Reflective Practice in Nursing Kuldeep Kaur Seneca College Student id: 142313188I am doing Chronic Disease Management program at Seneca College, Yorkgate campus. During my program, I got placement at veterans centre in Sunnybrook hospital. One day my clinical instructor was guiding me about the medication procedure. I was very excited, because this was my first day in Canada when I am going to administer any medication to a patient. There was a 92 year old patient having an order of hydromorphone tablet orally once a day during morning time. I had been asked to give hydromorphone tablet to that patient. I took the file of that patient from the counter and read the history and medicine order. I performed the assessment. He had stable vital signs and no critical problem. After that, I opened the medication cart with a password and just going to take off the medication, suddenly my instructor stopped me. She said me as this drug comes under the controlled drugs and substances, its mandatory to count the tablets before and after taking it off the cart and records it into the narcotics record register. On her instructions, I count the tablets and match it with the record register and then entered the count of tablet I took , followed by my and her sign on narcotics record register. Furthermore, she told me that when we administer narcotics there should be one witness of it. Afterwards, I crushed the tablet with crusher and mix it with apple sauce. Finally, by taking into account the six rights of medication (right drug, right dose, right patient, right route, right time and right documentation) I administered the medication to the patient.I was very happy on that day as I learned something new. I searched the list of controlled drugs and substances when, I went back to my home. I read that, hydromorphone oral tablet falls under a class of drugs called opioid analgesics and is used for reducing pain. It helps to reduce pain by acting on certain opioid receptors in the brain and spinal cord. A special precautions should be taken while administering as it has some serious side effects such as rash, hives, swelling of face ,eyes,lips,tongue and other body parts, hallucinations, fast heart beat, svere muscle stiffness ,decreased sexual desire, extreme drowsiness etc. Tell your patient, if any these symptoms present seek immediate doctor’s advice. Naloxone is the antidote for opioid analgesics which reverse the life threatening effects of an overdose. Further,its long term use must be avoided due to its habit forming capability.According to CNO practice standards, there are three principles outline the expectations related to medicine practices that promote public protection:Authority,Competence and Safety.Furthermore, I read an article Narcotic drugs-Handling and documentation, which provides me more detailed information. By reading this I come to know that there are various methods to store the contolled substances adopted by different health care centres such as locked cabinets ,medicine carts, automated drug dispensing system. In locked cabinets, only authorized personnel are allowed access to the keys and this type of cabinet is usually contained in a locked room further limit access. With this type of storage, the traditional end of shift narcotics count with the oncoming nurse counting and outgoing nurse verifying is usually conducted. Medicine cart is the another way to store drugs. There are various kinds of medicine carts, but most have individual drawers to hold medicine for each patient rather than the each drug. Refrigerated drugs are usually kept in central area under double lock in some type of refrigerator. The end of shift count is also conducted with this type of storage, but because, the narcotics are stored in a no. of different carts different pair of nurses may be conducted count at different carts. However in automated drug dispensing system there are automated References: http://www.cno.org/en/learn-about-standards-guidelines/standards-and-guidelines/ https://medlineplus.gov/druginfo/meds/a682013.html http://www.rn.org/courses/coursematerial-10004.pdf https://allontario.ca/controlled-drugs-and-substances-act/record keeping and require user name and password for access. A major advantage of this system is that there are less wastage and more accurate record keeping.Moreover, while taking controlled substances out of the cart, it should be witnessed by two health care providers who are licensed followed by signatures. The nurse should not carry excess narcotic in a tray or in a pocket or place it in a unsecured medication drawer. Additionally, under no circumstances should a health provider agree to sign for unwitnessed disposal of narcotics after the fact. Doing so could make the health care provider complicit in diversion or arouse suspicion of unprofessional conduct.