What happens after med error?

Specialties Geriatric

Published

Specializes in LTC.

I was reading another post about a nurse who made a med error. It got me thinking about my new job as an LPN and how easy it really is to make an error and how easy it would be to not report it.

So, what happens to the nurse who does report an error? What about the patient?

I have oriented for 2 days and will have 2 more days before I am on my own. There is so much info to learn for the day to day stuff. How will I ever know what to do if something out of the ordinary, like a med error, happens?

(deep breath)

But, so far, I really like my job. Great coworkers really make all the difference.

Relax!!

If you find a med error, report it. Ask how you need to to this in your facility. We have a med error form and an incident report that we do. Behonest. Notify the resident, family, doc and pharmac. (DON might need to notify the state too). Monitor the pt for any adverse reactions. If you aren't sure what to look for, the doc or pharmacist will let you know.

When you report a med error..they should be tracked. Someone should figure out why it happened and how to prevent another one. Was it a transcription error? Error from pharmacy? From this, the person making the error or the whole staff might be inserviced on this mistake.

Technically...giving a med late is a med error.....but that is a whole other thread...

Specializes in med surg, geriatric, clinical, pool.
I was reading another post about a nurse who made a med error. It got me thinking about my new job as an LPN and how easy it really is to make an error and how easy it would be to not report it.

So, what happens to the nurse who does report an error? What about the patient?

I have oriented for 2 days and will have 2 more days before I am on my own. There is so much info to learn for the day to day stuff. How will I ever know what to do if something out of the ordinary, like a med error, happens?

(deep breath)

But, so far, I really like my job. Great coworkers really make all the difference.

Just be careful as many drugs sound and are simiarly spelled as well. Some meds that sound alike are in both a pt's drawer and in the narc drawer, so just be aware.

Specializes in Gerontology, Med surg, Home Health.

The national statistics on the number of medication errors made every day is scary.

Even with the 5 rights and doing things exactly by the book it is still possible to make an error and there is not one nurse out there who hasn't made one. We all do or will and the thing to hope for is that there was no harm.

Reporting the med error should not be a punitive thing. Report it factually. Most facilities have a form to use. DO NOT write in the nurses' note that a med error was made. You should chart: Lasix 20 mg order. Lasix 40 mg given. MD notified. No new orders. Patient stable.

Sometimes it's a systems error and your reporting it could fix the system. I had to do the med pass one day when I was the day supervisor. It was on a very busy sub acute floor. The meds were written for 8am and 9am. Off I went. I got to the last room at about 9:30....oops...that patient was supposed to get a Fosamax at 7am before breakfast. How would I, or someone else not familiar with the residents, know that?

So I wrote up the med error report and came up with a new system. Any early med or any med given outside the normal pass would be written on an index card on the front on the med book. System fixed and the resident suffered no harm. My co-workers thought I was crazy for writting myself up but it fixed the problem. The nurses from the other units and the agency nurses found it extremely helpful to have the index card there.

Good luck with your career and please, if you make a med error, don't beat yourself up. You're only human.

Specializes in LTC, Subacute Rehab.

In my facility - DON, family, res (if capable), MD are notified, and a report is filled out.

Specializes in Med/Surg, Rehab, Burn, dialys.

Just be sure if you make a med error, assess the patient to determine if any adverse effects, notify Dr of error. And above all, if you were not the one who made the error, when completing med error form do a complete investigation of all facts and previous documentation, before turning it into your supervisor. Good luck on your new job!

This is an awful feeling! I made a med error this morning and told the CNL after it happened and just felt so stupid. Really wanted to throw in the towel. The wrong med was in the Pyxis drawer....of course, still my fault. Pt. will be fine, thank goodness, but just feel like I should have known better. Definitely a lessoned learned.

Specializes in med surg, geriatric, clinical, pool.
This is an awful feeling! I made a med error this morning and told the CNL after it happened and just felt so stupid. Really wanted to throw in the towel. The wrong med was in the Pyxis drawer....of course, still my fault. Pt. will be fine, thank goodness, but just feel like I should have known better. Definitely a lessoned learned.

It takes awhile to become familiar with drugs and their appearance, but you will be "old hat" at it in no time.

Maybe slow down, and if you are not sure it never hurts to ask no matter how much experience you have....just never get too sure, but you can't worry about everything either. The longer you are a nurse, the more you learn little tricks that defintely stay with you.

You should ask your supervisor how this is handled in your facility. You might find out though, that your co-workers support an atmosphere where med errors are "covered up". If this is the case, then you will have to think about your ability to fight the tide and do what is right. When I worked in LTC, I found that the nurses just routinely overlooked med errors. With one exception. There was one nurse who committed med errors deliberately and then accused other nurses of the error. She was terminated when one of her actions caused a patient's death. Be very careful about your own med pass practices and always double check everything. Remember that getting in a hurry is very often the underlying cause of med errors. Take the time to make certain you are doing it right. Good luck with your new job.

Specializes in acute care and geriatric.

Report it!!! In one hospital here, the facility put in hidden cameras (in the med cart!) and caught so many unreported med errors. I always respect my nurses who are honest. Of course please try to minimize them by being super cautious when you prepare and distribute the meds. Always remember the 5 rights of med adm. (right time, dose, medication, patient and route...). Never allow yourself to be distracted during med prep- dont answer phones, find a quiet place, etc.

I really respect nurses who come and tell me that they are tired from their work schedule and are afraid of making mistakes...

If we can't be honest- what good are we!!

Specializes in med surg, geriatric, clinical, pool.
It takes awhile to become familiar with drugs and their appearance, but you will be "old hat" at it in no time.

Maybe slow down, and if you are not sure it never hurts to ask no matter how much experience you have....just never get too sure, but you can't worry about everything either. The longer you are a nurse, the more you learn little tricks that defintely stay with you.

I always had my up-to-date drug book with me too. It is very important not to let others, no matter who they are, to distract you. I used to tell visitors who would want to come up and start a conversation and they would see measuring insulin, but that didn't matter to them, "I don't want to make a mistake measuring this insulin, can I talk to you later?" And they would go on their way. They were fine with that response.

So here is a situation that happend to me and maybe one of you can help me out with this answer.

First day of Orientation on a LTC facility I was following a LPN around during med pass. The state came in and was monitoring her during a med pass of a patient. A med error occured because someone did not change the MAR and the LPN was sighted for med error. I as a new grad RN. Am I to also be blamed because I am an RN and was there or becuase I was first day orientating not responsable. This happened today so please let me know.

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