Medical errors by nurses in hospitals are the result of?

Brian, ASN, RN · Sep 15, 2000

What sparked this survey question is that the Chicago Tribune ran a series of articles on September 10, 11, and 12 on medical errors resulting in patient deaths and injuries. Here they are if you are interested in reading them:

Nursing mistakes kill, injure thousands https://allnurses.com/news/jump.cgi?ID=278

Training often takes a back seat https://allnurses.com/news/jump.cgi?ID=279

Nursing accidents unleash silent killer https://allnurses.com/news/jump.cgi?ID=280

Oversight panels don't see all facts of medical mistakes cases https://allnurses.com/news/jump.cgi?ID=281

Problem nurses escape punishment https://allnurses.com/news/jump.cgi?ID=282

Many Nursing Associations responded to the articles with press releases, here are a few of them:

Minnesota Nurses Association https://allnurses.com/news/jump.cgi?ID=274

Washington State Nurses Association https://allnurses.com/news/jump.cgi?ID=277

Please post your thoughts or comments on this issue.

pickledpepperRN · Sep 15, 2000

The survey gave only one choice! All of the above apply!

Floating without training and orientation to the new unit and patient population can cause mistakes and/or late doses. Many times errors are made due to distractions caused by short staffing. Meds are not always available on time due to poor systems (computers?), short staffed pharmacy, and insufficient and/or poorly trained clerical workers. How can a nurse give meds on time when there is never a moment free of call lights, phone calls, codes, MDs asking for help, and new admissions and transfers?

The Department of Medicine Report quoted in the article also documented that RNs intercepted 86% of potential medication errors in hospitals (Handwriting related or wrong med sent by pharmacy).

They need to improve systems and staffing to save lives.

------------------

[This message has been edited by spacenurse (edited September 18, 2000).]

Mijourney · Sep 16, 2000

Hi,

I agree with spacenurse. All of the above.

LaurieCRNP2002, MSN, RN, APRN · Sep 16, 2000

I second Spacenurse's comments---it's all of the above! To try and blame one thing for the problems is short-sighted. How refreshing it would be if hospital administrators looked at the "big picture" and corrected the deficiencies instead of applying band-aid solutions (ie bonuses to name one). I just found www.florenceproject.org, which has a downloadable "assignment despite objection" form. I plan to print out many copies and have them available to fill out, not just for myself, but my colleagues as well. NO ONE on my unit last night got a real lunch break--NO ONE! I ran myself ragged all night just to keep up---thankfully no problems cropped (None that I couldn't handle, anyway! ) It's nites like these that make me wonder why I am still in this profession .

Laurie

jtfreel · Sep 18, 2000

No proferssional would use any of your survey choices as a "reasonable excuse" for making medication errors. They are factors which contribute. Others might include the following: inability to read the order, pharmacy issues, access issues, etc.

4 physicians made rounds on the unit, 3 wrote orders which NO ONE could interpret, it took 10 mins to clarify one MD's order, 2 hours to track down another and we finally had to call the associate of the last MD (the patient's primary physician) because of our inability the MD. Result: the last 2 MD's complained to administration that we were harrassing them and that medication errors had occurred because we were late initiating their orders. WE were requested to complete unusual occurrence forms which we did. Administration attempted to get us to change the write up because we included only the facts and supporting data.

Some contributing pharmacy issues: ordered medications are not on the hospital formulary. Through order entry they appear on the MAR, are documented as "not given, not available". This has gone on for days on occasion.

Another interesting observation: this topic is getting a lot of coverage in the professional nursing news. Be aware that there are JCAHO accredited hospitals implementing a program of training non-nursing personnel to administer medications on inpatient nursing units to "help relieve the nursing shortage."

In short, a complicated problem with many contributing factors.

iamme457 · Sep 18, 2000

I agree with all the reasons for medication errors. I recently resigned from a hospital position..ICU and critical care transport. At one time this was a very exciting job. When I was first hired for this position there were 58 full time RNs in this unit, this included the 5 nurses and 3 nurse/techs on the transport team. On my last scheduled day I think there were 27, except for the last week I worked we continued to accept patients no matter what the staffing was at the time and 3 patient assignments had become common. Most of the time there were no secretaries and no environmental aids. Nurses had to answer the phones, stock supplies in the rooms and on the carts and the charge nurse often had to take a patient assignment. This unit has 20 beds and I have found that since my resignation they can only accept 12 patients and have combined the CCU with the ICU because of lack of staff.

I had promised myself that I would not work in conditions that I felt were dangerous and in which I could not provide safe and adequate care for the patients assigned to me. I worked hard for my nursing license and dont feel that I should have to work in conditions that I feel are unsafe for me or the patients. I felt that though I gave proper care to the patients assigned to me, I couldnt really give them everything they needed in a timely manner.

Yes I did have an exit interview and left on fairly good terms, I stated that I would work at that facility again in the future if they were able to resolve the issues I spoke of in the interview.

