Have you ever made a medication error- yes, no or almost. - page 4
Nurses, how many of you have ever made a medication error. I don't know if the system will allow us to answer yes - no, almost or never.... Read More
Sep 11, '11Yep. It sucks when it happens. Thank goodness no one was hurt. I have little routines in place to prevent me from doing it again.
Sep 13, '11Oh, Jesus, yes.
My FIRST day on the job.
Our facility has no ID bracelets, and instead relies on photos of the patient that may or may not be several years old.
I mixed up two 100 year old ladies that were sitting next to each other in the hallway, after an Aide gave me the wrong name... "Oh yeah, that's Ms. So-and-So"
I was in tears, seriously
I'm also terrified of doing a med-pass with state. I have 30 patients, all on 5+ medications, several peg tubes- mostly bolus feedings, a couple of trachs, I do my own wound care, my own paperwork, I don't have a supervisor, unit manager, or unit secretary on my shift.
What a disaster. 2 hours? Sheesh.
Sep 14, '11Every single nurse has made medication errors (yes plural) and to me the scarieset ones are the ones that don't think they have. Or say they have only made a few in x amount of years.
What nurses are admitting to are the ones they realize they made. There are many others that people don't even know they have made.
I repeat EVERY single nurse in practice makes medication errors. The goal is to decrease them and make safety first.
And I notice most people add the caveat "nothing serious" "no harm done" blah blah blah. One really doesn't know for sure.
One person said they made only 4 in 24 years. I say get real. Sorry.
Sep 21, '11One time i had two different IV antibiotic bags to hang for two patients in my LTC facility. (I've got about 6mo. experience in nursing so far now) Both were on the same Nafcillin antibiotic, with the same 12gm in the bag continuous 24hr infusion; bags were the same size, etc.... and the name labels were printed VERY poorly- it was incredibly hard to even find the name on the bag. I hung the two bags, only to discover on the following shift, (i hung them at 6pm one night, and about 8am the next morning it was discovered) that they had the wrong bags. No real harm, (None of my med errors have resulted in any actual patient harm) but the dosage was slightly off- the pharmacy screwed up how they mixed one of the bags so they put a different rate on the order for that bag, than the rest- as there were 554mls in that bag, and 503mls in the other one. Both IV bags were 500ml IV bags though, and said 12gm Nafcillin on them in big letters.
I felt horrible though.
In part, I feel that my facility promotes med errors by using a paper MAR with lots of little square boxes to sign our initials in on the date we're giving a med... it's hard to immediately see where things are on the sheet, hard to do the triple-checking that is needed too.... plus that it is just challenging to remember to do all of those same checks every time, when one works in LTC with the same residents getting the same meds every day for months.
Lately I've been finding a number of med/treatment errors that other nurses have left behind though- Lidoderm and fentanyl patches not being replaced/removed when they are supposed to be, and PICC dressings not being changed for two days past their due date!!!.... the PICC dressings really tick me off, because those are central lines- not something to mess around with.
Sep 21, '11oh yes! we all make mistakes. Owning up to them is the part that not everyone does. It is difficult to admit it at times but many of them come related to being in a hurry trying to give the best care to many patients each day. I always try to remember that slowing down and thinking about it saves time in the long run..mistakes cost lives!
Sep 22, '11I made my fist error recently. The order was Dilaudid PO and I work on a floor where EVERYONE gets dilaudid IV around the clock. So, the PO order was strange and unexpected. I gave the med, (same dose) and then realized it was PO later. I guess I should have reported it, but, I know the pt would not be harmed and it would have cost me months of paperwork and suspicion to report it so I didn't. I don't regret my descision as the pt care is the most importtant thing to consider.
Sep 22, '11Quote from Jenni811At first, I thought this was crazy, but you know what? I think it would help a LOT.So when i'm doing medications, i am in my ZONE! Our hospital has actually talked about making us wear something when we are doing meds to tell people we cannot be talked to. Instead they thought that was a little excessive and tried the "safe zone" tape. when we are standing in the "safe zone" (a square of red tape infront of the pyxis) we are to not be talked to by anyone! even docs. we are to not answer our work phones.
I love love LOVE my PCTs, but wish they would make sure to at least be around to answer call bells when I'm doing my med pass. I've caught myself about to make an error when I've been interrupted.
I work 7P-7A and for some reason the techs always take their breaks at 730 when I'm getting my meds together.
Nov 29, '11If a nurses tells you they have never made a med error they are lying. Everyone makes med errors. Its scary to think how many errors occur in a hospital setting. I wish management would see the value in following acts.