Answer to peer

Two paragraphs and two references no more than 5 years, thank you

I work in a moderate-sized infusion pharmacy where we care for patients in our Ambulatory Infusion Suites (AIS) and their homes.  Our primary role is infusing intravenous (IV) medications to acute and chronically ill patients.  Many of the patients we serve receive medicines that improve their quality of life, stabilize a serious or debilitating illness, or require the medication to live.  That said, it is not uncommon for these patients to react to their drugs.  The reactions range from slight itching and a scratchy throat to anaphylaxis.  It would seem reasonable to have a standard of practice or protocol written for standing orders to treat patients’ unexpected reactions to these medications.  We don’t have a standard protocol.  Some providers give us fundamental orders, such as epinephrine and Benadryl.  Anything beyond that requires a phone call to the provider.  Some give extensive orders, and it is up to the primary RN providing the care to decide what to give when. 

          From the microsystems level, which according to Krawczyk et al. (2018), is where the individual experience takes place during a clinical encounter. The microsystem, which includes staff, patient care, and even equipment and protocol, is that the RN cannot have quick and efficient access to the necessary rescue medications within their scope of practice and safely treat the patient and their reaction to the drug. Not having the proper medications at hand can delay treatment due to the need to call the primary provider’s office, explain the situation and receive the order before administering the medication.  This delay in treatment can have severe consequences for the patient.  The mesosystem, intermediate aspects of the organization which affects health care policy, Krawczyk et al. (2018) is the providers not ordering enough rescue medications with the initial therapy treatment. Also, the pharmacists and pharmacy director have been opposed to creating standing orders and protocols and using an algorithm for the nurses to follow.

          A systems approach to improving the quality and safety of the care delivered in this situation can create a model or framework for sound, efficient and effective patient care.  Transformative changes are directly related to values from leadership and workplace leaders who value competency within the entire system (Martin & Manley, 2020). Clinical or workplace leaders have specialized training to offer input, work collaboratively with providers and leadership to explore the benefits of faster, more efficient care which would ultimately improve patient outcomes.  Systems focus improves efficiency, improves role clarity and overall team competence (Martin & Manley, 2020). Our organization is a High-Reliability Organization (HRO) and these organizations goal is to not react to a situation but to proactively generate new solutions (Chueng et al, 2019).

Cheung, R., Roland, D, & Lachman, P. (2019). Reclaiming the systems approach to paediatric safety. Archives of Disease in Childhood 104(12). 1130. https://doi:10/1136/archdischild-2018-316401 (Links to an external site.)

Marian, K., Sawatzky, R., Schick-Makaroff, K., Stajduhar, K., Ohlen, J., Reimer-Kirkham, S., Laforest, E.M., & Cohen, Robin. (2019). Qualitative Health Research, 20(4), 510-521. https://doi.org/10.1177/1049732318761366 (Links to an external site.)

Martin, A. & Manley, K. (2020). Developing an integrated career and competence framework for a whole systems approach to urgent and emergency care delivery. International Emergency Nursing 48, 1-7. https://doi.org/10.1016/j.ienj.2019.06.007

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