Explain test question, please

[Todd SPN]

Was taking a sample test the other day and ran across a question that I thought might be "faulty." I might be wrong, so I thought I would throw it out to the more learned. It went something like this:

Dr writes script for a particular drug for his hopitalized pt. Script is noted and transcribed. Nurse gives pt med for 4 days. On fifth day an audit catches that the drug was to be given for only 3 days and that the person transcribing failed to note that fact. Who is responsible for the drug error?

Answer: Nurse giving the med. Nurse should have checked what was written on Kardex against MAR.

What the heck is a Kardex? If I am giving a med, should I be double checking another source or can I take the MAR to be gospel? If the MAR is incorrect and because of that I incorrectly medicate someone, is it my fault?

[cannoli]

tonchitoRn, what type of floor do you work on?, and what is your patient load each shift?

[EastCoast]

NICU

what i mean is that on the start of a patients 8th day the med sheets are re-transcribed and double checked against the original order. (our medsheets covered a 7 day period). In general, when an order is written the secretary transcribed it , the charge nurse signs it off and then the care giver is responsible for reviewing any new orders written on their patient.

[CAR]

Hi!

The discussion related to medication errors is interesting to me. I remember the first error I ever made, which was as a new graduate back in 1971 so I take the subject very serious. It was probably more of a system problem, but nonetheless, I made an error, which I will never forget.

I teach pediatric nursing so I use my own error as an example and I also use the Colorado nurse incident (somebody already mentioned) as an example. We have to abide by the five rights. I add two additional rights for my students--right documentation and right approach.

I just read two articles (as a result of this discussion)

-

http://www.nursingworld.org/AJN/2000/FEB/wrights.htm

http://www.bridgemedical.com/patient_colorado.shtml

The shortage of nurses is most likely contributing to the increase in incidents. We have to speak up if we want change to occur. Make it a mission. Know what your rights are as a nurse. And, yes, the buck does seem to stop with us if we administer the medicaton.

Many of you had some great suggestions. Before you take a job, check into the support you get as a nurse. Find out if there is a committee you can serve on that deals with medication errors.

As an educator, my perception is that medication administration (all routes) is one of the most anxiety producing skills for students

[CAR]

Oops--I forgot to add the article about the Colorado nurses.

http://www.nursing world.org/tan/98marapr/news1.htm

I am sure there are many other sites about this incident.

[CoffeeRTC, BSN, RN]

Well, I have to add input from the LTC side. The nurse transcribing the order would be at fault. When a new order is recieve and verified by the Dr. the Rn transcribes it onto our orders on the chart then the MAR (Each pts has one MAR per month) The 11-7 Rn should review the charts and MARs for new orders each night this is for about 48 pts. Since we don't have a Kardex system the MAR is the only place to check. Now if the order had a stop date on it and it was transcibed to the MAR.... the nurse administering the drug after the stop date is responsible.

I know things are different in LTC, so I just had to add my 2 cents.

Oh just wanted to add, these MARs and tx sheets and monthly reorders are only checked monthly for accuracy.

[SteelTownRN]

The person responsible is the nurse who transcribed the order, but I would also hold pharmacy accountable for continuing to send up a med for 5 days that was only ordered for 3 days. The nurse is truly the last link in the chain for medication administration and as such, often bears the brunt of the blame for med errors. Whoever transcribes an order from the med sheet to the kardex is legally responsible for correctly transcribing the order, so that others behind them who administer the med can do so in a safe and effective way.

I am wondering if the sample question came from a review book that is rather old, as the practice of checking all meds, each time given, against the kardex, is a very dated practice. Current practice that I am aware of (please correct me if I am wrong) is that one nurse transcribes orders and others can go behind the transcriber without checking.

-STG

[Kayde]

We check everynew order in a 24 hr check to make sure all new meds and labs ect. are done as ordered that day. We then write 24 hr check, our name and date and time. Each 24 hr is then checked from that point.This is done some time on the night shift. In the exaple given , we would write day1,day2 ect on appropriate med sheat. for the days needed

[Todd SPN]

This is so weird. Started this thread this morning and just listen to what happened at work today.

The facility is assisted living. The company owns four units around the state and has one RN overseeing all of them. We have one LPN at my facility. All the CNA/NAs have had 8 hours training so we can administer meds. We were told that we fall under the RNs license. The LPN in the facility writes out the MAR monthly. About a month ago they hire an agency RN to work parttime in the facility. Last week she was auditing the MAR and found some errors. One of them being one of the residents meds (coumadin)was d/c as of three months ago, yet was still listed on the MAR, the pharmacy was still sending it and we were still administering it!

Gonna try to get an nurse/attorney to comment on this.

[Keysnurse2008]

it depends.......

what was the drug?if it was a narc then yeah....pretty much a standard that they run only for 72 hours and then must be renewed.....

but.........i would say the transcriber and whatever nurse is designated to do your 24 hour chart checks(comparing all daily orders/new mars)

but if you give the drug...........TAG......you are it buddy.

[Monica RN,BSN]

Ok I have to thow in my 2Cents worth.

I believe the error falls on the transcriber, but in my place of employment we fax every order to the pharmacy, who should have only sent three doses from the faxed MD order. Secondly. the orders written on a mar should be verified by another nurse to check for accuracy. As for those of you who say it is possible to check each med order before giving... I would like to know where you work, and how many patients you have. In Long term care it is not a reality to check all meds against the doctor orders before giving since the nurse has between 24-30 patients on any given day, any givin shift. many of the residents are on 10 or more meds each,,,, Not possible to check all of them.

Certainly, "When in doubt .... check it out."

Just my opinion here.....

[sharann, BSN, RN]

We just had a post-op come through recovery with floor orders to hang Pitocin 20 units in D5LR @ 125 cc/hr. Well, normally this is a fine order for a POST-C-section patient. THIS patient however, had a total hysterectomy. The doc ordered it though. Now I have some experience so I would question this, but how about a Newer employee... The phamacist wouldn't necessarily check WHAT surgery was done etc... This is why we have to question orders to each individual patient every time!

[Brownms46]

While I do realize that it maybe impossible or at least not practical for a nurse to review every order, especially in a LTC setting. But a nurse is responsible for the medications that she gives, no matter who else contributed to that error:) I'm sorry it's not fair, but that is the responsibilities that a nurse takes on. And checking every order is what a nurse is "supposed" to do, prior to administration of meds, whether it's feasible or not.