Major med errors...whose fault is it really?

[NeoPediRN]

We recently had two *major* med errors in my ER in the past four months with DPH involved both times. Staff turnover is at an all-time high in my magnet hospital and the staff who remain are burnt out. We have an extremely busy ER with somewhat limited resources. There are never enough beds and there is never a time where every room isn't filled. Ever. Our door-to-door times are being reported to DPH now too, which has only added fuel to the fire. Staff consistently report feeling overwhelmed because clinical lead/charge nurses are trying to do their jobs and as a result will give nurses 3 new patients at once to clear the waiting room, without regard for acuity (because if that's the only room available that's where the patient has to go). That might help the wait time a little, but it's not going to help the patient see a nurse or doctor any faster. There are almost never lunch breaks, the nurses are constantly RUNNING, and team work is diminishing because there just isn't time. Admin has responded to the med errors by creating more mandatory policies (some warranted, some for CYA) and education. In my opinion, it's lack of staff and resources, not education. The department is staffed as well as possible, we even a float but it's just not enough for the volume and we are out of places to put patients. The ER was renovated over the past few years but there's nowhere else to grow and the town will not approve expansion, but yet the residents complain about the long waits. I think if we could staff a 1:3 or 1:4 ratio with regard for acuity, our med error rate would diminish to almost nothing. Our nurses are smart and give 110%, but I feel like the system is failing them with patient safety.

[Sassy5d]

What are the med errors?

Even when we're slammed, the biggest med error. I've made, knock on wood, was giving say toradol by verbal order as the doc never puts the order in and we both forget.

[NeoPediRN]

I can't get too specific but one involved anticoagulation and the other involved an IV med error that was close to being a sentinel event...the patient experienced organ dysfunction as a result of an incorrect dose.

[zmansc, ASN, RN]

I'm not sure the specifics of the med errors is the important factor here. It seems to me the OP is pointing out that her ER is not currently safe. From my reading of your posting OP, I think you need to try to find out of the other nurses working in the ER agree with you and see if you as a group can approach management with your concerns. If others do not agree with you, they may have ideas as to why you have these concerns and they do not. I would take the concerns up the chain of command until you feel the care the patients are getting has returned to safe and effective care.

[NeoPediRN]

Almost all agree and have verbalized to management but falls on deaf ears which has prompted the rapid turnover.

[Sassy5d]

Usually there is an investigation as to the med error. With that, they can usually figure out what exactly caused the error.

So I guess the question would be, why did the errors occur? Wrong pt? The doc order wrong med? Given with an allergy? Nurse didn't check orders or allergies or pt?

Our licenses depend on being diligent, which includes knowing what meds we give, including safe doses ect, you already know this.

I guess the bottom line is, we can't blame staffing on making med errors, some chain is being broken, probably by cutting corners because everyone is overwhelmed.

[NeoPediRN]

You got it Sassy. Both med errors were wrong doses - like WAY off and improper administration.

[Esme12, ASN, BSN, RN]

Sounds like an ER I worked at in MA....I quit. It just became too unsafe. Unfortunately, these days jobs are hard to come by.

Staffing in the ED is imperative to help stop fatigue related med errors. But if they have more nurses than the space allows for patients it "looks" bad with the DPH and the JC.

The ED I worked would commonly have 24 patients for 10 "acute rooms". We would double up the 2 trauma rooms and begin putting acute patients in urgent care. We were scheduled 3 nurses and a charge with one MD in the main room. 1 triage RN and 1RN 1ED doc urgent care (1o rooms)...they saw about 70,000pts/year for a ED built for 35,00pts/yr.....they never diverted...which of course you cannot really do in MA any more.

But the "fault" will always fall upon the nurse.

ps. NEVER take verbal orders.

[nurse2033, MSN, RN]

Safe medication administration is the nurse's responsibility. Creating a safe work environment is management's responsibility. The nurse should not allow poor management to affect their work, although it is an obvious contributing factor. I will always take the time, especially in medication administration, to do it right. If the patients complain, I tell them the truth about why they are waiting. If management complains, I tell them the truth about why I'm working safely. In general I think nurses are too helpful, meaning they take up the slack for poor management and become enablers.

[Anna Flaxis, BSN, RN]

Has anyone considered organizing? Having a collective bargaining agreement is not a panacea, but it's a start. Is there a union in your state?

Your description does make your ED sound very unsafe. I left my last ED for similar reasons, and it wasn't even as bad as yours sounds.