A Brief Note On The Elevated International Normalised Ratio Essay

A Brief Note On The Elevated International Normalised Ratio Essay

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Q1: an elderly patient was hospitalised and scheduled for surgery due to a fractured femur. Medical Officer (MO) decided to treat the elevated international normalised ratio(INR) with a unit of fresh frozen plasma(FFP). There were no medical record to show whether patient was taking anti-coagulant. Also there were no medical order of the FFT nor consent form documented. The lab staff asked the MO to collect the FFT himself instead of getting it in person and checking the label and prescription order . MO did not check patient detail, which resulted in him taking the wrong patient’s FFP.
Due to lack of documentation and communication, nurse was unaware about the blood transfusion, hence did not set the patient ready for transfusion when the FFP arrived on the ward (NSW Health, 2012). Nurse noted the lack of paperwork then sent the patient services attendant(PSA) to collect it from lab. PSA came back and lied, stated there was no need for paperwork. Nurse believed the word of the PSA without further investigation. Both MO and nurses have poor knowledge on FFP’s universal group. They made an incompatible transfusion. There were no vital signs taken before transfusion nor was it taken during the transfusionl, hence the advise affect was not recognised until the lab staff reported it. Patient ended up with a mild adverse affect. The surgery was postponed for precaution reason.

Q2: this incident was significant to me because it happened in between multidisciplinary teams During my past clinical experiences, I was told multiple times “ because the doctor said so”, or being taught “to missing a step is OK” . But this incident has alerted me about the importance of evidence-based practices and compliance with standards and guideline (N...


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...also do not have the knowledge of the universal donor for FFP, in this case I would seek help from either a trustworthy senior nurse or the nurse educator. Then I would reflect upon my lack of knowledge in this area and attend in-serve classes to improve my competency. During blood transfusion, I would take baseline of the vital signs and keep close monitoring on patient’s condition to prevent adverse affect.
The broader issue need to be consider is the management system’s effectiveness (ACSQHC, 2011). If I have identify potential or actual risk related system issues, I would immediately report to my supervisor to improve the standards (NMBA, 2016).
In this way, Risks of patient harm can be reduced so is the quality of care can be improved. An environment with more positive outcome can be created through out health care professionals’ life long critical reflection.

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