help me stop making med errors!

button2cute · Oct 3, 2005

I keep identifying new ways to prevent them, but someting always slips through.
Most commonly, an order will say something like: Tylenol 325mg I-II tabs PO Q6h prn. I will only see the 325 and not the "1 to 2" part.
That's just an example. I have also missed a couple things outright. A few weeks ago I nearly gave the wrong heparin due to miscounting the zeroes... the patient would have got only a fraction of the dose.
A nurse at work has been on me about it, a bit overly so. Okay, a lot overly so. I feel like she's obsessed with everything I do. She has taken her concerns to our boss, and wasn't happy with her response so is taking it to the next higher boss now. Our direct supervisor is trying to help me but has advised me not to make even the tiniest mistake while I'm under such scrutiny, and yesterday, I made a mistake. She's fed up with me even though she agrees that my coworkers is overstepping her bounds.
In the past month I've made probably 4 real mistakes:
-one near underdose of heparin, caught by the other nurse
-one missed order which the MD did not flag (I was off the floor though on an ACLS run and left my patient in the care of another nurse for a while)
-one wrong route of an antibiotic.
-one antibiotic that didn't infuse, which I caught later and corrected, on an abnormally busy day... but it took me a long time to catch it
I have been trying SO hard not to mess anything up. I've become nearly obsessive compulsive, checking everything over and over throughout the day. Even after I've already seen it. And at the end of the day I check over every bit of paperwork and the patients themselves, with a second set of eyes to help me. But this overzealous nurse has written up, along with these errors which were true errors that needed to be adressed, about three times as many things that never happened. For example I had a detox patient with a high BP and she thought I never gave him his blood pressure medication. She asked him and he said nobody had given him any pills all day.
He also thought that something that had happened 4 hours ago, had happened "yesterday" (and this was day shift), that there were women in the bed near his, and that his walls and window were moving! Yet she is writing this up as an incident report, using sketchy circumstantial evidence to paint me in the most negative light possible. Even if most of them are false, enough write-ups and you look bad.
I can't afford to make a single mistake. Even non-mistakes are getting me in deep hot water. I am utterly desperate and trying my hardest to do everything perfectly, but I am in a job where neither of us are likely to be fired or transferred, and I can't quit.
Maybe I'm a terrible nurse for making these mistakes. All I can say is that I am doing my best. I am not stupid, careless, or lazy. For some reason I just keep messing up. And with this obsessive woman relentlessly breathing down my neck, it's so bad that I am losing confidence, losing sleep and losing weight from all the anxiety.
Can anyone help?
How do you prevent med errors?
Why do I keep making them? I've been a nurse for almost 3 years now.
How many med errors do you think each nurse makes on average anyway?
Am I just in the wrong career field? Should I not be a nurse?

Hello, Bulky

I read your post twice. I am tired and I will make this short. Do you have a learning disability? If so, if you do not mine what is it? If not, get tested. You seem to me that your mistakes maybe cause by an underlying problem that has been with you all your life and it could be stress as well.

Always do double checks and have someone tell you as well.

Emm, I have to write later cause I an very tired.

I will be back soon,

Buttons

BulkyMonster · Oct 3, 2005

Hello, Bulky
I read your post twice. I am tired and I will make this short. Do you have a learning disability? If so, if you do not mine what is it? If not, get tested. You seem to me that your mistakes maybe cause by an underlying problem that has been with you all your life and it could be stress as well.
Always do double checks and have someone tell you as well.
Emm, I have to write later cause I an very tired.
I will be back soon,
Buttons

I do have AD/HD diagnosed a year ago. Since taking medication I made a 180 degree turn for the better at work. Stupidly, I openly told coworkers I had it. I thought it would be good for others to know, like my strengths and weaknesses. I was wrong. I am very suspicious that this nurse has it in for me for that reason. At the moment maybe it's stress because since this all started (this nurse harassing me suddenly I'm making errors again the way I used to before medication. But sometimes they happen even on nonstressful days.

Even now I'm paranoid she or someone else will search the internet and find this post, but I need advice, I need someone outside the situation who is a nurse to talk to.

gwenith, BSN, RN · Oct 3, 2005

Soounds like you have a bad case of "self-fullfilling prophesy" It has long been acknowledged within educational circles that if you believe someone will do something they will act to fullfill that expectation. If you believe that they are a Klutz and jump on them every time they fumble something then they will become more and more clumsy. What you need to do is tell the nurse who is on your back to get lost. You might think about another job somewhere where you are not faced with this.

madwife2002, BSN, RN · Oct 3, 2005

I do feel for you, but the mistakes you have made could have potentially serious consequences. Have you asked this other nurse for help? Have you identified that you have problem with medication administration.

