How to avoid med errors . . .

[Lynda Lampert, RN]

Hello to all on this site!

I very often lurk here to find support and understanding, but don't often post because I don't have much to say. Right now I am going through some things and I think I need the advice of the group to put my best foot forward.

I am an ADN student who graduates in May 2007. My school is on a trimester system, so I had three weeks of school before the Christmas break and have the remaining seven weeks now. I will have another ten week term and then graduate.

I am one of the best students in lecture. My GPA is 3.989. I love patho. I always got "exceeds expectations" in clinical. I am excited to be a nurse. However, I've made some mistakes.

The first week of last term I did not know that my client needed two prednisone instead of one. I had pulled the meds from the drawer, waited for my teacher, and learned from the computer that I needed two. In practice, I feel I would have had the drawer and pulled two when the computer told me to, but this was called a potential med error. I accepted it and tried to move on.

The next week got worse. I have never spiked a bag of IV fluid in my life. We had just learned it in lab and my client needed a new bag of 0.9% NS. I pulled a 1000cc bag that said 0.9% NS, but, unfortunately, I didn't know and didn't notice that it also said 5% dextrose. My instructor was in a hurry. We did not scan the bag like we were supposed to and the wrong bag got hung. Fortunately, the client was not diabetic and his piggyback was mixed in D5, so it was compatible. No harm to the patient, but I felt like I was going to die. I didn't as yet get written up for this one because the instructor takes part of the blame for the mistake.

The next day I was crushing the meds for the same patient. My fellow student asked me in front of the instructor what I was giving. I said "hydrocodone". I even looked at the package and said "hydrocodone", but it wasn't. It was hydrocortisol. Of course, I knew in my head what it was, but I said the wrong thing. I got written up for that.

I was also supposed to go back and get my instructor after my client had not vomited for an hour. For some reason, I didn't. At this point, this far removed, I can't remember why I didn't actually go and tell her. The co-assigned nurse came in and turned the pump back on. I got written up for that, too.

Now I have been put on clinical probation. :uhoh21: I feel like I have been kicked in the stomach! After so much work and effort and WANTING to be there and being GOOD at it, I am now one step closer to possibly being kicked out of the program. I am told that this is just a way for the instructors to work with me, but I am terrified now of making a mistake and being booted. I feel like I have always BEEN careful. Now I'm not really too sure how to be more careful.

I also question whether or not I can do this, whether or not I will make it, and how this could happen to someone who has been such a good student. I'm still fairly in shock, to be honest. It's like learning someone died.

So, I ask of you all out there how I can approach these situations and NOT make the mistakes that I have made this term. Does anyone have any advice or routines they go through to prevent making med errors? How do you make the 6 rights part of your med pass? How do you move quickly yet carefully and without any mistakes?

I have quite a bit riding on this program, but it is also something that I feel deep down will make me happy. Yes, I know that it can be a tremendously difficult job, but I think it is the job for me. Actually, I would like to work critical care some day, but I feel like my dreams are evaporating.

I do have problems with depression and anxiety. I'm trying to deal with those, too.

So, any advice out there? Any wisdom from nurses in the trenches?

Ionafey

PS If this post belongs in another forum, please let me know how to move it around.

[Scrubz]

If you triple check your meds you're less likely to get them wrong. If you're doing this and still getting them wrong then just calm down, clear your mind, and focus on what you're doing.

You're actually making me a little nervous.. But just know that you're definitly not the only one who's made mistakes. Just focus!

[allthingsbright]

It sounds like you need to just slow down--I know, easier said than done because of the field we are in. How about when you get to the pyxis you take a deep breath and use like 3 seconds to calm yourself. Picture yourself giving meds correctly and get rid of any negative self talk!! Then, do your 5 (6) rights and 3 checks.

Anxiety can really screw us up. Are you on meds for anxiety? You may need to think about doing something more aggressive for that problem.

Please stop beating yourself up! We ALL screw up. Just slow down, tell yourself you can do it, and follow the procedures we have been taught. You are a STUDENT! Maybe having an honest conversation with your instructor will help as well. Just let her know where you are at and tell her you have every intention of proving yourself.

Best wishes!! (((HUGS)))

[sirI, MSN, APRN, NP]

Please check out the thread, Promoting Medication Safety

[Lynda Lampert, RN]

Thanks for all the replies!

Yes, I know I need to slow down. I was actually being rushed pretty bad by the instructors both times because my client was so complex and they needed to get to other students. I didn't even have a chance to do the triple check. *sigh*

Well, I'm just going to have to settle down. Allthingsbright, yes, I am on some medications, but they are not effective right now. I have this tendancy to develop a tolerance to SSRIs and that usually precipitates this sort of behavior. Will be seeing my doc on Tuesday so maybe that will straighten things out, too.

Just need to remind myself to breathe! Should be fundamental, but it isn't. Thanks everyone for the helpful words. You don't know how much I need them right now.

