No nurse is going to answer this honestly but here it goes........ - page 2
I'm the sort of nurse that has flown by the seat of my pants for many years. My first priority is making sure my patient is cared for...I hate paper work!!! What do the rest of you consider "med... Read More
Jun 12, '09Occupation: RN- Med/surg- and anything else my hospital asks Specialty: Psych, LTC, M/S, Supervisor, MRDD, ; Joined: May '09; Posts: 75; Likes: 127I assumed no other nurse would admit to making med errors they didn't report. And I probably give too much personal info on my profile to be admitting to such things.
Jun 12, '09From: TX, US ; Joined: Feb '08; Posts: 538; Likes: 379Quote from ElliShayI totally get your message--and agree with you... we are killing ourselves to just stay afloat on MedSurg floors these days. We need to keep our perspective, and separate the big issues from the minutea. Being 2 hours late with the Vanc is a biggy to me--not because of the "entire peak/trough thing" but because of the superbugs we are fighting. I would write that up if it were me. Everything else you mentioned? Probably not.
There are tons of reasons that vanc could be two hours late. RUined iv access. Pt gone for test. rx out of or is late getting it. Face it. Places use incident reports against the nurses. I was on peer review and the things i saw was just totally ridiculous. I am so glad to not be in med surg anymore. But as for time managemnt. what i did was do a quick walk around and check for immediate things like iv bags almost empty, need pain med, nausea whatever. What i might need for dressing changes then i do my meds, assessment and poss dressing changes all at once if poss. Lump meds together if poss. Say you have a 12 and a couple of 1300 meds. Give them at 1230. open your chart at the bedside while your talking to your pt. sure it may take a couple extra minutes but it does help
Jun 12, '09Occupation: Orthopedic Nurse Practitioner Specialty: CT ICU, OR, Orthopedic ; From: US ; Joined: Feb '09; Posts: 333; Likes: 223LOL! If I had reported every med error I made when I was new, I would be able to write a book!! None were bad enough for me to report except for the bag of Fentanyl that was misplaced when my of decided to code, and continue to code for my entire 12 hour shift (I wrote that one up)! Nothing ever happened as a result of my error... I learned from the mistake, and still share the experiences with new grads so that they will learn from them... I honestly don't know any one who reports every med error, and I know they occur... Is that honest enough for you?!
Jun 12, '09Joined: Mar '08; Posts: 3,791; Likes: 3,438On the other hand, if we don't report things like meds constantly being given really late, how does the hospital know there's a problem? The reports are meant to point out system errors BEFORE one of them causes patient/staff injury.
Jun 12, '09Joined: Jan '05; Posts: 4,765; Likes: 2,554Quote from ghillbertOn the other hand, if we don't report things like meds constantly being given really late, how does the hospital know there's a problem? The reports are meant to point out system errors BEFORE one of them causes patient/staff injury.
Ahhh, if only administration agreed. If only administration was non-punitive. If only....
Until then, I'd say probably 75% of 'med errors' won't get reported.
Jun 12, '09Occupation: RN Specialty: medsurg/ortho ; From: US ; Joined: Mar '06; Posts: 1,097; Likes: 460Quote from c_beshore_rndo you need a medication for your adhd? prioritize prioritize prioritize!!! and quit being so hard on yourself.i'm the sort of nurse that has flown by the seat of my pants for many years. my first priority is making sure my patient is cared for...i hate paper work!!! what do the rest of you consider "med errors"??? i know there are times in a shift when i've given an abt 30 minutes late, i forgot to lower the fluids from 100 to 75, i haven't been able to get the 9pm meds out until 1030pm. these are all true "med errors" that i should be filling out incident reports for everytime......am i horrible for just giving the meds and going on with my night????
no. there is nothing wrong with hanging an antibiotic 30 minutes late or early for that matter, imo. where i work, we have an hour window either way. i would consider a med error to be much more than what you describe here. wrong med, wrong patient, wrong route, wrong time (more than two hours later).
