Running Head: CLINICAL EXEMPLAR 1

Clinical Exemplar

Tiffany Tran

University of South Florida

CLINICAL EXEMPLAR 2

Clinical Exemplar

Introduction

In nursing practice, one valuable method of instruction lies in the employment of

clinical exemplars. According to Johansen and OBrien (2016), clinical exemplars are

real-life case studies that serve as models for others to examine such situations. Clinical

exemplars are particularly useful when it comes to illuminating the decision-making

process involved in clinical nursing. They permit others to understand the thought

processes behind decisions made in clinical situations and, therefore, offer insight to

those who have not personally experienced these situations (Johansen & OBrien, 2016).

Clinical Exemplar

The following clinical exemplar is one that surrounds the principles of medication

administration safety. It demonstrates the potential pitfalls that nurses can encounter

during medication administration. Fortunately, despite the fact that the patient outcomes

were positive, the following near miss was enough to inspire me to modify my practice.

Model Case

JC is a 51-day-old Hispanic male who was born at 24 weeks gestational age,

whose current corrected age is 31 weeks gestational age. It is the last round of the

morning, prior to shift change, and he is my last patient to assess and feed. Due to his

history of respiratory issues, as well as his current form of oxygen therapy, he does not

yet qualify for oral (PO) bottle feedings. His method of feeding is via his orogastric tube

(OGT).

Although I am still a student, I am in my final preceptorship and largely

independent in tasks, such as assessing and feeding. The only portion of the feeding
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process that I cannot do independently is the scanning of breast milk or formula, prior to

administration, into the electronic medical record (EMR). Thereby, during administration

of feedings, my preceptor is generally available to supervise this portion of the process.

During this particular round, however, my preceptor is otherwise occupied, assisting

another nurse with her patient.

I begin the round, as usual, by acquiring JCs mothers breast milk from the milk

depot. Firstly, I verify his name, date of birth (DOB) and medical record number (MRN)

against his label at the milk depot refrigerator. Immediately upon entering in his room, I

approach his isolette and verify the same information against his name band. Once I have

verified that this milk belongs to him, I place the milk in the warmer and begin his

assessment. The hope is that my preceptor will become available by the time his milk is

adequately warmed for administration.

Contextual Factors Influencing the Decision Making Process

Upon completion of my assessment and the warming of his milk, my preceptor is

still unavailable and the patients feeding is now past due. Furthermore, the patient is

beginning to cue readiness for feeding. Rather than leaving the bedside to find my

preceptor, I decide that, because I have completed my safety checks and the six rights of

medication administration, it is acceptable to continue and scan the breast milk when my

preceptor arrives. I verify his name band information against the information on the

breast milk one last time, and then administer his feeding through his OGT, via the

enteral infusion pump.

By the completion of his feeding, my preceptor is still occupied. Therefore, I

begin charting on my last round, stocking and preparing for shift change. By the time she
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returns, I have forgotten the need to scan the breast milk. Only during report, about 30

minutes later, does it dawn on me that I have not scanned his breast milk.

Implications for Nursing

Fortunately, in this case, the circumvention of scanning does not affect the patient

outcome. Nonetheless, the realization that I had nearly forgotten to scan his breast milk

altogether haunts me for the next few days. I find myself repeating the scenario mentally

and reflecting upon my clinical decisionswhat I did well, how I can improve my

practice in the future, and the like.

Although I did the proper safety checks, I realize that skipping the scanning step

prior to administration could lead to several mishaps. For instance, I could have

accidentally administered expired breast milk or breast milk that belongs to a patient with

a similar name or birth date. The administration of, and exposure to, another patients

breast milk would be considered a medication error and could pose both ethical and

health concerns. For these reasons and more, I decide that I need to rethink and refine my

administration process.

Conclusion

Ultimately, the gravity of this near miss inspired me to change my practices in

both breast milk and medication administration. Now, I do not allow myself to open the

product to be administered until I have conducted three safety checks and scanned it into

the EMR. By establishing more methodical practices, I have protected my future patients

and myself against these types of medication errors and potential resulting harm.
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References

Johansen, M. L., & O'Brien, J. L. (2016). Decision making in nursing practice: A concept

analysis. Nursing Forum, 51(1), 40-48. doi:10.111/nuf.12119