I agree that alot of med errors don't get reported for fear of reprisals. I agree that there also needs to be focus on the system also. There can be numerous factors in the working environment that can cause medication errors that never seem to be addressed:
1.
Interruptions. How many times are you interrupted when dispensing meds. There are all kinds of circumstances when your interrupted.
2.
Late administration, wrong time. A real problem at times where I work. Despite 3-4 calls to pharmacy on orders sent down and receiving medication 8 hours after orders were sent. Also you can't always provide total patient care and be on time with your medications. I've had MARs sent with meds scheduled for 2100 for example and the patient had been admitted at 0100 on the unit and the orders were sent at 0105.
3.
Stat medications not readily available. I've sent stat orders for a medication and not received it until 4 hours later, despite calling pharmacy and telling them I just sent a stat order.
4.
Wrong dosages. I've received medications that were the wrong dosage. If it's a new medication I always check the orders. I've had MARs printed and sent that were missing medications that were ordered, and no these were not new orders, these were admitting orders. Although as a nurse you are supposed to check your orders, there are times I can't even thoroughly go through the chart until 4-6 hours into my shift. I've received IVPBs with the wrong infusion printed on the label, If I'm not familiar with a medication I always double check it, sometime asking a co-worker to double check with me.
5.
Wrong route. Real problem with administration via NG. Some of the medications ordered should NOT BE CRUSHED. I've had many patients become angry because "the other nurse" crushed the meds and pushed them through the NG and I wanted to them to take them PO (not contraindicated). I had one new employee who crushed all the meds and mixed them together and then flushed them down the NG, thankfully she is no longer working there. I've had medications ordered IM that the previous nurse gave IV (yes, med could have been given IV if ordered that way), I then have to call to change the order to IV because patient refuses IM.
6.
Inadequate instructions/insert provided with medication. This is so true with medications that we normally do not administer. I had a patient who required immunization shots and I was not provided any information concerning what I was administering. There are some medications where certain muscles cannot be used for IM. Some immunizations you can't administer on the same day as another, had to call pharmacy for instruction.
7.
Policy and procedures on-line. Try and find it, good luck.
It's taken me 20-45 minutes to find something. Wasting time is a huge pet peeve, especially when it concerns info I feel I should be able to have easy access to.
8.
IV compatabilities and protocols. No manual on unit. Have to call pharmacy, like they're not busy. Alot of the staff don't know what the protocol is for administering Hydralazine IVPB and it is not an uncommon order for our unit. I previously worked at a place that had an IV formulary on the unit, the great thing was that if I was unfamiliar with a IV medication, I could photocopy that particular med administration and compatibility and place it in the MAR. Our pyxis had a medication list to look up meds, few know that its there.
9.
IV pumps. We have triple pumps where you have to be very careful not to mix up the lines. Pt had a DL PICC and TPN & lipids infusing, the lipids were infusing in her peripheral site, instead of her IVFs with PCA. I've taken to labeling IV tubing in these situations. Also you have to stop the infusion on these pumps and to change the rate.
I do feel a big problem in our facility is that there is inadequate orientation regarding utilization of policy & procedures on-line, TPN & lipid administration, NG administration, use of equipment. Few of the people I work with (some have been there YEARS longer than me) have no idea how to utilize the On-line reporting for incidents. Information needs to be more easily accessed where I work. The things I learned after I was done orientation.
Last place I worked at had a committee comprised of both pharmacy and nurses for the purpose of decreasing med errors. Reported errors were reviewed with the goal of improving the system.
Good topic Sbic56.
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