Jump to content

How to avoid med errors . . .

Specializes in telemetry, med-surg, post op, ICU.

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.

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.. :uhoh3: But just know that you're definitly not the only one who's made mistakes. Just focus!

allthingsbright

Specializes in LDRP.

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)))

Lynda Lampert, RN

Specializes in telemetry, med-surg, post op, ICU.

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

Specializes in Emergency.

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

Specializes in ICU, PACU, Cath Lab.

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

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

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

Specializes in orthopaedics, perioperative.

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. :)

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

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

Specializes in med/surg, telemetry, IV therapy, mgmt.

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

Lynda Lampert, RN

Specializes in telemetry, med-surg, post op, ICU.

Yes, I did get rattled by the instructor. My patient was very complex. I had to crush all the meds and give them via peg tube, which I had never done before. I had to hang new maintenence fluids, hang a piggyback, and change all the tubing which I hadn't done before, either. My instructor actually said to me, "Come on we can't be taking this long. You have to hurry up."

I guess I just haven't really gotten into a rhythm doing the meds and that's the problem. We go to two different hospitals and have a new instructor virtually every week. One hospital uses pyxis, the other uses something called a MAK. It's sort of like a grocery store scanner. It's great for catching med errors, but very different from pyxis. With pyxis, you triple check off of the meds due list. MAK you sort of triple check between the screen and the med. There just isn't the triple check with this particular system, and that's what I was using during all of these mistakes.

I think what #1rnstudent said is very, very important. No one should be talking to me while I'm giving meds! One of the things my instructors love to do is ask questions while we are pulling and checking meds. That's rattling! I know I'm going to have to learn how to do it with distraction, but I didn't really realize how difficult it is to "just hand out meds." Man, it's nerve wracking!

So, I will have to swallow my pride and accept probation. It still makes me sad that I am branded with it, but I think that's just my ego talking. The fact of the matter is that I did not consciously check the "rights" and I did not triple check. That *is* a problem and if this is what it takes to correct it, maybe it will save someone's life.

Thanks again, all. I can't tell you how much it strengthens me to come to this post and see all of your support.

Ionafey

Lynda Lampert, RN

Specializes in telemetry, med-surg, post op, ICU.

Sorry, I didn't see the posts on the second page!

Finallyat40, I don't get to select my patients. They are always selected for me. I actually requested from a few instructors that I be given patients that were a bit more complex because I enjoy the challenge. I like having to figure things out. Most of the time I can handle them. This time it just didn't work out.

The good news is that this week and next I will be on a psych unit, so there should be some meds, but not as many complex ones. This, hopefully, should give me some confidence when I have to head back to the medical floor towards the end of the term.

As for prioritizing, I have decided that my first priority for the day *is* meds. God, why didn't I think of that sooner? It's like, duh! I guess I was just sort of skating and becoming complacent with the fact that I could handle what was coming my way. I guess it is a humbling experience and that's what's really needed for a student. Not that I was pompous, mind you, but I felt confident I could deal with whatever came up.

*pauses for laughter*

I will also be meeting with the department head tomorrow to discuss my probation. I don't have a primary instructor in either clinical or lecture. They all sort of rotate -- and we rotate clinical sites about every two weeks. So, I have been told I will get an action plan then. Hopefully this meeting will not be about making me feel worse about what has happened but about using the resources of the school to ensure that these types of mistakes don't happen again.

So, the "rights", do focused checks three times, and take your time though a million people are screaming at you . . oh, yeah, and make meds a priority. I think I can do these things.

Ionafey

Quit beating yourself up! You've made a mistake, you accept and readily admit that you made a mistake (which is 90% of the battle as far as I'm concerned) and you're ready to move on and make an action plan for SUCCESS! You're a good student nurse....I can't imagine having to jump between numerous med systems with more than one clinical instructor so that you never are really able to get your groove going....I've been an RN for two years now and that would still probably throw me if it were on a regular basis!

Enjoy your psych clinicals....I don't think I could ever work it full time, but loved it during school. I'll be thinking of you as you meet with administration and prepare to move forward....years from now, you'll look on this as the learning experience that it is rather than the nightmare you're feeling it is right now!

Jamie

Lynda Lampert, RN

Specializes in telemetry, med-surg, post op, ICU.

Thanks, Jaime. :) I will settle down. Just going to breathe. I actually am looking forward to psych because it was one of my initial interests -- and it may still be a path I want to go down. Just haven't had the experience yet.

No more beating up, I promise. Only steely eyed determination to make myself the best nurse I can be.

Ionafey

lvs2nrs3535

Specializes in Med-Surg, LTC, Rehabiliation Nursing.

