Weekly SJT (NOv 17th)
Ranking Question
You have prescribed a regular dose of Co-codamol to a post-operative patient. You are bleeped by one of the nurses who tells you that the patient is still in pain
A Tell the nurse to give a stat dose of tramadol and you will sign for it later
B Assess the patient on the ward for any post-operative complications
C Prescribe oral morphine
D Prescribe IV morphine
E Ask the nurse to page the anaesthetist from theatre
Answer: BDECA
When any post-operative patient is complaining of increased pain, it is vital to assess them as with any other potentially unwell patient on the ward, using an ABCDE approach. Obviously you would want to know a bit more about the patient in terms of their co-morbidities and type of surgery, but they may be having an acute MI and would warrant an urgent review (B). The most appropriate medication in this situation is to prescribe IV morphine (D), titrated to pain and sedation. In the post-operative period, the GI tract does not function properly and, in any situation, the correct analgesia for acute severe pain is intravenous opiate analgesia, not oral morphine (C). It would be favourable for you to review this patient instead of the anaesthetist as you will be able to see them sooner, and they are your patient now they are back on the ward (E). However, the anaesthetist may be able to set up a PCA and this also ranks ahead of (C) for the simple fact that oral morphine, in this situation, would be an inappropriate prescription. No medications should be given in this situation before you review the patient (A), and this is placing the nurse in an awkward position and should never be done in theory.
Multiple Choice Question
A confused patient has intra-abdominal infection and acute renal failure after a procedure. Instructions to the nursing staff are clearly written in the notes regarding what action to take in response to a change in the patient's urine output. On the morning ward round you find these instructions were not followed by the night nursing team and the patient has deteriorated as a consequence. You immediately ensure the patient is treated appropriately.
A Inform the nurse in charge of the ward of the incident
B Explain to the patient that there was an error with the management of her condition
C Inform a senior member of the medical team of the incident
D Speak to the nurses involved next time you see them about your concerns with their management of the patient
E Find out whether the nurses were aware of the instructions regarding changes to the patients urine output
F Offer to write a protocol formalising team communication
G Record your account of the nights events in the patient's notes
H Ask the nurses to increase the frequency of observations on the patient
Answer: ACE
This question assesses your ability to work well in a team and communicate effectively. Senior nursing and medical staff need to be aware of the incident so that the incident can be logged, investigated and any action taken (A),(C). Instructions had been formulated so it needs clarification as to whether these were communicated (E) but the incident itself would not require a change in these instructions (H). Whilst you should record the events in the patients notes (G), this is not an immediate priority. Option F and D are presupposing the outcome of any discussions so maybe incorrect actions. Option B is not immediately necessary and the patient would probably not be able to retain or understand the information as they are confused.
You have prescribed a regular dose of Co-codamol to a post-operative patient. You are bleeped by one of the nurses who tells you that the patient is still in pain
A Tell the nurse to give a stat dose of tramadol and you will sign for it later
B Assess the patient on the ward for any post-operative complications
C Prescribe oral morphine
D Prescribe IV morphine
E Ask the nurse to page the anaesthetist from theatre
Answer: BDECA
When any post-operative patient is complaining of increased pain, it is vital to assess them as with any other potentially unwell patient on the ward, using an ABCDE approach. Obviously you would want to know a bit more about the patient in terms of their co-morbidities and type of surgery, but they may be having an acute MI and would warrant an urgent review (B). The most appropriate medication in this situation is to prescribe IV morphine (D), titrated to pain and sedation. In the post-operative period, the GI tract does not function properly and, in any situation, the correct analgesia for acute severe pain is intravenous opiate analgesia, not oral morphine (C). It would be favourable for you to review this patient instead of the anaesthetist as you will be able to see them sooner, and they are your patient now they are back on the ward (E). However, the anaesthetist may be able to set up a PCA and this also ranks ahead of (C) for the simple fact that oral morphine, in this situation, would be an inappropriate prescription. No medications should be given in this situation before you review the patient (A), and this is placing the nurse in an awkward position and should never be done in theory.
Multiple Choice Question
A confused patient has intra-abdominal infection and acute renal failure after a procedure. Instructions to the nursing staff are clearly written in the notes regarding what action to take in response to a change in the patient's urine output. On the morning ward round you find these instructions were not followed by the night nursing team and the patient has deteriorated as a consequence. You immediately ensure the patient is treated appropriately.
A Inform the nurse in charge of the ward of the incident
B Explain to the patient that there was an error with the management of her condition
C Inform a senior member of the medical team of the incident
D Speak to the nurses involved next time you see them about your concerns with their management of the patient
E Find out whether the nurses were aware of the instructions regarding changes to the patients urine output
F Offer to write a protocol formalising team communication
G Record your account of the nights events in the patient's notes
H Ask the nurses to increase the frequency of observations on the patient
Answer: ACE
This question assesses your ability to work well in a team and communicate effectively. Senior nursing and medical staff need to be aware of the incident so that the incident can be logged, investigated and any action taken (A),(C). Instructions had been formulated so it needs clarification as to whether these were communicated (E) but the incident itself would not require a change in these instructions (H). Whilst you should record the events in the patients notes (G), this is not an immediate priority. Option F and D are presupposing the outcome of any discussions so maybe incorrect actions. Option B is not immediately necessary and the patient would probably not be able to retain or understand the information as they are confused.