Medication Errors

[PurifiedNurse]

Hello everyone, wanting some insight, I've been an RN in a LTC for almost 6 months. I've had 4 med errors, first one I accidentally gave someone levothyroxine that wasn't suppose to get it, 2nd had a R come to my hall that had a 12a narcotic, I didn't see it and missed this. 3rd was a order said 1.) D.C. Mylanta, Tyl then had a small 2 beside tyl and said 145mg fenofi rate HS. I misinterpreted the order and thought it wanted to D.C. Fenofibrate, I even had a nurse double check me and still was not caught. I forgot to give a xanax for a R, I swore I gave it, but she only gets it once at night and the count was off on me. I reported 3/4 of those on myself, the fenofibrate was caught on change over but I wasn't given the med error til 1/2 a month later. I'm just feeling hopeless, I've learned from each error.. but I feel like maybe LTC isn't for me? But then it seems everyone is making med errors, mainly not giving narcotics, one nurse even missed 3 in one night (not found by me). So I know I'm not the only one, but I feel we could improve the system. Just looking for insight.

[cardiacfreak, ADN]

4 med errors in 6 months seems like a lot to me. I am not trying to be deceitful in any way, just an observation from what you wrote. What is going on during your med pass that has you distracted? Have you tried writing down medications that are scheduled at an off time? Clarifying confusing orders with the doctor is better than making a med error even if you get scolded for calling. LTC nursing is not for everyone, they are the masters at time management.

Do you use computer or paper for charting meds? I have no advice on haw to improve your system of passing meds, just be as mindful as you can.

[PurifiedNurse]

We have paper charting, but the thing is a lot of the med errors are people missing narcotics, some people have more than me... one nurse even had 3 missed narcs in one night (which is overboard), I'm hoping we can improve the system...

[quiltynurse56, LPN, LVN]

Electronic MARS are definitely helpful. In the meantime, I would suggest a cheat sheet with who gets what meds at what med pass and then check them off when given on that sheet as well as the MAR. Another idea is if the paper MAR has tabs in the notebook or you can use the small sticky notes, designate a color for each med pass. If there is an order that is not clear on the MAR, then you need to go back and look at the physician orders.

In LTC, one has so many residents to pass meds to and then other things come up that need attention. That is why I created a cheat sheet and would print off new ones for each time I worked. Or, you can use the resident list and write in who gets what when on one of those and keep it handy. I found that copying new ones each day worked best for me.