Med Errors... Are they unavoidable?

[CashewLPN, LPN]

Hi guys... I'd like to get some feedback on something I wrote in my blog... I'm going to post it below, in a nicer, more family friendly way... Please, let me know what your thoughts to this are...

Ok, now, for the most of it... I'm really peevedd... I got written up at work again... a minor write up....but, hell... c'mon... you float me to how many floors a night, and I'm spot on for how many patients worth of meds for how many passes, and I get written up for missing one... luckily, the night nurse after me got written up as well, so, I'm not gonna go off the deep end on it... And what really stinks is that because of that one night nurse, one simple phone call (which is why I give my relief my cell phone, is to avoid cow chips like this.) would have averted both me and her getting written up...

I'm gonna figure out this mathematically... what are my odds for screwing up, if that night was to be an average of whats happening in the wild and wooley world of nursing...

ok, lets see... I started out one 1 unit, and made 2 passes of meds... the unit has 22 patients, and for the first pass, 75% of them recieve meds, the second, 100% recieve meds.

After completing said pass... I got pulled to floor number 2... floor number 2 has if I'm not mistaken 36 residents, and, I made 2 passes... with the same percentages as the above... oh, and I did all these meds between 7pm and 10:30pm.

so, (pulling o ut the calculator here...) that would be a total of 4 med passes.... on floor 1/pass1(f1/p1), I passed meds to 17 patients (rounding up, because you cannot pass a med to half a patient, no matter how mangled they are). on f1/p2, I passed meds to 22 patients... total of 39.

on f2/p1 I passed meds to: 27 patients, then, on f2/p2, I passed meds to 36 patients... total of: 63... which ends up being a whopping 102 medication transactions between 7p and 10:30p... (210 minutes....)

so, that would equal just over 2.06 minutes per person per transaction, on average.... which does not include dealing with families (approx 10 minutes total) and fielding PRN's and patient questions (maybe, another 15 minutes total), so lets figure this out... with a weighted amount of 185 minutes (factoring in families and patients, and actually attempting to be a good nurse...) drops the per patient per transaction time to 1.81 minutes per transaction per patient.

now assuming that each patient is getting 6 meds each... that means... 0.3 minute per medication-- to verify the Medication record, and pop the pill, and finally to give the pill... (0.3 minutes is roughly just under 20 seconds per med...)

so, basically, all in all.... I'm *self censored* no matter how I look at it. It ends up that with 102 transactions, if I made 1 error, thats a percentage of... um... 102:1 uh, i think if my math is right... it might not be so any of the math geniuses that are out there... ends up being 0.98% for 1 error in 102 transactions. So, to dumb it down, theres basically a 1 in 100 chance of making an error, and ya know what... I met the odds, and wow...the odds kicked my BUTT!

I just don't know at the moment... how on earth are we, the human nurses supposed not to make an error when using that scale...and, mind you, I'm just discussing the 8p and 10p medpass... and, I'm being real generous with the times alotted for things to happen.... I mean, what happens if you drop your MAR, or, what happens if you need to refill your water pitcher, or you run out of a med, or you drop the med cup... (pills in the crapper, do it again.),you need a narcotic, someone demands juice, or that the water is just not cold enough, or 'gee, you look just like my cousin's uncles brothers sisters grandniece's neighbor' or, god forbid, a patient goes bad, or a family gets angry at you for seeming frustrated when mom takes next to forever to swallow those pills....

I dont think that the families realize that those 5 minutes a patient spends doing something is time I can spend in nearly 3 rooms... and, heaven help us if someone has to pee, hell help us if its me that has to pee... we're essentially screwed everwhere it seems...

Its essentially a no-win situation from my POV.

and now, what can we do, as responsible members of the nursing community?

lets go over our options and some rationale why or why not it would be appropriate:

1) Start Earlier...

Rationale-- start earlier and finish later, increase the time you take to pass the meds, therefore allowing more time to do the pass

--Try again... this will not work for the large amounts of meds we have to pass... why? Turns out that you only have an hour before and an hour after the perscribed medication time to admininster medications lawfully and safely... you cannot pass an 8pm med at 6pm, or 10 pm med at 8pm.... its illegal. In an optimal world, this would never happen, but even in the non-optimal world, there are just some meds that you cant safely pass that early... like... Pain pills... you can od your patient, or, leave them medless for a portion of the night, or you can impare them enough where they can become a danger to themself.... also... would You like to recieve a sleeping pill with your dinner, or, would you like me to wake you up with said pill after you've drifted off for a half an hour? I think not.

2) Leave the pills with each patient and run to continue

Rationale-- You in effect spend less time with each patient, so, you should be able to do more in less time

-- What? You'd dare actually do this in a facilty in a state where you hold a license? Uh, not only is that illegal, but, its damn dangerous too... I drop Mrs. X's pills off on her nightstand and run out.... her roomie, Mrs. 'Confused out of my loony tune mind' Wanders out of bed and eats mrs x's meds... Mrs. Looney tune is allergic to most of whats int he cup, has anaphylaxis and dies, mrs x accuses you of never giving her the meds... or, even better, the patient who is enough with her mind, but decides to hoard the meds until she needs them... hides them for a few days (mind you, its a ton of pills at this point) and downs them all... After all, she feels she needs them, and gets sick off of her beta blockers,psych meds and lasix... She goes to the hospital very hypotensive, and very dehydrated, with med levels all over the place...., well, at least she's not dead.... but her family will now make you wish you were... ... or, the patient just tosses out his pills with the afternoon trash... then has seizures repeatedly from missing his dilantin.... see.. its not a safe thing to do....

3) Hire more nurses,

Rationale-- More nurses means a lighter workload so, in effect you would end up having to do less med transactions, and would be able to spend more time doing it....

-- Ding Ding Ding Ding, you've got a correct answer!, or at least as correct as possible at this point in time.... Turns out that the nursing shortage means less nurses and more work... so, basically this option, while being one of the best, is still not feasable at this point in time...

4) Make the nurses work longer hours....

Rationale-- more time in means more time passing meds, means need to hire less nurses to get the results from option 3...

--Sure...mandate the masses, reduce morale to even lower than what it is now.... Gee... a tired, unhappy, unrespected nurse cannot be expected to work as well as a fresh, content, respected nurse... After all... pro athletes are pampered and pushed and I dare say even coddled into playing their best, once or twice a week.... We nurses are expected to work through fatigue, exhaustion, injury and all else and still work at 100% efficiency every day... Dan Marino, try to do what I do... I dare ya.

For now, thats it...

Perhaps, more ideas on what we can do to help eliminate errors, or to at least drop the error rate to under half a percentage point.

I hope to continue this at a later time

-Cashew

[stidget99]

Although we all know that we WILL make med errors, any med error is unacceptable. One might just give that pt w/ a brady heart a pill for someone w/ a tachy heart. Or give a BP med to someone who already runs low. Or give a sugar pill to someone who's already had theirs. In any of these examples, the pt receiving the wrong meds coud potentially die! So, in my opinion....no med error margin is acceptable.

Another possible solution......maybe have the docs change the times of administration to allow a longer time for the med pass.