A nurse manager notes that the number of medication administration errors has increased on the unit. Which of the following actions should the nurse take first?

A. This statement indicates that the client may have difficulty with activities of daily living (ADLs), such as bathing, due to their rheumatoid arthritis. An occupational therapist can help by providing adaptive techniques or tools to make these tasks easier, thus making this an appropriate referral need.
B. While this statement reflects a common issue for clients with rheumatoid arthritis, it primarily points to a need for pain management and potentially medication adjustments, which are more typically addressed by a rheumatologist or a pain specialist rather than an occupational therapist.
C. This statement is related to nutritional needs and weight management. A dietitian or nutritionist would be the most appropriate professional to help with meal planning and maintaining a healthy weight rather than an occupational therapist.
D. Difficulty with stairs is related to mobility and functional limitations. An occupational therapist can assist by assessing the client’s home environment and recommending modifications or adaptive devices to improve safety and mobility, making this an appropriate reason for referral.

A. The Institute of Medicine (now called the National Academy of Medicine) provides broad recommendations on healthcare practices, quality improvement, and patient safety. While their reports and guidelines can influence overall healthcare practices and policies, they do not provide specific, actionable guidelines on nursing procedures or scope of practice for individual procedures like chest tube removal.
B. The state nurse practice act is the most relevant resource for this policy. It defines the scope of practice for nurses within a particular state, including what procedures and tasks nurses are legally authorized to perform. Reviewing the state nurse practice act will ensure that the policy aligns with legal requirements and scope of practice regulations, which is critical for ensuring both compliance and safe practice.
C. The American Nurses Association (ANA) Standards of Practice provide a framework for the expectations and competencies required for nursing practice. While these standards can guide the development of policies and procedures, they focus on general standards of care rather than specific legal or procedural guidelines.
D. The ANA Code of Ethics provides ethical guidance for nurses' behavior and decision-making. However, it does not provide specific guidelines or legal parameters for performing specific procedures like chest tube removal.