[meditate]

I am so anxious that once I become an RN I will make a mistake giving a pt their meds., especially with the high nurse to pt ratio. Any experienced nurses out there have any advice. Also, will we have to convert the dosage or does it come as it is supposed to be given?

Thank you!

[Emmanuel Goldstein]

Yes, there are times you have to calculate a dosage or drip.

The best advice is to always follow the five rights. Don't give a med you're unfamiliar with; don't 'blindly' follow a doc's orders (they make mistakes too) and don't depend on whatever technology you're using to avert all mistakes. And when you're pulling, pouring and administering meds, do not allow anyone or anything to distract you.

[NancyNurse08]

It's Six Rights now. Maybe even seven. The Sixth Right is Right Documentation. I'm not sure what the seventh would be.

I find it helps to have a system that I follow every time and do not deviate from. For instance, I get a med cup and go down the MAR, in order, placing each medication into the cup as I go. The meds come all mixed together in a bag, so it would be easy to just check them against the MAR as I find them, but for me, going in order of the MAR feels safer.

Any pill that needs to be split or any IV med that needs to be drawn up goes NEXT TO the med cup, NOT in it. Then I go to the med room and split the pill or draw up the med, double checking the dose one more time before I give it.

When I was first starting out, I kept all the wrappers after giving the medications, to use to double check against the MAR when I charted that the meds had been given. Now I only hold onto PRN med wrappers to remind me to chart them, since they're on a different screen than the scheduled meds.

If you have a lot of meds that won't all fit into a med cup, you can use a paper or styrofoam cup.

Edited to add: Another thing I did when first starting out, to remind me to check the patient's ID, was to place one of their inpatient stickers over the meds in the med cup, so that I couldn't take the meds out of the cup without peeling off the sticker. This reminded me to ask for their two identifiers.

[Emmanuel Goldstein]

Originally Posted by NancyNurse08

It's Six Rights now. Maybe even seven. The Sixth Right is Right Documentation. I'm not sure what the seventh would be.

Documentation? Showing my age, I guess lol. Not sure how documentation after the fact will prevent a mistake, though.

Wonder what the 7th right is? Maybe something to do with the planets being in the proper alignment...

Ah, I googled it. "Right reason". Well, that would go along with what I said about not just blindly following an order. Although another site listed the seventh as "Right technique". And another listed "Right to know effects/side effects".

Does that mean we're up to nine now?

Interesting perspective: http://www.ismp.org/newsletters/acut...0125.asp?ptr=y

[nursemike]

Not very long ago, I heard someone refer to Ten Rights, but I suspect even they would have had trouble naming at least three.

On a night like last night, I feel I deserve some credit just for being in the right building.

[MelBel]

I think documentation is incredibly important in preventing errors!

Ever been told in report that a PRN narcotic was given just prior to you getting on shift, but not seeing it signed off in the MAR? And the only way of knowing that it may have been given is that it had been taken out of the pyxis?

What if it was something that didn't come out of the pyxis, and wasn't documented or told in report? If it was me I would be giving something unknowingly if it wasn't documented!


Also, I've followed nurses who will sign off meds early(such as abx given at the end of the shift), and forget to give them. Even if I find the timed/dated abx in the med cart, I can't give it if it's been signed off!

[meditate]

Thank you all for your input. Very helpful things to remember once I start clinical.

[Emmanuel Goldstein]

Originally Posted by MelBel

I think documentation is incredibly important in preventing errors!

Ever been told in report that a PRN narcotic was given just prior to you getting on shift, but not seeing it signed off in the MAR? And the only way of knowing that it may have been given is that it had been taken out of the pyxis?

What if it was something that didn't come out of the pyxis, and wasn't documented or told in report? If it was me I would be giving something unknowingly if it wasn't documented!


Also, I've followed nurses who will sign off meds early(such as abx given at the end of the shift), and forget to give them. Even if I find the timed/dated abx in the med cart, I can't give it if it's been signed off!

Ah, good point. I was thinking about how it would affect my administration, not the documentation of others. Thanks. We have a barcoded system and pyxis, so meds can't be charted until they're given plus there's no problem with prns not being charted on the MAR. And everything comes out of the pyxis.

Originally Posted by nursemike

On a night like last night, I feel I deserve some credit just for being in the right building.

I feel your pain lol.

[NancyNurse08]

I think that's the seventh I heard; Right Reason. And Right Documentation does make sense. I know nurses that pre-chart. If for some reason, the med isn't given and they forget to go change the MAR, then the patient is documented as having received a med that they didn't.

[NancyNurse08]

Originally Posted by nursemike

On a night like last night, I feel I deserve some credit just for being in the right building.