Med Errors - page 22
For our collective benefit, list some of the med errors you've seen committed or caught before they were committed. The only rules are: 1. No blaming. 2. No naming names. 3. State what the... Read More
Nov 7, '10Here is the report
Nov 13, '10Quote from nursel56Miss Julie you bring up what is a pretty common source of error - and that's when the responsibility for pulling, giving, charting, etc is divided over more than one person. If a nurse has sole responsibility for her patient's meds and waits to chart it not much will happen as long as she doesn't report off to someone else or leave without charting it. The nurse did not adequately communicate with you and should have thought about that when she took the Digoxin out of the baggie.
I have to agree with this. The majority of med errors I have encountered recently (missed medications, not doubled doses), come from this scenario. Either a splitting of a shift or someone taking over a cart without proper communication.
Nov 14, '10Last night, I found an IV med error. I work at a SNF, and our meds come from an offsite pharm. The IVs were in a plastic bag, and the label for the ABT indicated that it was two different concentrations...it was given by four nurses before I found the error. Just goes to show...do the checks yourself, rather than rely on what others have done. You can't assume that they have all done it correctly, even though 99% of the time they have.