Did I make a med error?

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just graduated nursing school in December and work at an assisted living. My boss is trying to say I made a med error. What happened was I was day shift nurse on Tuesday. I had a signed new order from the doctor for a patient to increase there lasix from 40mg daily to 40mg 2x a day. I followed all my steps. Faxed this to the pharmacy so they can put it in our EMARS, let family know if the med change, documented it, sent a message out to other nurses, and told other nurse in report. Well the patient was only receiving her 40mg a day. I didn't work day shift again that week so I really didn't know what happened after that. Can all this blame be put on me ? I guess I should have followed up again with pharmacy about this but I sent it to them and followed all my steps. Does some of the blame also go to the nurses who saw it on the message board and who I told in report? I feel like a terrible nurse :(

Specializes in Critical Care.
How should I continue from here? I know it wasn't a major error but how do I continue from here?

Ideally you would follow the process that already exists for error reduction and improvement, and identify the problem (neither the physician nor the nurse are keeping the eMAR up to date) and propose a solution (physicians and nurses change the orders in the eMAR directly).

If there is no established process where you work for identifying and solving these problems then you would need to start with advocating for such a system.

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Specializes in Psychiatric Nurse Practitioner.
No, we don't have anywhere for the physician to put in the orders. We have to fax them to the pharmacy and the pharmacy puts them in and we have to confirm they r correct. My concern Is that I didn't give the med at 5pm yet because I didn't see that the pharmacy had put it in the computer yet. I feel like the nurse for the next day shift should have followed up on this and looked for it.

What hours were you working that shift? And how was the order written for the furosemide?

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What hours were you working that shift? And how was the order written for the furosemide?

The order was given over the phone . I wrote it on an order sheet and faxed it to the office. They faxed it back signed. But they didn't send the official signed one back u til 530 pm. I was working 630am-630pm

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It was written as Lasix 40mg tab PO 2x daily

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Specializes in Critical Care.

Is the regular process really for the pharmacy to modify the order in the MAR? It seems unlikely that a third party pharmacy would go into your eMAR and modify the order. Many pharmacies are EMR-connected, which just means prescriptions can be entered into the EMR and then are automatically routed to the chosen pharmacy, but I doubt there are any that would modify the order for you in your EMR based on a Fax for script.

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Is the regular process really for the pharmacy to modify the order in the MAR? It seems unlikely that a third party pharmacy would go into your eMAR and modify the order. Many pharmacies are EMR-connected, which just means prescriptions can be entered into the EMR and then are automatically routed to the chosen pharmacy, but I doubt there are any that would modify the order for you in your EMR based on a Fax for script.
. Yes, we receive The order and fax it to the pharmacy and they put it into the computer. We then go and verify that it is correct.
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Specializes in Critical Care.
. Yes, we receive The order and fax it to the pharmacy and they put it into the computer. We then go and verify that it is correct.

Why aren't you or the physician putting it into the computer?

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Not sure... I just started there in January. It's just what they do. We have had issues with the pharmacy in the past.

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Hmmm. If the new order was for the 2nd dose to be given at 5pm, I would have given it even if pharmacy was not caught up on entering it. You received the order, so its ok to give. I'm thinking that was the problem.

I agree that this ^ would be a correct thing to do. And yet - - I seriously believe that in some places it might be a different "error" to administer it without it being entered/approved/verified by pharmacy. Or to administer it and not document it "properly."

Anyway, all that aside, I would think carefully about all of this. I despise the mindset behind these types of reports to BoNs. It is not appropriate. It is meant to just knock people down and keep them down. I wouldn't stay, but that's just me. They could find someone else to treat that way.

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Specializes in Critical Care.
Not sure... I just started there in January. It's just what they do. We have had issues with the pharmacy in the past.

Are you sure you maybe didn't misunderstand, and the reason why the pharmacy didn't update your EMR was that it isn't actually something they do?

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Haha yes I'm sure. Every single time we get a new order we fax it to pharm script and they put it in our EMARS. Depending on the doctor sometimes the doctor will send it to pharmacy script to put it in but not this one.

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Specializes in Critical Care.

That seems like an error that is not only possible based on the process being used, but should be expected. It would be far more safe and reliable if (preferably) the physician was placing the order directly into the EMR, or failing that, the nurse should be able to keep the EMR up to date.

LTCs aren't typically covered under Meaningful Use yet, but they likely will be in the future, which means that the physicians and nurses will be legally required to be the ones making these changes, so it would make sense to start being compliant now.

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