nursing Council of New Zealand, 2016). These violations can potentially result in adverse patient outcomes and legal consequences for Syd, Kay, and the facility.
Health Practitioners Competence Assurance Act
The Health Practitioners Competence Assurance Act (HPCA) 2003 establishes the regulatory framework for the registration and competence of healthcare professionals in New Zealand. Accordingly, the Act requires that healthcare professionals provide services to the public safely, ethically, and competently. Furthermore, the Act stipulates that nurses must continually maintain their competence through ongoing professional development and education.
In this scenario, the actions of nurses Syd and Kay can be qualified as a breach of the Act (New Zealand Parliament, 2003). The reason is that Ms. ZX’s medication was administered despite her unwillingness to take it, without proper documentation and without following the correct medication administration procedures. As a result, the nurse manager must investigate whether a violation has occurred and whether any action is required under the Act. Therefore, there is a danger that nurses will continue to prescribe and administer medications to patients without their consent.
Medicines Care Guides for Residential Aged Care
The Medicines Care Guides for Residential Aged Care 2011 was created to provide healthcare professionals with guidance for the care and treatment of older adults. One of the most important provisions is guidance for healthcare professionals on how to safely and appropriately administer medications to residents of residential care facilities (Boyd et al., 2011). In this scenario, Syd and Kay did not follow the guidelines outlined in the Medicines Care Guides for Residential Aged Care. One problem is that Syd did not document the intake of vitamins and iron tablets in Mrs. ZX’s medication chart.
The Medicines Care Guides for Residential Aged Care regulate the rules for completing documentation. Accordingly, failure to follow them violates the Medicines Care Guides for Residential Aged Care. Furthermore, the Medicines Care Guides for Residential Aged Care recommends that drugs should only be crushed or mixed with food or beverages if they are specifically designed for this purpose (Boyd et al., 2011).
In this scenario, there is no indication that the vitamin and iron tablets were intended to be crushed or mixed with food. This may have contributed to the side effects experienced by Ms. ZX, including confusion, weakness, and nausea. It is important to note that the nurses did not obtain the patient’s informed consent to administer the medication, which is also against the rules (Chadwick & Gallagher, 2020). In general, Syd and Kay’s actions in administering Ms. ZX’s medication were not in compliance with the Medicines Care Guides for Residential Aged Care.
Code of Conduct
It is crucial to recognize that an ethical code of conduct is designed to govern the actions of individuals working in socially responsible industries. According to the scenario, the actions of Syd and Kay in prescribing medication to Ms. ZX raise several ethical issues that violate the Code of Conduct (Nursing Council of New Zealand, 2012).
The first issue is that RN Syd failed to obtain Ms. ZX’s informed consent before administering the medication. The nurse attempted to mislead Ms. ZX by instructing Kay to grind and mix the medication with yogurt, violating Ms. ZX’s right to make decisions about her care. Second, Syd introduced two new drugs without proper authorization or documentation in Ms. ZX’s chart or medication chart, violating the principles of accountability, responsibility, and integrity.
Third, Syd and Kay violated the principle of non-intentionalism by exposing Mrs. ZX to the risk of harm by using an unauthorized medication administration method, which resulted in her developing side effects. Finally, Syd neglected to ensure that Kay had sufficient knowledge and competence to administer the medication safely and effectively, thereby breaching the principle of competence. The Code of Conduct requires nurses to act in accordance with the principles of respect, partnership, accountability, responsibility, integrity, and competence (Smith, 2019). Accordingly, the actions of Syd and Kay, in this case, violate these principles.
Code of Ethics
The actions of Syd and Kay in the scenario raise several ethical issues in relation to the Code of Ethics. First, Syd failed to respect the patient’s dignity and rights by ordering Kay to grind and mix the medication without consent (New Zealand Nurses Organization, 2019). The patient refused to take her medication, and Syd’s decision to administer it without the patient’s knowledge and consent violated her autonomy and right to make decisions about her treatment. Secondly, Syd failed to comply with the principle of informed consent by failing to provide Ms. ZX with sufficient information about the supplemental vitamins and iron tablets or to obtain her consent to take them. This violated Ms. ZX’s right to be fully informed about her treatment options and to make informed decisions about her care.
Third, Sid failed to meet basic responsibility standards to promote health and prevent harm by administering medications without proper documentation, resulting in adverse patient outcomes. The lack of documentation regarding additional drugs and the reasons for their administration raises questions about the appropriateness and safety of the care provided to Ms. ZX (New Zealand Nurses Organization, 2019). Finally, Syd did not follow the principle of collaboration by delegating the task of administering medication to Kay without appropriate supervision. This highlights the importance of clear communication and cooperation among healthcare providers to ensure safe and ethical patient care. Thus, Syd and Kay violated the basic rules outlined in the Code of Ethics.
Duty of Care
The Duty of Care rules require nurses to provide patients with care that meets professional standards. Moreover, the Duty of Care’s main objective is to ensure that healthcare professionals’ actions are consistent with patients’ needs and choices (New Zealand Nurses Organization, 2016). In this scenario, Syd and Kay failed in their duty of care to Ms. ZX. First, Syd added two new medications without obtaining informed consent from Ms. ZX and without ensuring that the medications were necessary and safe to administer. These actions violate the principle of the duty of care, which emphasizes the importance of informed consent, patient safety, and appropriate prescribing.
Secondly, Syd instructed Kay to grind and mix Ms. ZX’s medication with yogurt without ensuring that this was the proper method of administration. Grinding medications can alter the rate of absorption and effectiveness of medications, potentially leading to side effects, especially in elderly patients. The principle of nursing care requires nurses to ensure that medications are administered safely and effectively according to the patient’s needs and preferences (New Zealand Nurses Organization, 2016).
Finally, Nurse Syd needed to document the administration of the new medication in the patient’s medical record. This affected Ms. ZX’s health, as other doctors were unable to identify the cause of the patient’s deterioration immediately. This violates the principle of the duty of care, which requires nurses to maintain accurate and relevant patient records. Thus, Syd and Kay’s actions in this scenario violated the duty of care principle outlined in The Duty of Care.
Conclusion
Therefore, the primary task of healthcare professionals is to ensure that patients’ rights are respected and that they receive appropriate treatment. Healthcare professionals are also required to adhere to the ethical standards outlined in the Code of Conduct (2012) and the Code of Ethics (2019), particularly the Duty of Care. Meanwhile, medical professionals Syd and Kay violated such legal provisions as the patient’s informed consent, recording in the medical record, prohibition of mixing drugs, inadequate supervision, and proper delegation of duties. They also violated several ethical principles, including the duty of care, the duty to ensure patient safety and dignity, and the right to autonomy.
References
Boyd, M., Bish, T., & New Zealand Ministry of Health. (2011). Medicines care guides for residential aged care. Web.
Chadwick, R., & Gallagher, A. (2020). Ethics and nursing practice: A case study approach. Bloomsbury Publishing.
Nursing Council of New Zealand. (2016). Competencies for registered nurses and scope of practice. Web.
Nursing Council of New Zealand. (2012). Code of conduct. Web.
New Zealand Nurses Organisation. (2019). Code of ethics. Web.
New Zealand Nurses Organisation. (2016). Duty of care. Web.
New Zealand Nurses Organisation. (2019). Guidelines for nurses on the administration of medicines. Web.
New Zealand Parliament. (2003). Health practitioners competence assurance Act. Web.
Smith, M. C. (2019). Nursing theories and nursing practice. FA Davis.
Suresh, S. (2018). Nursing research and statistics. Elsevier Health Sciences.