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?
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.
That is strange that the pharmacy would still be sending the med, especially coumadin, without an order for 3 months????
And aren't orders updated each month??? And what does it mean, that you can "administer" medications after 8 hours of training???
That is strange that the pharmacy would still be sending the med, especially coumadin, without an order for 3 months????
And aren't orders updated each month??? And what does it mean, that you can "administer" medications after 8 hours of training???
Can't answer for the pharmacy. The eight hours of training allows us to administer routine and prn pills/liquids, not injectibles. Scary I know and yes, there have been errors. I would never put my RN license on the line like this. A co-worker called and said the agency RN who discovered the problem has been let go. Things are pretty tight liped right now.
This incident in recovery would not to be a med error as the original poster implied. You noted that the physician shouldn't have ordered something. In your expertise you had this corrected. If a newer employee didn't pick up on this I think it would fall still on a MD who ordered the meds. Jeez, how many things are we going to make nursing responsible for here? Now we need to check all the MD orders to make sure they know what the heck they're doing??? I understand that sometimes we catch errors before they happen (thank God) but on the floors (Not in a PACU where the usual daily meds are not given so the meds you give are inital type meds,,,pain,antiemetic etc.) it is not likely or timely to check every med (I'm with MonicaRN on this one).
The majority vote being made is that the RN who signs off the order now needs to be rechecked by another RN every time the med is given. Previous there was a thread about nurses and insulin. Many nurses felt it was ridiculous and not time efficient to double check insulin once it's drawn up but now you have the time to go through pages and pages of orders for every med. Boy, I want you guys to care for my patients...
Specializes in Med/Surg, ER, L&D, ICU, OR, Educator.
I would be laughed out of the hospital I work at if I suggested that each and every med given needed to be checked against the original order! Impossible...unless, under primary care, each nurse had only, say 4 patients. We still have an old fashioned med nurse, who dispenses all the meds to all the people...sometimes an overwhelming job. She often has a hard time just staying on time (within the 30 min. early/late rule) with just the MAR (our bible).
Our orders are transcribed by a ward clerk and signed off by the charge nurse. The charge nurse would be faulted for any error.
As far as the above Pitocin order being in error...I believe that the nurse does have shared responsibility with the physician in this error if the med was given. Part of our job is to know the appropriatness of treatment, and catch/question improper orders. Fair? That is not part of the equasion.
I would be laughed out of the hospital I work at if I suggested that each and every med given needed to be checked against the original order! Impossible...unless, under primary care, each nurse had only, say 4 patients. ]
We do primary care at my hospital. Sometimes I am with a LPN or a PCT but often times have 4 patients by myself. Even in that setting in would be humanly impossible to check every medication error against the original. I would also be laughed out of the unit. I even got a call once for an order that I signed off. It was MY fault, not the nurse giving the med. It was not serious though. I do not know what would happen if it went to court or something. But, it is not usually one person's fault, but several.
Can't answer for the pharmacy. The eight hours of training allows us to administer routine and prn pills/liquids, not injectibles. Scary I know and yes, there have been errors. I would never put my RN license on the line like this. A co-worker called and said the agency RN who discovered the problem has been let go. Things are pretty tight liped right now.
What is wrong with administration? They terminated the agency nurse for finding an error that should of been found long before this? I wonder what the reasoning behind the termination was. Can't help but think that they are trying to cover this up. Assisted living facilities are regulated and certified by the Office of Elder Affairs here in MA and they would have a field day with this.
Nurse is responsible. Must check and sign off original order. That was the time to note how many days or doses on MAR to be given. Pharmacy does have a responsibility in this issue and an incident/occurance needs to be filed against them.
In my experience, the doctor writes the order and places it in the cart for the order to be process and faxed if need be (Pharm, X-ray, ect.) and the unit secretary enters it all in the system, faxes, and calls if consults are needed and adds the new meds to the MAR, then she signs off that it has been entered. The RN must go into the system and the MAR as well and sign off the orders against the chart. You can see where a mistake can be made if a secretary misinterperts something and the RN doesn't sign off her orders.
Todd SPN
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