I can understand the nurse you are working with having concerns especailly as recently i worked with somebody who made similar mistakes and in the UK she is not only practicing on her own registration but on the charge nurses registration, if that nurse knows of the problems and does not report it, then they made loose their right to practice. There is a person who trusts and relys on us to look after them and they tend to be very vunerable. I suggest when you are giving out meds you take your time and double check and ask for no interuptions.

How we solved this problem was by the use of supervised practice which meant she had to do meds with another trained nurse until it was deemed she was ready to go it alone.

We also implemented that the nurse who was giving out medication does not get called to phone or interupted for anything other than an emergency.

Remember it is easy to make a mistake we are human

DusktilDawn · Oct 3, 2005

BulkyMonster,

Definately the stress of someone always looking over your shoulder in the hopes of "catching" you making a mistake doesn't help.

gwenith: Soounds like you have a bad case of "self-fullfilling prophesy" It has long been acknowledged within educational circles that if you believe someone will do something they will act to fullfill that expectation. If you believe that they are a Klutz and jump on them every time they fumble something then they will become more and more clumsy. What you need to do is tell the nurse who is on your back to get lost. You might think about another job somewhere where you are not faced with this.

Very good point Gwenith about "self-fullfilling prophesy."

But this overzealous nurse has written up, along with these errors which were true errors that needed to be adressed, about three times as many things that never happened.

OK it's one thing to write up errors that actually happened, but to make things up is malicious and slanderous. Have you discussed your AD/HD with you supervisor and how the added harassment (yes, that is what this person is doing) by another employee is impacting your job? It sounds as though your being discriminated against and harassed by this person because of your AD/HD. If your direct supervisor is unwilling to really do anything about this, you also have the option of taking this matter to the "next highest boss," and use the words discrimination and harassment when you do.

Madwife's suggestion of a period of supervised practice is also an excellent idea.

If you can't leave this position, perhaps you can change the shifts you work so you don't have to be around this person.

BulkyMonster · Oct 3, 2005

I don't know how to use the quote function for multiple replies so I'm just going to try ans answer everything.

Well I can't change jobs or anything, I'm in the military. As for shifts, we only have 8 nurses, and she follows everything I do whether she is on the shift with me or if she follows me. I'm just now moving to mid-shift so I'll be on the 5 days a week 8 hour instead of 12 hour day or night. This is a new thing we're trying on our floor and I'm the second person to take this shift, so we'll see how it helps.

My supervisor knows I feel harassed and is disapproving of the other nurse's over involvement. She says my coworker is overstepping her bounds as this other nurse is not my boss. She's also going around asking other people about my AD/HD and has written up paperwork containing statements I've made or other people have made. My supervisor has told the other nurse to come to her with problems and not take them into her own hands, especially as 75% of her concerns are extremely exaggerated, even patently false, not to mention inappropriate.

However my supervisor and I both agree that my making errors is a problem. Having someone else watch me, though, just makes me so nervous and preoccupied about getting in trouble that it seems even more likely I'll mess up from nerves. I know very well its a catch-22 for the supervisor: she can't supervise me *less* when I'm messing up, and I can't think of another solution.

I just feel so, so rotten. I can't think of anything else, can't figure out why this is happening, and can't think of how to stop it.

"You've got to be more careful," they say. If only it were that easy for me. I wish I knew how to explain, to prove, that I'm doing everything I can.

Thanks everyone who's given me input so far. It helps to have objective "ears" available.

rn/writer, RN · Oct 3, 2005

Make sure you keep breathing. When you go to the med room, take five seconds to close your eyes and calm your spirit. Tell yourself you can do this.

Keep a 3 X 5 card in your pocket. When you are reading the med sheet (MAR), put the card over the order and advance it one component at a time. This should allow you to see each element of the order. It should also help you count zeroes.

At least for while, double check those 5 rights. If it wouldn't make you look nuts, read the order out loud to yourself. But at least do it in your head.

Wake up your brain by using the notecard to read the order backwards. Sometimes I think we get so conditioned by what we expect to see that we just slide right over changes.

