help me stop making med errors!

[BulkyMonster]

I keep identifying new ways to prevent them, but someting always slips through.

Most commonly, an order will say something like: Tylenol 325mg I-II tabs PO Q6h prn. I will only see the 325 and not the "1 to 2" part.

That's just an example. I have also missed a couple things outright. A few weeks ago I nearly gave the wrong heparin due to miscounting the zeroes... the patient would have got only a fraction of the dose.

A nurse at work has been on me about it, a bit overly so. Okay, a lot overly so. I feel like she's obsessed with everything I do. She has taken her concerns to our boss, and wasn't happy with her response so is taking it to the next higher boss now. Our direct supervisor is trying to help me but has advised me not to make even the tiniest mistake while I'm under such scrutiny, and yesterday, I made a mistake. She's fed up with me even though she agrees that my coworkers is overstepping her bounds.

In the past month I've made probably 4 real mistakes:

-one near underdose of heparin, caught by the other nurse

-one missed order which the MD did not flag (I was off the floor though on an ACLS run and left my patient in the care of another nurse for a while)

-one wrong route of an antibiotic.

-one antibiotic that didn't infuse, which I caught later and corrected, on an abnormally busy day... but it took me a long time to catch it

I have been trying SO hard not to mess anything up. I've become nearly obsessive compulsive, checking everything over and over throughout the day. Even after I've already seen it. And at the end of the day I check over every bit of paperwork and the patients themselves, with a second set of eyes to help me. But this overzealous nurse has written up, along with these errors which were true errors that needed to be adressed, about three times as many things that never happened. For example I had a detox patient with a high BP and she thought I never gave him his blood pressure medication. She asked him and he said nobody had given him any pills all day.

He also thought that something that had happened 4 hours ago, had happened "yesterday" (and this was day shift), that there were women in the bed near his, and that his walls and window were moving! Yet she is writing this up as an incident report, using sketchy circumstantial evidence to paint me in the most negative light possible. Even if most of them are false, enough write-ups and you look bad.

I can't afford to make a single mistake. Even non-mistakes are getting me in deep hot water. I am utterly desperate and trying my hardest to do everything perfectly, but I am in a job where neither of us are likely to be fired or transferred, and I can't quit.

Maybe I'm a terrible nurse for making these mistakes. All I can say is that I am doing my best. I am not stupid, careless, or lazy. For some reason I just keep messing up. And with this obsessive woman relentlessly breathing down my neck, it's so bad that I am losing confidence, losing sleep and losing weight from all the anxiety.

Can anyone help?

How do you prevent med errors?

Why do I keep making them? I've been a nurse for almost 3 years now.

How many med errors do you think each nurse makes on average anyway?

Am I just in the wrong career field? Should I not be a nurse?

[Cheyenne RN,BSHS]

maybe i'm a terrible nurse for making these mistakes. all i can say is that i am doing my best. i am not stupid, careless, or lazy. for some reason i just keep messing up. and with this obsessive woman relentlessly breathing down my neck, it's so bad that i am losing confidence, losing sleep and losing weight from all the anxiety.

can anyone help?

how do you prevent med errors?

why do i keep making them? i've been a nurse for almost 3 years now.

how many med errors do you think each nurse makes on average anyway?

am i just in the wrong career field? should i not be a nurse?

it doesn't sound like you are a terrible nurse. over stressed maybe. anyone who knows that they are being watched constantly becomes more stressed and stress can affect one's ability to do their very best.

the fact that you want to do better and that you are concerned shows that you are a "caring" person and want to be a "good" nurse. the most dangerous nurse of all to me is the one who is a know-it-all and refuses to admit their limitations.

the work enviroment that you are in does not sound condusive to learning. no one can do their best in an enviroment of hidden hostilities and animosity. you cannot "give" caring and time to administering medications safely when you are watching to be stabbed in the back constantly. if you have to worry over every move you make and check and re-check yourself out of fear, then you are putting yourself through h**l.

i would think that changing jobs or units or even hospitals might give you a fresh start. choose a place of employment where there are not as many medications to give.

medical or tele units, dialysis units, nursing homes, places like these do give tremendous amounts of daily medications while other positions may not have as many.

you may want to consider giving yourself a fresh start in a different place.

[FirstYear2005]

As a student med errors scare me. it really bothers me that physician handwriting is so difficult to understand, etc. I am very nervous !

[brenzgrove]

I'd like some advice from other nurses reading this thread, what types (specific) of nursing positions would be best for someone with a disability like ADD?

[WAZZA]

I do not think that the fact you have someone bullying you at work (and that is what it is) that should be allowed to go on. I suggest that you speak to the person and suggest that you and her speak to the supervisor together and also tell her (in a nice way) that the way she is behaving is adding to your stress levels and the cause of some of the mistakes you are making. I am sure she would not like to be told that she is causing some of these problems and that in the long run you are responsible to your supervisor. Making mistakes is not good and you could look at some ways, with which you feel comfortable, to reduce these and as someone else suggested the fact that you are looking at some improvements will stand you in good stead. I always find that if I have a problem I tend to stand back and think of ways of improving the outcomes. Good Luck and don't let anyone tell you that you are not worth the effort to try and improve. Ask your supervisor for some suggestions and try to work together without being in your face at all times as I am sure this does not help the situtation.

[lisa bear rn]

I hope you figure out the problem soon, because med charting errors left me with a suspended nursing license, had to go to a facility for a 5 day eval to see if I was taking drugs, three months later and no job, finally cleared of drug use, but on probation for 3 years, and a ton of fines and restrictions on my license!! Not to scare you but try hard to better yourself!! This is one HARD lesson to learn.

