Bite-Size: Safe Medical Practice — Reflecting and Learning from Mistakes.
Introduction
A new blog concept for my website. These blogs tend to be small and introduce a concept or talks about an experience I had. Bite-size blogs should be a little less than 2 minutes read and may be less than 600 words. Nothing too prominent with a relaxed feel to it and no insane reference list.
In this edition of Bite-Size, I reflect on what I have done well to create safe medical practices and discuss some of the mistakes I have done involving needles. Reflecting is healthy and helps in sharing ideas with colleagues and improve ourselves as healthcare professionals.
Reflecting is important
I like to reflect on the things I do well in medicine and on my previous mistakes. From there, I ask myself, how can I improve and what strategies or action plans can I use?
Introduction
In the past 2.5 years of my medical studies, which is mostly based on lectures along with four placements, what have I done well to create safe medical practices? What mistakes have I made and what have I learnt from them? It is noteworthy to mention that the MBBS degree is a 6-year undergraduate course where year 4 and onwards is heavily based (almost purely) on clinical settings and rural/remote placements.
So far, hand washing has become second nature to me, although I believe I could still do better. It has been ingrained in my brain since the first year of my medical studies. I remember on my one-month rural placement in Benalla (Victoria State) that my hands were always cold from using the handwashing materials so often. Patients actually complained as if my fingers never had blood in them and asked if I was alive (and I had to reply, yes indeed I am alive). Even when sometimes it feels trivial or insignificant, I still do it as I know that handwashing is responsible for decreasing microorganisms transmission significantly, improves hygiene and save lives. It was found that 1 in 3 diarrhoea and 1 in 5 respiratory infections can be prevented from good hand hygiene. The 5 Moments of Hand Hygiene definitely helps in knowing when to wash your hands, and I highly recommend it. This is a safety skill that I am happy with, where even Ignaz Semmelweis would approve and be content of my handwashing behaviour.
In first-year, I remember saying that a needle stick injury (NSI) is hard to achieve and that the person is obviously not entirely focussed or is blatantly ignoring procedures or clumsy and so on. I believed it would be impossible for me to get an NSI but hold and behold on my second placement; I poked myself with a fresh vaccine needle. The risk was as low as it could have been as the needle was sterile. I was maybe exposed to a tiny amount of vaccine from the tip but nothing else. The patient was safe and I was safe. However, it really made me think. My profession is surrounded by sharp needles, and my overconfidence has costed me in being stabbed, which definitely gave me a new perspective as well as a big wakeup “slap” and being slightly embarrassed.
Then the second incident happened. I gave an injection on my one-month rural placement only to put the vaccine on the side of the bed as I was immediately doing the next step. The patient brought his arm down and ever so slightly scrapped himself or, let us just say, poked himself on the used needle. How did I let that happen, and why did I do that? On that day, I decided from now on to prioritise and disregard anything sharp immediately (which is what you are supposed to do) and put extra focus and attention in doing so. I also decided to look up, learn and refresh myself on the safety procedures that involve sharp objects. I got so caught up with the clinical setting that I forgot about the safety of my patient, my colleague and myself. This was not good enough and I needed to do better, which so far, my handling of sharp objects has yet found human flesh (at least unintentionally). When I had to cannulate a patient under the supervision of the anaesthesiologist, I was anxious at first and I didn't want to accidentally stab anyone, but I did become a lot more confident in using needles and how to dispose of them. This needs to become second hand learning like handwashing, where I don't need to think about it. My main point was that I got tunnel vision instead of doing steps in a logical order and forgot to do simple but crucial steps. A mistake can happen but learn from it and do better.
One of my proud moment is the 6 Rights of Safe Medication Administration, where so far, I have been conscious and meticulous at each step in providing the safest medication delivery. Whenever I had doubts, I would ask the nurse who supervised me and we could reflect, identify the problem and improve myself. Medication is part of my future profession and knowing its safety steps from the back of my hand is key. It is especially important when the medication enters the bloodstream, such as an intravenous route of administration as the adverse effects are amplified and do pay extra attention when handling paediatrics’ medications.
All my safety behaviour is backed up by my professionalism. The respect and duty I have for being a medical student on placement, the morals and ethics I have to follow, the responsibility that rests on my shoulders, being part of something bigger than myself, all of these I am aware of. I am aware that my lack of trying, lack of being educated in doing the correct procedure could well, in fact, kill someone. It is daunting to know that not being cautious or responsible could end a human life.
Published 25th September 2020. Last reviewed 1st December 2021.
Reference
Centers for Disease Control and Prevention authors. Handwashing at home, at play, and out and about. Centers for Disease Control and Prevention website. https://www.cdc.gov/handwashing/pdf/handwashing-poster.pdf. Reviewed June 22nd, 2020. Accessed September 22, 2020.
Government of Western Australia Department of Health authors. The six rights of safe medication administration. Government of Western Australia Department of Health website. https://ww2.health.wa.gov.au/-/media/Files/Corporate/general-documents/safety/PDF/Medication-safety-resources/Six-rights.pdf. Reviewed 2018. Accessed September 22, 2020.
World Health Organization authors. 5 moments for medication safety. World Health Organization International website. https://apps.who.int/iris/bitstream/handle/10665/311157/WHO-HIS-SDS-2019.3-eng.pdf. Published March, 2019. Accessed September 22, 2020.