I am a recent graduate and went through something very similiar. Please, please, before you do anything else, forgive yourself! Remember, tomorrow is a new day, and you get a chance to start over. My second semester was a nightmare, I felt like my instructor truly did not like me, and nothing I could do was right. This made me more nervous, and I made mistakes that were nothing more than nerves. I finally decided, I DID NOT COME THIS FAR TO BE BOOTED OUT BECAUSE OF A SUBJECTIVE OPINION!!!!!!!!!!! I did prove myself to her, and now she is one of my best references.

This is probably the most stressful time of your life, and you truly have to give yourself a break. Then, you have to listen to the more experienced nurses advice. DONT let anyone rush you. Dont let anyone distract you. If you are anything like myself, it is very hard to feel as if you are brushing off someone, anyone who wants to chat, has questions, ect. But, when you are passing meds, nothing else matter. I remind myself that my patients life is in my hands, (and this is a literal truth), and they deserve nothing less than your full attention. Take a deep breath, or two or three, and remind yourself how hard you have worked to get this far, and do not let anyone or anything deter from what you know you can be. A nurse. I believe that we are so important, and there are so few people who can get through what we do, that we deserve to be proud of what we do, proud of what we went through to get here, and that was my mantra. I want to be a nurse. I will be a nurse. I am nobodys handmaiden. I am my patients lifeline. I am their voice, their advocate, their courage and their strength.

And,.....at the end of the day, there is nothing more satisfying than knowing that YOU made a difference in someones life.

You can do it.

Hang in there.

WDWpixieRN, RN

Specializes in Med/Surg <1; Epic Certified <1.

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.

One day early in our clinicals this semester, my instructor was asking what fluids were running in my pt's IV and I said I thought it was D5"something" (forget now specifically).....but I was looking at the chart and realized it was supposed to be NS....the assigned nurse (young and fairly new RN) was nearby and my instructor asked her what was hanging....she said, "Oh, NS; I hung it yesterday"....I mentioned I could be wrong and just didn't look at it correctly....she ran in to look and sure enough, it was the WRONG solution....again, thank heavens no one was injured....but it just proves that we can all make mistakes...

I've just decided after reading nightmare stories on these boards to take my time with meds no matter what...if my instructor or anyone else wants to hurry, then THEY can admin the meds...I know I couldn't live with myself if I seriously hurt or killed someone...

The other important piece of advice is to breathe and think....I see fellow students just stress like crazy over a skill or a med admin while in clinical and they not only drive our instructor nuts, it's kind of crazy to watch...we're students....we shouldn't know everything the first (and maybe the second or third) time we do it...we're learning....but one thing I know is, if someone before me was able to do this, then I probably can too (many, many "someones")....nerves and trembling/stressing doesn't help anything!!

Hang in there!!

My *first* day of clinicals, I went in to my patient's room to hang up a piggyback. The old piggyback from the day before was still hanging there - completely unused! The nurse the day before (who has been a nurse for more than 20 years, btw) had forgotten to unclamp the tubing.

My second day of clinicals, my instructor handed me the wrong med to give to my patient. I caught it and we got the right one. I don't know if it was on purpose, to test me, or if she was making a mistake.

Like everyone else said - slow down. The patient will be okay for 5 minutes while you make sure you've got the meds right. I am doing my first clinicals in inpatient oncology, and all of my patients have been on a ton of meds which can be really intimidating! I have never had a problem asking someone else to double check the meds I'm giving before I give them. I'd rather ask and take 5 more minutes, than not ask and be wrong. And eventually, I assume I won't have to ask as much any more - but if I am just having a frazzled day, I'll still ask even 10 years down the line.

Slow down, and speak up too. If your instructor is rushing you, phrase it in terms of patient safety. "I understand that this piggyback was supposed to be hung 20 minutes ago, but I don't want to make mistakes. I think it's better for the patient to wait 5 more minutes while I make sure I give them the right medication in the right fluid, rather than rush and make mistakes."

cherokeesummer

Specializes in OBGYN, Neonatal.

My best advice is to take your time and to heck with the rushing. Yes I know instructors have work to do but patient safety is number one. Being rushed is dangerous. Especially when we are new at this!

The mistake of saying the wrong drug, I'm sure that happens alot but I'm suprised you got written up for saying the wrong word...as long asyou are giving the right drug, and caught your mistake, like oh wait I said hydrocodone but I meant to say hydrocortisone, sorry! I guess they just wanted to keep you on top of the names though.

At any rate, I think time is probaby the issue here, just try to take the time to double/triple check and make sure you feel comfortable.

Guest
This topic is now closed to further replies.
×

By using the site you agree to our Privacy, Cookies, and Terms of Service Policies.

OK