Good Luck, Lisa

[HappyJaxRN]

Bulkymonster,

I was diagnosed with ADHD over 5 years ago. I tried meds for awhile and then couldn't tolerate the side effects. Sometimes I wished I had. I have moments where I get so flustered. I've learned my limits. When you feel flustered, stop, take a breath and reassess what you're doing. Sometimes, if I have a lot going on, I have to sit down and write a list of things that I need to do. Don't try to do extra things to help people...until you are 100% you're finished with what you're doing. And I mean 100%.

I haven't had to mention to the team leaders or nurse manager about my ADHD yet, because it has never become a problem for me...or so I think anyway. When I was being precepted because I was asking a lot of questions over and over and I think my preceptor was loosing his patience with me.

Lately as the stress has been getting worse, I've noticed that I've been reacting more impulsively than usual. And altho I've been fair and usually in the right for feeling the way I was (because a team leader was being inappropriate), I shouldn't have been so short wicked. I know it's the ADHD, they don't.

ADHD can be used to your advantage too. Once you learn your limits, you can fly through hoops with the abundance of energy that you have. Might I recommend, stay away from caffeine. Not only does it make the ADHD worse sometimes, but it can send us into super duper hyper mode.

I don't know about you, but I can spot when something is not right immediately. Especially when looking at orders and doing chart checks.

All I can say it, we have to pay extra attention (funny, right? Pay attention)...anyway, we have to pay extra attention to ourselves and what we're doing. S-L-O-W down.

Good luck. Hope that helps.

Oh and....consider yourself lucky....you have ADHD, not ADHD and PMS...Those two are killer together!

[nursey_girl]

When i first got out of nursing school, I was in the same situation. Couldn't get it together, and all the eyes upon me thing just made things worse... I got to the point that i absolutly HATED my job, and was so stressed out because of... I ended up leaving, trying something different, then altogether taking a break...No job, no school, no nursing PERIOD... Was just a little while, and yes, I was poor for that time, but came back foused and ready. I pulled it together, and actually became quite admired and respected in my old area, but in a NEW location. Was the very best decesion for me professionally.

[TEXAS_onc_RN]

I don't have a lot of patience for all of the people who seem to feel sorry for you and are getting attitudes toward the supervisor who is taking a proactive roll in trying to help you overcome your lackadaisical outlook on medication administration. The fact that you haven't been formally written up is concerning to me.

It is pretty easy to administer medications properly:

1. read the order.

2. obtain the correct medication.

3. verify the correct med by comparing it to the order.

4. verify the time due.

5. verify the route.

6. verify the dose.

7. verify the patient.

8. verify the med again at bedside.

9. give the med.

Quit making excuses and pay attention

[Margie/NM]

Hi,

You do have a problem. The one thing I might suggest is to have someone around that can check you out BEFORE you give a med.

The other thing that strikes me is that you are in the military. If the nurse that is bugging you so seems to be doing it in violation of of a direct order by her superior and charges can be brought. Unless the superior has not told her to lay off.

My other thought is that maybe you should look for a different avenue of nursing, and avoid direct patient care.

Margie/NM

[button2cute]

Hello,

Texas onc Nurse,

How can you allege that she is making excuses? Have you ever been diagnosis with ADH/ADD? Have you seen individuals with ADD/ADH and their performance on the job or studying or completing an everyday task? Well, it is very hard to understand and to deal with on a daily basis. It is like being on a high speed train or car without brakes. You cannot get off the train or stop the car with the brakes. Instead, you are going for a ride that you cannot stop without assistant. You have to see a medical professional or a holistic physician (certified) for a resolution to the problem. Medications are used to slow down the train or the car and finding which medication is suitable for the individual can be difficult at times. Trainning is needed to adapt and to deal with the diagnosis sometimes is overwhelming. First, thing someone can do who is diagnosis must learn acceptance about it. Second, thing is to learn how to deal with it on a everyday basis. Thirdly, to seek professional assistance and find resolutions to help the individuals with the disabilitiy. Fourthly, re-trainning is an essential tool to make it through the day as well as on the job. Fifthly, knowing your limitations as well as how to deal with the limitations on a daily basis. Lastly, if the individual refuse to participate in a structure treatment and/or re-trainning, it is their choice.

ADD/ADH is a diasability that hinder people in their lives and they need to learn that is it not their fault of having this disabliity. It is something that happen inner uterine during their development. It is not an excuse, it is real and it is not the idividual fault that has it. Therefore, it is about learning how to deal with this disability on a positive note.

As a person, who do not have the disablity, may need to do research on the disability and learn the effects it has on the individual. To understand it is not an excuse, it is a disability that can be control with different types of therapy, re-trainnning, mediations, and diet. Before, you can say ADD/ADH is an excuse. The explainations one may give to not going for the treatment maybe fear or being scare that he/she may feel inadequate of completing a task as someone without the disability can do easily. Therefore, one need to be less critical on those who have disabilities and to understand there are other methods to complete the task just as one can do it their way.

That is my two cents....

Buttons

[sjrn85]

I don't think it's realistic to expect that another nurse be available to double-check every time this nurse needs to give meds. For heaven's sake, it's hard enough to get your own work done, let alone have to partially do someone else's work, too. It's one thing when you're doing it with a new rmployee/new grad., but eventually you expect that person to function independently.

I honestly think that bedside nursing may not be the best area for this nurse. Giving meds is a deadly serious business; a nurse's disability should not be accommodated to the point that patients are endangered.

[button2cute]

[i honestly think that bedside nursing may not be the best area for this nurse. Giving meds is a deadly serious business; a nurse's disability should not be accommodated to the point that patients are endangered.

I would like for you explain the above? Because I need clarification from you prior to me making comments.

Thank you,

Buttons