Survey about med administration for a class

[Casey, RN]

I'm working on a project for my RN-BSN class about medication administration safety. I've created a short survey (6 questions) and would love if some of you wouldn't mind responding. It's completely anonymous and I would really appreciate some responses!

Here is the link: http://www.surveymonkey.com/s/X2L8JQ5

Thank you in advance!!

[amoLucia]

I looked at it too. Pretty much hospital lop-sided. Wouldn[t have any real value to add for you.

[mmc51264, BSN, MSN, RN]

We don't allow hand written orders at all any more, so I can't answer the first two questions. We do bar code scanning so 4&6 don't apply to me either.

Me, too.

We have EPIC so the computer wouldn't let us give a pt the wrong meds or ones they are allergic to (at least it alerts/reminds us). Heck, it gives me a hard time when it thinks I am giving too much tylenol.

[blondy2061h, MSN, RN]

We also do barcode scanning, but I still have to ask my patient's name and DOB (they might have the wrong band on).

Out of curiosity, you don't chart the meds after you give them? I've only ever worked at one hospital so I only know our system - we scan and ID the patient, scan the meds and then hit "chart" on the computer in the system.

Scanning the barcode automatically charts the administration. I ask name and date of birth when putting a wrist band on initially, and check that they have the correct wristband on once a shift, then don't recheck it. My patients have a length of stay averaging 6 weeks and get meds pretty much hourly. Honestly, even before barcode scanning I rarely ID'd patients every time I gave a med.

[JBudd, MSN]

Since we are scanning, the charting is done at bedside, but in the ER we can't always scan for hallway beds. The handheld scanners glitch a lot. I still ask people who they are before scanning. As far as verbals, we have a great team relationship with our docs. While we aren't supposed to do non-emergent verbals, if someone needs a med now and the doc trusts me enough to order it without seeing the pt immediately (it is an ER after all, :) ); then I take the verbal, either enter it myself or remind the doc later.

[NicuGal, MSN, RN]

I could only answer a couple also. No verbals except for an order set we sign on the computer when the eye guy calls us from another facility to dilate eyes.

We scan at the bedside and sign off. And my babies can't talk so we use 2 other identifiers :)

[AJPV]

Another hot topic with dual identifiers that you might want to look at is lab draws. This topic was not as emphasized in years past, but it is now being mentioned a lot by the Joint Commission due to lots of incidents occurring. One situation that seems to invite errors is when you have a label printer on your unit that automatically prints lab labels for your patients. When a long string of labels prints off and you tear it off (it can be two to three feet long with a new admit or a patient that is decompensating and needing tons of labs), the nurse has to be extra careful to check the name and DOB on EVERY SINGLE label and not just assume that the whole string of labels is for the same patient. Sometimes the label printer will insert a different patient's label into the string of labels. Think of the implications of the wrong patient's lab results getting posted to your patient's chart - and then being treated according to those results! Even scarier is if one of the tests is a type and cross.

[KelRN215, BSN, RN]

Another hot topic with dual identifiers that you might want to look at is lab draws. This topic was not as emphasized in years past, but it is now being mentioned a lot by the Joint Commission due to lots of incidents occurring. One situation that seems to invite errors is when you have a label printer on your unit that automatically prints lab labels for your patients. When a long string of labels prints off and you tear it off (it can be two to three feet long with a new admit or a patient that is decompensating and needing tons of labs), the nurse has to be extra careful to check the name and DOB on EVERY SINGLE label and not just assume that the whole string of labels is for the same patient. Sometimes the label printer will insert a different patient's label into the string of labels. Think of the implications of the wrong patient's lab results getting posted to your patient's chart - and then being treated according to those results! Even scarier is if one of the tests is a type and cross.

I agree that this is a bigger issue. When I worked in the hospital, our lab had a policy to automatically cancel ALL specimens received if there were multiple patients' labels in the same bag of specimens. So, if you draw a slew of labs on Mary Smith but one label for Josephine Jones snuck in and you're careless/slap this label on one tube, you need to redraw everything.

I did once have a situation where the lab didn't follow through on that- I sent labs at the exact same time as another nurse. She had inadvertently labeled one of her patient's specimens with my patient's label. My patient was critically ill with cerebral salt wasting and everything we were doing with him was dependent on his Na+ levels. So his labs came back and listed a sodium of something like 137. This was the first time in a million years that he'd had a sodium in the normal range... it had been in the 120s the night before. Then something like 5 minutes later, a second result of something like 131 came back. I called the lab to basically say what is going on and they stated that they had two separate specimens for this patient. When they told me the initials on the second one, I knew immediately what had happened. The other nurse and I had to walk over to the lab and verify that the second specimen did not belong to my patient. When we did, I said to the lab tech "shouldn't everything have been canceled for this second specimen since two patients labels were in the same bag?"

[gypsyd8]

I took the survey, but it seems like many of these questions are outdated. For example #1 is unnecessary with CPOE. I do not do #1 or #2 because the physician is usually not there to ask. I do not do #3 because the physician either will or will not and there is nothing I can do to make that determination. I usually cannot get an answer to #4 because the patients are non-verbal or non-responsive, #4 is probably not practiced in facilities with BCMA (although we should be checking the armband to ensure it is for the right patient). I always do #5 as part of report, and #6 because of BCMA.

[oncnursemsn]

This is a great survey and I'm amazed at the different scenarios in which we nurses work! I'm in a large multi-center institution outside Boston- and almost every question is applicable. I'm in ambulatory heme/onc infusion unit- we have hand written orders, probably about 90%, and pre-printed order sets, but the MD/NP has to check boxes. Seems that more and more orders are unclear than ever, but we're in early phase of implementing EPIC. Target start is late 2014... So, we have no CPOE currently or bar coding. Good luck on survey and compiling results!

[loriangel14, RN]

I don't ask the doctor to clarify or explain written orders unless they are still on the floor.Usually I just ask another nurse "Do you know what this mean?" .I have called an MD to clarify an order only if no one else can get it.I can't usually ask for DOB because many of my patients are confused.Our system would flag allergies and we don't have bedside charting.Actually we did have bedside computers but they removed them because they were in the way and no one used them.

[bostonrnbsn]

Done!