High Risk Meds

[Special31]

Good evening, I am trying to get a little information. I work in an institution where high risk needs to be double checked and signed by two RNs independently. The process is to verify patient, drug, and dose. The nurses are running around extremely short and with severely high acuity patients and there are still med errors even with this process. I am trying to understand or get input for what is done at other institutions?? How are high risk or even standard med errors eliminated??? We are not a facility that is computerized yet we are still using paper charts...help please

[kcksk]

Our high risk meds need to have a co signer every time it is given. That should mean that two nurses are checking the order and actually looking at the med given. At our hospital it is for insulins, morphine gtts, cancer drugs, heparin gtts. Those are the common ones we run into on our floor. I am sure an ICU or tele floor has a lot more. In theory, having two sets of eyes verifying everything should cut down on med errors because one of you should catch it.

[Horseshoe, BSN, RN]

As long as humans are involved in the process, you will never "eliminate" errors. The best you can hope for is to reduce or limit them. Regardless of the safety nets put in place, under staffing will always diminish the effectiveness of these attempts to prevent med errors.

[wee_oneRN]

Perhaps you need to research these med errors and find out what factors are involved so you know what needs to change. Are they happening at certain times of day, do they not match the original md order, is the nurse drawing up the wrong ml's, are mess being missed, are the incorrect dosages being prescribed, etc...

Try to have a third-party handle the research, font penalize nurses for the errors or you may have difficulty gaining their honesty and participation.

[reg.nurse]

Good evening, I am trying to get a little information. I work in an institution where high risk needs to be double checked and signed by two RNs independently. The process is to verify patient, drug, and dose. The nurses are running around extremely short and with severely high acuity patients and there are still med errors even with this process. I am trying to understand or get input for what is done at other institutions?? How are high risk or even standard med errors eliminated??? We are not a facility that is computerized yet we are still using paper charts...help please

Sometimes as busy nurses we glance quickly during a check or many things that can happy. My best advice is to be SURE 100% that each nurse stops what they are doing completely and focus on the med check and nurses need to remember this isn't about having no respect for the nurse with 20 yrs experience or trusting one another. It's simply a safety procedure that needs the attention provided in the instructions of the checks and balances.

[reg.nurse]

Understaffing.....great point!!!

[MunoRN, RN]

We found we had much better compliance when we limited double checks to things that truly needed to be double checked. We used to double check SQ insulin, although there's no evidence that has any effect on error prevention, same with pre-dosed SQ heparin. Having Nurses just double check when double checking actually has some benefit made double checking less frequent and therefore made it more practical to do the double check effectively.

[Flo., BSN, RN]

I think the culture of the floor makes a big difference. On my floor we take the double checks seriously. I was floated to another floor and their attitude was totally different. We have computerized charting so the nurses would just give each other their codes without doing a double check. Scary!

So maybe you could identify what the culture is on your floor. Do people resent it or embrace it?

[Orange Tree]

At the end of the shift, everyone gives their list of what needs to be co-signed to a co-worker. That's how we complete our required "double checks" in the computer. No one has time to do it the right way. Insulin is often given hours late by one nurse, and would never be given (at all!) if we had to wait for two nurses to become available.

I will always require another nurse to check my heparin drip calculations, though...and physically walk in the room to check the infusion pump settings, too. And anything that doesn't seem standard (with any medication order) gets researched and checked by someone with more experience, too.

Oh! And most importantly, I scan everything. Because you might think you have a low risk med in your hand and actually have something quite different. Unfortunately, I learned that one the hard way.

[FootballGirl]

At my hospital double checks are completed in different ways for different meds. For SQ heparin you do not have to put a double check into the MAR (we use all computerized charting as well as bedside barcoding). For insulin gtts, heparin gtts, and PCA pumps the other nurse has to actually do in and put a 'double check' in the MAR space. As for blood, the second nurse has to actually be in the room with you and punch in their code at the time of the delivery.

[RyanRNBSN]

Do other hospitals require double checking on SQ Lovenox? With the huge push for DVT prevention our facility has largely increased in Lovenox administration... curious if other facilities are doing the same with double checking.

[Flo., BSN, RN]

We don't check lovenox. I don't see the point with that one. It comes in prefilled syringes. If you have computerized charting thats like an automatic double check.