Medication Errors and You. And Cheese.

  1. Ok, so I was kidding about the cheese part. Sorry.
    I'm looking for input. My hospital is looking for ways to reduce medication errors, specifically errors of omission and "late" meds.
    We have a computer-entry system that prints out orders for us. Our care plans are all printed out and have the meds highlighted for the shift.
    Couldn't get much easier, but for some reason, we're still not giving the meds on time. We have a Pyxis. The wait time to get meds doesn't seem excessive.

    I've been racking my brain here. I'm good at thinking outside the box, but am not having any luck coming up with solutions. I was wondering if anyone out there had some special ways of reducing med errors at their institutions.

    Thanks!
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  2. 10 Comments

  3. by   dianah
    Seems like some sort of flow study should be done, to break down the various components of passing a med, so they can be analyzed and the weak points brought out. System is only good if it WORKS, so even if you have a good system, its execution might be fine-tuned in certain areas, to improve the overall outcome (i.e., meds getting passed faster). Anyone else??
  4. by   sharann
    What is your staffing like? Do you have "med nurses". In our facility "late meds" are a direct result of constant interruptions (like answering phones and call lights and taking orders off) due to lack of adequate staffing help. How can one pass ALL 0900 meds by 0930 when you have 8 or more comlex patients and are primary nursing for 5-8? This is the main reason. The second is the difficulty with getting another nurse to come to the Pyxxis every time you need a dang "witness".
    Just how I see it.

    p.s: Maybe if we were fed some good cheddar we would work faster!
  5. by   heart queen
    Our charge does not take patients, or sit on their butts. They help with the am med "pass" while we assess our patients, meet with the docs. We changed a position to 11a-11p to be purely assistive, we're short now so from 11-3 we have a nurse that "floats" unassigned until 7pm. that helps with admissions, meds again, helping with Iv's what ever you need. when staffed that person floates from 11-11.

    Now I'm 100% sure that adding MORE staff, won't be part of your solution, but consider you resourses... how is your charge utilized, ours on days does pure bed control and assistive. They never sit. On busy days the assistant manager joins in as well as the manager. I've been other places. I know this is not the norm. but it is WHY I chose this unit.

    We have the same ratio's of other units, but choose not to carry fewer patients at times but use the truly assistive personal, for meds and help because a heavier load is sooo doable, with help.

    Speaking from an ICU with 2-3 patients 3-4 if just swanned and stable on heavy, non titrating drips waiting transplant. 6 months in, no late meds. plus the other nurses when done with their meds always ask "what can I do to help" No one really sits until every one is done, then we chart. it works great.
    Last edit by heart queen on Feb 25, '04
  6. by   sharann
    I agree with you Heartqueen that if managers help out and "never sit" and if tasks as properly delegated, there should be no prob. I see that you choose to work in a unit that is pro-teamwork, as I choose to. The reality though is that many units are "dysfunctional". This comes straight from the top I believe. When staff see their superiors roll up their sleeves and pitch hay alongside them, things are indeed improved.
    So Shoelace, what is YOUR situation in your unit?
    Intersting topic too!
  7. by   shoelace
    Quote from sharann
    I agree with you Heartqueen that if managers help out and "never sit" and if tasks as properly delegated, there should be no prob. I see that you choose to work in a unit that is pro-teamwork, as I choose to. The reality though is that many units are "dysfunctional". This comes straight from the top I believe. When staff see their superiors roll up their sleeves and pitch hay alongside them, things are indeed improved.
    So Shoelace, what is YOUR situation in your unit?
    Intersting topic too!
    Well, I have much the same situation. I think the admins are asking for suggestions on a broader scale, like hospital-wide. I work in CCU, never have more than 2 patients, and our charge is almost always free to help out, co-ordinate admissions/transfers, AND we have a "break nurse" from 11a-3p (usually picks up patients at 3) to help out and give breaks.
    I'm not sure that our particular unit is having problems, but I think it's a problem on med/surg floors.
    As for teamwork, I simply could not work in a better unit! We help each other out splendidly. Maybe other units are missing the teamwork... hmmm... and I know for a fact that other units give their charge nurses patients to take care of, in addition to staffing, etc.
    Interesting thought.
  8. by   sharann
    You know I just read something in a journal about the most med errors arising from lack of staff, and poor staff education on medication policy. I have witnessed in our "sister" unit a nurse drawing up a med and then asking me why she is giving it. I said, if you don't know why then you better hold on and look it up, then ask the prescriber if you are still not sure. She has been a nurse 30 years but worked OR for 29, so she never gave meds.(The med she almost gave without knowing was Robinol)
    Nurses MUST know EVERY drug they give (look up ones we don 't)
  9. by   Tweety
    There's too many variables going into a med pass. You can't just walk into an assignment and expect everyone to get their meds on time. Sorry but someone sometime is going to be late, unless they ignore other patients needs. "Sorry I can't help you to the bathroom, I must pass my meds. Sorry I can't take report on the ER admission, I must pass my meds."

    I say relax and don't expect miracles. If most of the meds are passed in a reasonable amount of time, I'm happy. But stuff happens. Give me a safe ratio, no admissions, and plenty of nursing aides and my meds will get passed on time, otherwise get out of my face.
    Last edit by Tweety on Feb 26, '04 : Reason: several typos...opps...
  10. by   Rapheal
    Quote from 3rdShiftGuy
    There's too many variables going into a med pass. You can't just walk into an assignment and expect everyone to get their meds on time. Sorry but someone sometime is going to be late, unless they ignore other patients needs. "Sorry I can't help you to the bathroom, I must pass my meds. Sorry I can't take report on the ER admission, I must pass my meds."

    I say relax and don't expect miracles. If most of the meds are passed in a reasonable amount of time, I happy. But stuff happens. Give me a safe ratio, no admissions, and plenty of nursing aids and my meds will get passed on time, otherwise get out of my face.

    Amen! So true Tweety.
  11. by   gwenith
    It depends too on what you consider "late" i.e. I had one colleague try to round on me because I had not given the warfarin on time - this was 20 minutes past the due time. I took a deep breath and quietly explained that the doctor had requested a hold until we had the pt's coag profile back. So what do you consider "late"
  12. by   RNKPCE
    Is this something the hospital has figured out since the pyxis holds all the meds now. How are they determining that the meds are late? By when they are checked out of the pyxis? I work at the same hospital as Shoelaces on a med/surg floor. Sometimes there is a really slow turn around on new meds being okayed by pharmacy before we have access to them in the pyxis. I know sometimes meds might appear late but aren't like when a doctor order kcl bid with meals and the computer makes that 12n but our meals don't come til 1:15p or later. Or prednisone due at 8a but makes more sense to give with breakfast which comes at 9a. Or patient off the floor for tests.

    I think the meds that are most often late without good reason are now and stat meds especially if these meds are enter into the computer after the next shifts careplan has printed out. I think nurses aren't as good about checking for new order late in the shift.

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