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Any suggestions for ongoing med errors?

Posted

Specializes in long term care, school nursing.

My nursing staff is continually making med errors. For example, transcribing orders wrong (giving a nasal spray twice daily instead of daily as ordered) or not removing medicated topical patches at night when ordered to remove after 12 hours. I am now at the point of issuing verbal and / or written counseling plans (write ups) that remain in their individual files. We have provided education already to all nurses and have had the staff education dept do spot med pass audits. I am at my wits end with these continued errors. Because I work in personal care/assisted living all medication errors need reported to the Department of Public Welfare. I feel that I am reporting events entirely too often. Any ideas?

I hate to say this, but with the employment situation the way it is, you might have a pool of ready, willing, and able replacements just dying to have a job. They might need a job so badly, that they would take more care with their med handling. Follow through on the write-ups with a termination and see if that helps. Also, more supervisory oversight. Hold their hands but with a price for it. That is the only thing I could advise. At the same time you are doling out punishment, if you can find an employee who excels by not making med errors, give them a reward in the form of a small raise, even if it is only .25 an hour. Reward good behavior.

island40

Specializes in ICU, School Nurse, Med/Surg, Psych.

In a tight budge rewards don't have to be in the paycheck. You might be pleasently suprised with incentives such as meals, mugs and posters on the bulletin board. Anyway to single out the ones that are doing the job right go hand in hand with pointing an acusing finger at the ones who are failing. Most of all the staff needs to know that it is personal and not errors that other nurses are doing.

This sounds like two things: sloppiness and a system error.

Make transcribing orders a two-person job, one to enter, one to check.

As to not removing the dig or lidocaine at night, that's sloppy, lazy, or both, and warrants writing up after the same offender does it twice.

CapeCodMermaid, RN

Specializes in Gerontology, Med surg, Home Health. Has 30 years experience.

Do you have a pharmacy consultant? Try having him/her come in and do training. Sometimes an outsider person helps. I agree with the rest...write ups and counseling needs to be done before a serious med error happens.

I had an employer that had an ongoing problem one time. I was one of the people that was doing it right. It so impressed the employer that they gave me a bonus in the form of a pay raise. Don't know if they told others that they had rewarded someone for doing it right, but it sure made me feel a little better for a little while.

ididit

Has 1 years experience.

As an LPN working in an assisted living facility, I can't imagine making those errors. Our orders are picked up then checked by another nurse (next shift). As for taking Fent Patch off at night...shame on them....their responsibility is to remember! Seems ridiculous that you have to reward a job they should be doing correctly in the first place! I agree, there must be plenty of nurses willing to work responsibly. Good luck!

I was on peer review where i used to work. You can have only 3 med errors a yr and then its reported to the board or you participate in peer review. I would give one warning. the next write up would result in a suspension or requiring them to give some kind of inservice on med admin. or both. They need to learn the correct or be reminded of the 6 rights of med admin

Havin' A Party!, ASN, RN

Specializes in ICU, CM, Geriatrics, Management. Has 10 years experience.

bdgmpark -- Are you talking about nurses or med techs?

The ALF I work for uses med techs, who in my opinion would need more explanatory info regarding some of the issues you've raised than LPNs or RNs.

Feel your pain. Repeated reportable incidents can place a black mark on a facility and those associated with it.

Just started at an ALF three weeks ago, and I'm having my first official staff meeting next week. One of my principal topics for discussion will be med errors.

Good luck!

lots2care4

Specializes in Geriatrics. Has 10 years experience.

Hello fellow nurses! :) I work in an adult home where cnas are employed as med techs. Our facility works off the 'point' system...you make a medication error, you receive points based on the error, type of med, etc. When an error is made, it really irritates me to hear, "I got 4 points!", or, "suppose you heard I got a med error...5 points!" Not once have I heard anyone remark as regards how that error may have effected the resident! Shouldn't that be their first concern? It just baffles me :banghead: to know there are people out there who do not put their patients' well-being as the priority. I know we are not perfect...mistakes happen. But...

As a new LPN the pharmacology training I received in school was no where's near enough...I am presently taking a refresher course online. Medications are tough and changing all the time. When hired at my place of employment, we had a "medication review and test" we had to take. As regards meds and administration of such, CNAs go through the same training and orientation as a LPN. It's basic...if you can read, you can pass meds. So, if you are matching the blister pack label to the MAR before popping the pill, how can you give the wrong med? And yet, it's done... :cry:

I don't know what the answer is as to how we can improve in this area...there has to be something besides 'rewarding' someone for doing what they should have done in the first place. Suggestions would be appreciated. Thanks so much...for listening to me vent! :twocents:

Without question, the RN must be diligent. But even the most attentive RN will make a mistake when overworked, rushed, and forced to multitask night after night after night. I know this was the situation on the skilled unit where I worked last year. We were so short-staffed and asked to do so much that it was clear the system was as much at fault if not more so than the individual. Compounding the problem was the constant use of per diems, who were simply not held accountable.

So what I'm saying is: It's a two-way street. Is the OP sure that his/her staff is operating in a good working environment? Are nurses encouraged to take charts into quiet areas with computers to focus solely on transcribing and/or proofreading orders? Or are they tackling transcription while answering the phone with the nonstop beep of the call bell in the background? Do they have adequate support staff to ensure that they have the time they need to transcribe accurately? If the answers to those questions is yes, then the individual RN must be held accountable.

Edited by Freedom42
typo

Havin' A Party!, ASN, RN

Specializes in ICU, CM, Geriatrics, Management. Has 10 years experience.

Very valid perspective, Freedom.

Mistakes will happen no matter what. My hope is that these errors are the type that are inconsequential, and of minor significance to our patients.

Thanks, Party. I also wanted to let the OP know that I read an article somewhere on this forum in the last six months or so regarding nurses at a particular hospital group -- I think it was Kaiser -- who tackled this program by carrying colored folders. If a nurse was carrying a green folder, it meant that s/he was processing a medication order and was not to be talked to until the process was complete. Granted, this was meant to minimize adminsitration errors, but the point was that minimal interruptions minimized errors.

This doesn't mean that I don't think nurses should be held accountable. We also need to encourage nurses to come forward once they realize an error has been made so that we can minimize damage.