I fail to understand what the hospitals think they are accomplishing by understaffing.

frustrated RN in Pennsylvania

Noodle669 · Sep 20, 2000

All I want to know is, why all this finger pointing at nurses? I know that cut backs have made things very difficult, but the article I read made it sound like nurses and only nurses were at fault for these trageties. Where are the finger pointing at the doctors who wrote these orders. Are we responsible for there mistakes as well? I would like to see some articles in which doctors were responsible for SOMETHING other than good outcomes. In the future, I would like to see some more responsiblity on the MD's, insurances and hosptials. Amen!

------------------

NK

BROWN_KK · Sep 20, 2000

I am with Noodle! Why are the nurses the only ones mentioned for making these mistakes. The sad truth is that we are not considered part of the health care team. We have to be afraid of calling to clarify orders which are written illegiblely by physicians. That is inexcusable. We need to be able to work within the framework of a team with all involved....on equal standing. Again a fundamental lack of respect for our huge part in seeing patients safely and hopefully more healthy and functional out of our hospital doors. Instead we are the hired help who are often treated like we do not have a brain in our head and that our time is less valuable than someone elses. Shame on the papers for not investigating the story more deeply. Almost nothing in a hospital setting can be traced to just one person!

[This message has been edited by BROWN_KK (edited September 19, 2000).]

D.Johnson · Sep 20, 2000

I have to disagree with spacenurse. 3 of the factors contribute to errors. The bottom line is the Nurse. It is his/her responsibility to assure correct time/dose/patient/etc. Are some errors unavoidable? Maybe. Are we always up to date and informed on medications/policies/ outcomes/etc? Hardly. Yet it is still our responsibility to do the right thing. Be it questioning MD's orders; Refusing to give as ordered; Verifying with pharmacy; etc. We are the first line. And this is a war!

------------------

pickledpepperRN · Sep 20, 2000

Originally posted by D.Johnson:
I have to disagree with spacenurse. 3 of the factors contribute to errors. The bottom line is the Nurse. It is his/her responsibility to assure correct time/dose/patient/etc. Are some errors unavoidable? Maybe. Are we always up to date and informed on medications/policies/ outcomes/etc? Hardly. Yet it is still our responsibility to do the right thing. Be it questioning MD's orders; Refusing to give as ordered; Verifying with pharmacy; etc. We are the first line. And this is a war!

Of course it is our responsibility to follow the "five rights".

It is also the responsibility of the hospital to provode enough staff, support systems, and equipment for adequate care.

How is a nurse to be perfect at all times? What about the 16th hour of mandatory overtime when your newest admit is your 12th med-surg patient. The temperature is 103F. You call the MD, get blood, sputum, and urine cultures, write an order for antibiotics to be started stat as soon as the cultures are obtained, there are 8 call lights on, one patient is in stool from ankles to neck, another c/o chest pain, another is suddenly confused with SOB. You put the antibiotic order into the computer and FAX the order to pharmacy. Get an EKG on the chest pain, put O2 on and call the doctors of both these patients.The confused SOB patient who cannot be left alone due to safety reasons. You call the supervisor from that room for help and are told, "Do the best you can." An Aide magically arrives to sit with this patient so you can admit another patient, however the bed is not clean. You clean the room and bed, take vital signs on the new admit, read the EKG while giving the 3rd NTG,give report to the next shift, try to finish charting all of this and then GET WRITTEN UP FOR BEING LATE WITH THE ANTIBIOTIC THAT HAS NOT EVEN ARRIVED FROM PHARMACY YET!

Are you, the nurse the only one responsible?

You have now been at work from 7:00PM untill noon! You are also in trouble for staying to chart! How can ONLY ONE person take ALL the blame?

You made a "war" analogy. Is the nurse the enemy. Management wants us gone so they can make ever increasing profits. How many patients can you care for?

We are all only human. We should look to the true problem. Everything you said was true. How can we be the first line if that line is stretched so thin? A line can be broken. Those who send us off to fight a war should be sending us to care for the sick and injured! Those who send us to fight behave as though they are the enemy!

Do you think ANY nurse WANTS to make errors? Miss a dose? Should we have time for caring too!

Thank you from a hard working, caring, imperfect nurse

------------------

[This message has been edited by spacenurse (edited October 03, 2000).]

Tobash · Sep 21, 2000

I agree that the problem of medication errors is multifactoral with the nurse playing the pivotal role prior to administering the med. Unfortunately, when you add inexperienced or graduate nurses that are developing their technical and assessment techniques into a busy acute care setting it can spell disaster. Even after an extended orientation (ours is six weeks) many new nurses feel uneasy about questioning the physician orders. You couple that with our current environment of herding patients through like cattle and even experienced nurses are more apt to make mistakes. Believe me Im thankful to have new nurses come to our unit due to the shortage and I try to give them an extensive orientation and mentoring. The current situation is rough on us "older" nurses, you can imagine how overwhelmed they must feel. Our present health care system must be overhauled with strong representation by nurses in all levels to improve patient care and decrease the incidence of drug errors. thanks for letting me reply........Tobash