Ionafey

[emtb2rn, BSN, RN, EMT-B]

At this point in my education (2nd semester of 4), I check meds 4 times before giving them to the pt. That advice about taking a deep breath is excellent too. When you walk up to the cart/pyxis, take 10 seconds to clear your head, works great. Master the fundamentals and the speed will come naturally.

[NeosynephRN]

I would say if your instructor is in a huge rush to help another student then tell them to go help that student and come back...then you can prepare and settle yourself and not everyone will feel rushed!! When we try to hurry too much is when we get into trouble!!! GL!!!

[AnnieOaklyRN, BSN, RN, EMT-P]

I use a peice of paper at clinical to write things down about my patient. I use a multicolored pen, one of those ones with 4 ink colors and I make sure if something needs to be done at a certain time it is in red ink. For instance if I need to recheck a temp it does in red so it sticks out.

Swtooth

[#1rnstudent]

Rule 1: never bother the nurse (nursing student) giving medications. I got scolded in the past for smiling and saying hi to a patient walking the hallways while getting my meds set up... ever since then I just ignore everything around me and pour out my meds. Always triple check minimum and then check the band on the patient's wrist (or wherever their ID is). It's just common knowledge where I study/work that one never talks to the nurse at their med cart when they are doing med pours. Hang in there. Things will get better. :)

[CHATSDALE]

sounds like good advise from all responders..do not let anyone rattle you, not pt, not other nurse/student,not instructor

this is very important, this is sometime yo will need to do for your career in nursing, get a clipboard and when you take report write down what you need to do and when..as these are done check off and write down anything you have observed..this is will help in report...make a mental check list when you are doing meds...

yo will never regret doing things by the book

[Finallyat40]

the reality of the situation is that whether as a student or an RN, med errors will happen....anyone with any period of experience who tells you they've never had an error is likely kidding themself!

It really sounds as if you're getting really overwhelmed by the quantity of meds that especially your complex patients require (I had one in school during my first semester that had 17 meds to pull at once...I thought I would lose my mind!) There is so much to remember, so little time to regurgitate and so much on the line. I realize you're at the end of the program pretty much, but maybe it would serve you well to choose patients with a little less complexity for a couple of weeks to build up your self confidence when it comes to the meds and then move on back into that. Just a thought!

I would recommend scheduling some time with your primary instructor and putting together and "action plan" of sorts to ease your mind....so that he/she can help guide you if they see you getting flustered. And I agree with many of the above posters about making sure you do ALL your checks....this is where med errors happen the most, when you get in a hurry. If you've got a less complex patient that needs meds at the same time, can you give theirs first so that you'll feel less pressured about the other one?

Don't give up....and don't allow yourself to believe that because these things have happened you won't be able to work in critical care or other areas.....you're still a student, you're learning, you can do this. Deep breath in, deep breath out!

Jamie

[Daytonite, BSN, RN]

here's a very good piece of practical advice that you can do when pouring any medication. put the finger of one hand on the page of the medication sheet so you kind of "highlight" the name of the medication. use your other hand to hold or point out the name of the medication you are about to open up and pour. ask yourself "do these names match?", "do the doses match?" you have to make a conscious effort to do this. and, these can't be quick glances. spell out the names of each in your mind if you have to. the actual time you lose in doing this is only a few seconds, not minutes. do the same with bags of iv fluids. use a finger and trace the printing as you are reading along. it only takes a few seconds longer. doing this is very important. it can mean the difference between being a safe practitioner and committing malpractice. there is no in between.

as for remembering things to follow up on, there is such a thing called a to do list. normally, i mention them when students ask for information about prioritizing. in short, a to do list is a list of the things you need to do during your day at work (clinicals). the most important things should be at the top of the list. as things are completed you cross them off. now, when you are new to nursing it is helpful to actually write these lists out. that way you don't forget anything. you put something down on the list immediately as it is known. as you get experienced, you can run the list in your head. i would recommend that you carry some kind of little pocket notebook with a list like this that you set up for every single clinical. it will help you organize your time as well as prevent you from making the same kind of mistake you mentioned in your op--that is, assuming you remember to put the task on the list and remember to refer to the list periodically. i will also tell you, that when i was working on a busy stepdown unit i would circle a couple of times in red ink those things that i needed to remember to do so they jumped out at me every time i looked at my "brains". you can do the same by using a yellow highlighter if you don't have a multi-colored ink pen. here is a copy of my "brains". [attach]5032[/attach] i often put things i needed to chart or follow up on on the back of this piece of paper as well. it was folded up and i kept it in my pocket or on my clipboard during my work shift.

"setting priorities" - setting priorities

http://www.ehow.com/how_3812_make-list.html - how to make a todo list

to-do lists from mind tools - learn how to plan your time intelligently. free template! - to do lists