Document (for your own purposes) any situation you believe is being written up and record the circumstances so you will have the facts at hand if you are accused.

Along with the above suggestion, make your own action plan and implement it unofficially. Then if someone approaches you with accusations, you will be able to say, "That might have been a problem in the past, but I have taken the following measures to improve my skills and ensure patient safety." If I were a supervisor, I'd be impressed with someone who was making positive changes without being forced to.

Be absolutely scrupulous about signing for meds and treatments. Doing things is only half the task. Documentation is the other half.

As I'm sure you've learned, be very careful about informing others of your weaknesses. Sad as it is, there are those who love to feel better about themselves at someone else's expense. Don't provide them with ammunition. If you must address an area of need, do so from an attitude of strength. Don't say, "I have ADHD and sometimes make mistakes." Instead, say, "I've learned some tricks to make sure I'm being accurate." Stress the compensations rather than the deficiencies. Then others will see you not as having a problem but having overcome a problem. That can make a big difference.

Most of all, de-stress as much as possible. The more wired you become, the greater chance there is you're going to mess up. If the nurse who is writing you up is a complete whack job, treat her with utter courtesy and avoid her as much as you can. If she's a decent sort who just has her undies in a twist, approach her at a quiet moment and ask if she would share her concerns with you and offer any hints or advice for you to become a better nurse. Again, do this with the attitude that you are a strong, capable person who is mature enough to accept constructive criticism, not as someone who is defective.

Tuck a Reader's Digest in your work bag and at those moments when you just want to tear your hair out and cry, take one minute to read a selection from their various humor pages and feed your spirit a little treat. This will help you break the downward spiral and give you a few seconds of a better perspective. Sneak a little piece of chocolate. Give someone a compliment. Do anything and everything to carve happiness out of your shift and pass it on to others. Pretty soon, you'll be so busy you won't be worrying.

I hope some of this helps.

BulkyMonster · Oct 3, 2005

Make sure you keep breathing. When you go to the med room, take five seconds to close your eyes and calm your spirit. Tell yourself you can do this.
Keep a 3 X 5 card in your pocket. When you are reading the med sheet (MAR), put the card over the order and advance it one component at a time. This should allow you to see each element of the order. It should also help you count zeroes.
At least for while, double check those 5 rights. If it wouldn't make you look nuts, read the order out loud to yourself. But at least do it in your head.
Wake up your brain by using the notecard to read the order backwards. Sometimes I think we get so conditioned by what we expect to see that we just slide right over changes.
Document (for your own purposes) any situation you believe is being written up and record the circumstances so you will have the facts at hand if you are accused.
Along with the above suggestion, make your own action plan and implement it unofficially. Then if someone approaches you with accusations, you will be able to say, "That might have been a problem in the past, but I have taken the following measures to improve my skills and ensure patient safety." If I were a supervisor, I'd be impressed with someone who was making positive changes without being forced to.
Be absolutely scrupulous about signing for meds and treatments. Doing things is only half the task. Documentation is the other half.
As I'm sure you've learned, be very careful about informing others of your weaknesses. Sad as it is, there are those who love to feel better about themselves at someone else's expense. Don't provide them with ammunition. If you must address an area of need, do so from an attitude of strength. Don't say, "I have ADHD and sometimes make mistakes." Instead, say, "I've learned some tricks to make sure I'm being accurate." Stress the compensations rather than the deficiencies. Then others will see you not as having a problem but having overcome a problem. That can make a big difference.
Most of all, de-stress as much as possible. The more wired you become, the greater chance there is you're going to mess up. If the nurse who is writing you up is a complete whack job, treat her with utter courtesy and avoid her as much as you can. If she's a decent sort who just has her undies in a twist, approach her at a quiet moment and ask if she would share her concerns with you and offer any hints or advice for you to become a better nurse. Again, do this with the attitude that you are a strong, capable person who is mature enough to accept constructive criticism, not as someone who is defective.
Tuck a Reader's Digest in your work bag and at those moments when you just want to tear your hair out and cry, take one minute to read a selection from their various humor pages and feed your spirit a little treat. This will help you break the downward spiral and give you a few seconds of a better perspective. Sneak a little piece of chocolate. Give someone a compliment. Do anything and everything to carve happiness out of your shift and pass it on to others. Pretty soon, you'll be so busy you won't be worrying.
I hope some of this helps.

