I am currently in orientation and my educator and my preceptor stated two different things.
I was told by the educator that if a PRN medication Trazodone (tx insomnia) is given before bed instead of PRN Tramadol (opioid pain med the pt actually asked for) that an adverse action report be written. However, my preceptor stated that it doesn't have to be, just as long as we inform the patient, document it was given, and we follow up and because both meds were PRN medications, the patient shouldn't have adverse reactions.
I'm confused? So because both are medications the patient is assigned that an incident report nor an adverse action report needs to be written as long as we document and follow up?
If you thought you were giving the patient tramadol or meant to give tramadol but instead gave trazadone then that's an obvious med error. So long as the reporting system is focused on root causes (similar names) then you shouldn't be hesitant to report it, it can be helpful to know if sound-alike med errors are happening frequently, not to punish the nurse but to find a fix. I do get however that not all med error reporting systems are as blame-free as they should be.
As you are in orientation this med error is on your preceptor. This is why they are trying to claim it is NOT an error. The patient asked for pain relief, not a sleep aid.
Your preceptor lacks integrity and is setting a terrible example.
It's good you're catching this sort of thing and learning from it before you have a patient with PRN hydralazine and hydroxyzine- a near miss I caught in nursing school.
Confirm the rationale for the ordered medication. What is the patient's history? Why is he/she taking this medication?
Revisit the reasons for long-term medication use.
Patient requested something to help with pain; received a medication for insomnia instead.
Definitely complete an incident report- late is better than never. Soundalike names are one of the reasons that my facility ensures that those drugs are kept in separate Pyxis drawers, pops up an alert if patient is ordered drugs with soundalike names, and requires scanning of drugs. It's an opportunity to fix a systems issue.
I am currently in orientation and my educator and my preceptor stated two different things.
I was told by the educator that if a PRN medication Trazodone (tx insomnia) is given before bed instead of PRN Tramadol (opioid pain med the pt actually asked for) that an adverse action report be written. However, my preceptor stated that it doesn't have to be, just as long as we inform the patient, document it was given, and we follow up and because both meds were PRN medications, the patient shouldn't have adverse reactions.
I'm confused? So because both are medications the patient is assigned that an incident report nor an adverse action report needs to be written as long as we document and follow up?
By the way, there are no ACCIDENTS in medication administration, only errors.
An accident is "an unforeseen and unplanned event or circumstance". Plenty of foresight involved.
It's a med error plain and simple...but it's OK!!! I gave sudafed instead of sudafed non-drowsy once and it nearly ruined my confidence. It did however bring home the 5 rights to administration....I haven't (to my knowledge) made an error since. Expect to make mistakes, don't hide them, just learn from them. Nobody died right?? No...all is well then.
I think if you meant to give one and gave the other you should be writing it up. I think that if they were both PRN and something that could be given at HS that's fine and great - this time. What if that's not the case with the next patient? What if then it's just the wrong med - something not even ordered PRN? I'm making this statement based on my read of the original post was you/someone gave one when you/they meant another. I mean...is there a process that could be looked at to prevent the more serious option from happening? Most of our incident reports focus on what we could do better. We're supposed to write up med errors even if we catch them right before they happen.
The question I got on my assignment stated This patient scenario took place at 2100. Patient goes to bed at 2300. Trazadone (wrong med) given instead of requested (Tramadol). Answer was a report should be written. Preceptor said no because it was PRN hs, and though it was the wrong med, the patient has prescriptions for both and to just monitor and document "given" on the MAR.
So, this is at-work homework, not an actual situation?
In ideal world, any time you give a medication to a patient and it is not perfectly administered, it is reportable.
Same thing in the real world, but a lot of nurses will rationalize almost everything except giving a med that had a poor outcome because they don't want to do the paperwork and are afraid they'll get written up for self-reporting.
MunoRN, RN
8,058 Posts
If you thought you were giving the patient tramadol or meant to give tramadol but instead gave trazadone then that's an obvious med error. So long as the reporting system is focused on root causes (similar names) then you shouldn't be hesitant to report it, it can be helpful to know if sound-alike med errors are happening frequently, not to punish the nurse but to find a fix. I do get however that not all med error reporting systems are as blame-free as they should be.