Nurses don't do their 3 med checks?

Nurses General Nursing

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I've been to two higher acutity clinical sites so far on a med-surge/oncology floor and a cardiac observation unit (step-down CCU), and some of the nurses seem to not do their three medication administration checks. I didn't give it much thought until my second clinical rotation and now I'm wondering if this is considered "normal" for some nurses? For instance, I shadowed a charge nurse in the CCU and she would just open up the patient records on the EMR then take medication out of the pyxis without even reading the labels on them. I asked her why don't she read the labels and she said that she been doing this for a long time and know how each medication package looks like... So then went to each of our patient rooms and gave the medication to them without asking for their name/DOB. She just scanned their bracelet and administered the medication without telling the patient about the meds. Plus, she made me administer heparin in an insulin needle saying it's "fine".

She is not the only nurse who I've have seen not doing their 3 med checks, and I wonder if this could become a problem?

Specializes in Critical Care.
Yeah, I thought it was completely bizzare too, especially being just a student. I kid you not, she just started grabing meds out the pyxis drawer very quick and then put them on the counter to put them in the cup or draw them up. Not once did she look at them labels. And she even told me what packaging to look out for when taking meds out the pyxis, which I took as her "teaching" me to be good as her.

I don't understand how she was "grabbing meds" without being able to see them, was she blindfolded?

I don't understand how she was "grabbing meds" without being able to see them, was she blindfolded?

I dont think that is the case, she was able to see the meds and she knew exactly which pocket in the drawer to grab from. But honestly, it happened so fast that I was kind of blindsided myself and that's when I asked why she didn't read the labels. And she didn't deny it either. I just chuck it up to her being on that particular floor for years and she did say that she knew what to look out for with how specific meds comes and its characteristics.

Well, sometimes you learn as much from watching bad practice as you do from watching good.

Specializes in Critical Care.
I dont think that is the case, she was able to see the meds and she knew exactly which pocket in the drawer to grab from. But honestly, it happened so fast that I was kind of blindsided myself and that's when I asked why she didn't read the labels. And she didn't deny it either. I just chuck it up to her being on that particular floor for years and she did say that she knew what to look out for with how specific meds comes and its characteristics.

The time it takes to reach for and pick up the vial is more time than it takes to read the "Heparin 5,000" on the vial, so there's not going to be additional time spent reading the labels beyond just the time it takes to grab them.

Was she then not scanning the patient or the med?

Regarding your initial post, heparin actually can be given in an "insulin" needle, since an insulin needle is more correctly described as a subcutaneous injection needle.

Specializes in 15 years in ICU, 22 years in PACU.
I was not teaching anything to the charge nurse as I was just shadowing her. Plus, I did all what she wanted me to do. And you are very rude. I guess the saying is true that nurses do eat their young...

Good gravy. Just STOP.

The time it takes to reach for and pick up the vial is more time than it takes to read the "Heparin 5,000" on the vial, so there's not going to be additional time spent reading the labels beyond just the time it takes to grab them.

Was she then not scanning the patient or the med?

Regarding your initial post, heparin actually can be given in an "insulin" needle, since an insulin needle is more correctly described as a subcutaneous injection needle.

I did not know about the insulin needle thing. My classmates acted as if I was stupid to give heparin in a insulin needle. Also the charge nurse did scan the patients bracelet and the label on the package before she administered it at least.Plus, when she scanned the medication label she did have to click "ok" on the box that kept poping up on the screen after every scan, so I guess that also helps.

Specializes in Critical Care.
I did not know about the insulin needle thing. My classmates acted as if I was stupid to give heparin in a insulin needle. Also the charge nurse did scan the patients bracelet and the label on the package before she administered it at least.Plus, when she scanned the medication label she did have to click "ok" on the box that kept poping up on the screen after every scan, so I guess that also helps.

Scanning the patient and medication is checking the patient and medication, there are varying views on exactly how the nurse should double check the scanning, but there was at least one check of both that occurred.

I did not know about the insulin needle thing. My classmates acted as if I was stupid to give heparin in a insulin needle. Also the charge nurse did scan the patients bracelet and the label on the package before she administered it at least.Plus, when she scanned the medication label she did have to click "ok" on the box that kept poping up on the screen after every scan, so I guess that also helps.

So she *did* read the labels. This makes more sense now.

She saw the drug and dose on the MAR. She saw them again on the label when she grabbed the vial of heparin. In real world nursing, the check doesn't necessarily involve holding the vial up to the computer screen, or something super obvious like that. Then she saw the patient's name on the MAR. And again when she scanned the wristband. And she saw everything yet again when the computer prompted her to click "OK" with each medication. Sounds like at least 3 checks to me.

Scanning the patient and medication is checking the patient and medication, there are varying views on exactly how the nurse should double check the scanning, but there was at least one check of both that occurred.

Thank you for clearing that up for me! I thought I was crazy from what I saw.

So she *did* read the labels. This makes more sense now.

She saw the drug and dose on the MAR. She saw them again on the label when she grabbed the vial of heparin. In real world nursing, the check doesn't necessarily involve holding the vial up to the computer screen, or something super obvious like that. Then she saw the patient's name on the MAR. And again when she scanned the wristband. And she saw everything yet again when the computer prompted her to click "OK" with each medication. Sounds like at least 3 checks to me.

Okay, thank you. I'm obviously still learning and I did not know this would be considered 3 checks. And you're right, I did think that she had to read the labels at the pyxis. Also, this is why I like asking certain questions on Allnurses rather than asking my clinical instructor because I was afraid that I might get that nurse in trouble, so I didn't say anything.

Specializes in LTC.
I was not teaching anything to the charge nurse as I was just shadowing her. Plus, I did all what she wanted me to do. And you are very rude. I guess the saying is true that nurses do eat their young...

There was nothing rude about what she said. It sounds like you can't take any form of criticism, but are ready to dish it out.

There was nothing rude about what she said. It sounds like you can't take any form of criticism, but are ready to dish it out.

I understand, this was a huge learning experience for me. And I do now see where Sour Lemon was coming from.

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