Miranda,

I haven't heard the note card suggestion before and will give it a try. Thanks for all the advice. I really appreciate your taking the time to spell things out for me. I'm already trying some of the de-stress stuff. Every day I try to greet my coworkers with a smile and hello and ask how they're doing. I am working on not blurting things out and screening what I say.

Again, thank you so much. I go to work in a few hours and will use your index card trick starting today.

DusktilDawn · Oct 3, 2005

My supervisor knows I feel harassed and is disapproving of the other nurse's over involvement. She says my coworker is overstepping her bounds as this other nurse is not my boss. She's also going around asking other people about my AD/HD and has written up paperwork containing statements I've made or other people have made. My supervisor has told the other nurse to come to her with problems and not take them into her own hands, especially as 75% of her concerns are extremely exaggerated, even patently false, not to mention inappropriate.

She's she's questioning staff about your AD/HD and eliciting statements from other staff, WTF :angryfire

You're manager needs to be more proactive in this situation. This behavior is called harrassment. This employee is creating a hostile work environment. These are things you manager should be saying to this person and if necessary disciplining her. She also needs to inform this person that the situation involving any medication errors you make are her's to deal with as your supervisor.

BulkyMonster, you could look at being supervised as a breather. What I mean is that the purpose is to help you not hinder you in the long run. View it as a positive not a negative.

PS: if you want to quote, highlight the portion you want to include in your post, right click, left click on copy, go to your post, right click, left click on paste, then at the top of you message you'll see a a white "statement" balloon underneath you "color" option (last icon on the left), OK then highlight what you just pasted and click on this icon.

moonchild20002000 · Oct 3, 2005

Have you seen your Doc lately? Could you need your meds adjusted?

I really do not understand why your supervisor is allowing this co-worker to cause such grief. With ADHD you would fall under the Americans with Disabilities Act.Your co-worker is definately causing a hostile work enviroment.

I think it may be a good idea to have another nurse observe your med pass for a while,not this nurse though. Stress could be a factor in your mistakes.

Good luck.

mydesygn · Oct 3, 2005

I am one of the few indiviuals who do not fully place blame on nurses for med errors. It doesn't solve the underlying issue and causes more errors in the end. When you look at it, I bet there are improvments that could be made in the system that could have prevented most of the errors. For instance, a good barcoding system eliminates the possibility of most med errors resulting from 5 rights, utilizing a true unit dose system prevents most dosing error, holding physicicans to a standard for writing orders and refusing to fill any order not written correctly (better yet going to computerized order entry) Although you can't force the facility to invest in the technology, additional pharmacy tecs etc.. needed to improve the safety of med administration, there are things as a nurse you can do to improve your own practice. Here is what works for me:

1) not sure how many patients you care for but I keep 6 small 1/2 inch binders and at the very beginning of the shift, the first 30 minutes (get in the habit of not setting foot in a patient room until you do this) I place a copy of the MAR for each patient in it's own binder. I then go thru med drawers and remove all the meds to be given within the first 2 hours and check them against the MAR. I then leave the binder with the meds in the med room and as I go do assesments I bring in that patients binder and give meds. It allows you to bring the MAR in the room with you. This may feel time consuming but will actually save time in the end in terma of questions and possible errors and the ability to re-check the med at the time you administer it.

2) Always tell the patient which meds you are about to give. Granted some patients don't know or don't care but an astute patient can help you prevent a possible error by questioning you.

3) do not sign off any order that you have not verified against the mar. Nurses feel the need not to leave any unsigned order for the next shift -- get over that. Many mistakes result from incomplete and inaccurate orders that are signed off at change of shift. It's better to leave an unsigned order - it's a flag to the next shift that something needs to be followed up on.

4) Set a specific time to check your charts the same as you would an med. Every 3 hours I walk to the front desk and open every one of patient's charts to look for and sign off orders, these are the only times I do it.

5) Get on the computer and Customize a "jot" for yourself and print copies of it and use it. Can't tell you how many times I have watched nurses scribble info form the kardex on a sheet of paper. It's easy to overlook info when it is not in a organized format. Mine looks a bit like this but is formatted on legal size paper with the times extending across the paper, I write in the name of the med that is due under each time at the beginnig of the shift when I am organizing my binders

Name:

Dx.

IVF:

Diet:

Report:

Inc/Wds:Labs:Notes:

2000 2100 2200 2300 2400 0100 0200 0300 0400 050006000700