i understand that if i gave someone 10mg of ativan instead of 10mg of valium that'd be a biggy to call the dr about. i also understand if im 2 hours late hanging the pts vanc- thats a biggy, it'll mess up the entire trough/ peak thing. i also understand if i give kayexelate through a urinary cath- i'm just retarded and should surrender my license asap!! (lol did anyone else read that??)
we use bar coding system for meds, and if our computer is down, i take the mar into the room and do it the
old fashion school way. you can never be too careful when giving meds. also, if you don't know what a med
is or what it's for, or unsure of side effects, look in lexicomp or the good old drug book. it's your responsibility!
since i moved to med/surg it seems time management is a huge issue. (i had 20 patients on psych and could break up brawls, talk folks off of ledges, teach groups, etc and not blink an eye) we do total care at our hosital most of the time and i usually have 4 or 5 patients (which isn't that much, i know). but when you have 2 crawling out of bed, 3 incont of bm and 1 of those are on a colonoscopy prep, 2 fresh surg., 1 screaming in pain etc etc.....4 patients can seem like a million!! any suggestions would be appreciated!! my adhd is kickin my rear and my conscience itches.:bowingpur
there have been times i've been late on meds due to be so busy......that isn't a med error in my book, that is
doing the best i can do in the time i have to do it in. good luck.
Jun 12, '09Occupation: dialysis Specialty: dialysis (mostly) some L&D, Rehab/LTC ; From: US ; Joined: Jun '08; Posts: 355; Likes: 630bowingpurGod Bless M/S NURSES* I swore I'd never do it...& I have never.......
Jun 12, '09Occupation: Staff Nurse Specialty: MICU/SICU/CVICU ; From: US ; Joined: Oct '07; Posts: 74; Likes: 133I think M/S nurses are all superheros. I could never, not in a million years, do what they do every day. Hardest workers in the hospital, hands-down.
Jun 12, '09Occupation: RN Specialty: 15 year(s) of experience in Medical Surgical ; From: US ; Joined: May '01; Posts: 674; Likes: 1,217I really don't know what good it would do to write up when meds are late. Ours have only a 30 minute window either way. There is no possibility whatsoever that those meds are going to be given "on time" with the 3 ring circus that is med-surg today. And does that hurt the patient? No. Sure we could write it up but would things change? Not in a million years. Writing it up would be foolish, I'm sorry.
Jun 13, '09Joined: Sep '08; Posts: 6Reports are good if they are acted on but the main problem is the patient ratio which is generally due to staff shortages - all we can do is the best for the patient and sometimes that may mean that medications are a little behind ( I don't report myself ) - sometimes an AB will be behind schedule because an IV is needed and theres no one around to do it!
Jun 13, '09Joined: Sep '06; Posts: 355; Likes: 97I just completed a 'how to prevent medication error' class online, it was useful..you can find various classes online..my class discussed different approaches on how to deal with med errors and some tips for nurses on how to avoid them
Jun 13, '09Joined: Jan '05; Posts: 4,765; Likes: 2,554Quote from thekidI just completed a 'how to prevent medication error' class online, it was useful..you can find various classes online..my class discussed different approaches on how to deal with med errors and some tips for nurses on how to avoid them
Not to be rude, but this isn't what the conversation is about. We know how to avoid med-errors. We don't need an online class to teach us why our med errors are happening.
We are talking about short staffing, poor ratios, and overworked nurses with too many sick pts. We are talking about the impossibility of doing the job perfectly and on time due to the position that our workplace puts us in.
No online class needed for that. Better management, fewer ratios, more nurses, and appropriate assignments would be a start...
Jun 13, '09Joined: May '09; Posts: 277; Likes: 220i was trained by NPs for my RN. they always told me to use my best judgement. for example, realizing you're running an IV at 80 ml/hr when it should be 100 ml/hr and then correcting, truly isn't that big of a deal. simply adjust the rate and go about your business. there are much, and i mean much, bigger fish to fry.
also, if mr. smith gets his multivitamin at 2300 instead of 2100, it's not the end of the world. i think the longer you've been a nurse, the more relaxed you become. use your best nursing judgement.