First med error

Shane505 · Aug 26, 2012

The DON will find the med error. My girlfriend made her first med error on her second month on the job. It was some drug for Parkinson's that can't be held. Her resident was asleep so she held it. A week later the DON told her about it and made her sign some paper work.

The other day she called me crying cuz she made her second med error. Like all new nurses that work at a LTC/SNF, her training didn't deserve to be called training. Shawdowing nurses that don't want to be bothered and not explain things for 2 weeks is not training. It's sink or swim in LTC.

Anyways she's been working for 4 months at a SNF and this is her second med error. They have a 3 Strikes policy on med errors where she works. After the third med error they put you on probation. Then the decide whether to let you go.

Because there is never enough time to get your duties done in LTC/SNF, you can easily get into the mode of just passing meds mindlessly trying to get everything done. Especially if you didn't get enough sleep the night before. Be careful of that.

That is what happened to my girlfriend for her 2nd med error. She didn't read the chart carefully on her med pass on one resident and gave aspirin to a patient that was on coumadin. The aspirin was supposed to be held. She caught the error herself later then told her supervisor. The DON wrote her up. They never trained her on INR ratio and what to look out for when dealing with anticoagulants. The following day the DON had an inservice with all the nurses about anticoagulants because of my girlfriend's med error.

Now I know why nurses quit working in LTC/SNF especially if they are new nurses. Your license is constantly at risk with the lack of training and lack of staffing. Anything goes wrong it's all on the nurse. Lack of training can lead to med errors and it is the nurse that will get written up even if it's a mistake out of lack of experience or knowledge. Understaffing leads to hastily passing out meds to try to get everything done. It's tough.

WittySarcasm, BSN · Aug 26, 2012

That's horrible for your girlfriend. I'm so sorry for everything she had to go through!

I know the DON is gonna see this error. It's my first med error (I've had other errors that weren't med related in the past) in 2 years of working there. I just keep going over and over in my head, what do I say, what do I do. I know it's going to be seen Monday because an error report was written. But, argh!

BrandonLPN, LPN · Aug 26, 2012

A "three strikes" policy re: med errors is absurd. All it will result in is nurses who lie and are good at covering their tracks.

CapeCodMermaid, RN · Aug 26, 2012

It seems all y'all are more worried about yourselves and not about the residents who could suffer because you made a mistake.Not all SNfs are horrible. We give new nurses at least a month of orientation...some more than that. Is it the fault of the facility that new nurses didn't learn enough in school to be safe? I think not.

BrandonLPN, LPN · Aug 26, 2012

It's not the facility's fault if a nurse makes a med error. But it IS something we all do, occasionally. Even the best nurse working at the best staffed nursing home ever will make med errors at some point. That's why a "3 strike" policy is stupid. It won't actually decrease the number of med errors. The nurses will just become paranoid and better at covering them up. Any nurse who says he NEVER makes med errors is either lying or too stupid to realize he's made them.

P_RN, ADN, RN · Aug 27, 2012

First she should admit the error rather that having someone else come upon it. That way it wouldn't give the appearance she is covering up. It will probably get written up. Three strikes is not fair to a new Nurse. All it will do down the road is encourage dishonesty. If this ECF is that hard on new nurses, then they eventually will run out of applicants or begin to acquire deceitful ones.

Shane505 · Aug 27, 2012

@WittySarcasm I don't know how strict your DON is at your facility but I hope it's nothing major besides non-threatening paperwork.

I understand it's not the facilitiy's fault when a nurse makes a med error. That's the nurses fault. I'm focusing on the training, culture, and treatment of new nurses in these types of facilities. This particular facility has a high turnover rate.

@P_RN I totally agree three strikes is not fair to a new nurse. There are nurses at her work that lie and sign off on small things like scheduled treatment creams that they never administered whenever it gets crazy busy like multiple falls, admissions, and change of conditions. I'm sure these are ethical decisions nurses go through every day. But you know what they say. He who is dishonest in small matters will be dishonest with big matters.

bubblejet50 · Aug 27, 2012

When I worked ltc I had 2 days of orientation. I think I had more training when we went from the paper mar to the emar than on orientation! Our don had this nasty habit of changing a policy and not communicate it then write up someone for not followimg the unknown policy. She also kept meds on hand not in the emergency box that were previous patients who passed so that she didnt have to bother pharmacy. I left that ltc to save my license. Oh the stories I have from my one year of experience! But it didnt sour me from ltc...i just learned what questions to ask during interviews to prevent it. I think the biggest prob that causes med errors in ltc is the big ratios. It can be intimidating and stressful to the new grad. Sometimes a med change happens that doesnt get written down on shift report and you know your residents so well that you glance to check the med but not the dose. Not that that practice is correct or should be condoned but it happens.

mariebailey, MSN, RN · Aug 27, 2012

Here's my thought, for what it's worth: I'm glad you made sure the patient was ok and you plan on reporting the error, but don't delay telling your supervisor! When you do tell her, also tell her what steps you'll take to prevent it from happening in the future. We ALL make mistakes. Good luck.

nik415 · Aug 28, 2012

That's horrible for your girlfriend. I'm so sorry for everything she had to go through!
I know the DON is gonna see this error. It's my first med error (I've had other errors that weren't med related in the past) in 2 years of working there. I just keep going over and over in my head, what do I say, what do I do. I know it's going to be seen Monday because an error report was written. But, argh!

In regards to what to say just tell them exactly what happened. I was raised to always tell the truth, and that has never steered me wrong.

girtster · Aug 28, 2012

People have written scholarly articles on this and there's a world of information out there about safety culture. A blind 3-strike policy would not fit with any of these concepts. Errors that can't be reported without fear of losing one's livelihood only increase errors by failing to identify education needs and system flaws. Accusing people of not learning enough in school is certainly less than useful. Cape Cod Mermaid isn't the only poster who cares about patients. What protects the patient and provides the best possible care is a culture of safety. I work in a hospital setting but these concepts can apply to LTC too. Of course then the facility might have to spend money on training and providing safe staffing levels. You know it won't come out of the CEO's salary. Here's some links:

Moving from a culture of blame to a cultu... [Nurs Forum. 2006 Jul-Sep] - PubMed - NCBI

Culture of Safety Reduces Medication Errors - Mosby' s Nursing Suite