How do you keep from making med errors?

meanmaryjean, DNP, RN · Jun 23, 2018

Well, first of all you use the five rights every single time.

And to your other question, you must know your facility policies related to meds.

elmerj · Jun 23, 2018

Thank you. I do follow the five rights. Also, I follow the facility's policy's to the best of my knowledge. I just feel like there is something else I am missing.

allnurses Guide · Jun 23, 2018

I would never give a medication based on vital signs I had not checked myself same with giving insulin I would take my own Blood sugars before administering insulin. This is just good practice. Secondly practice your five rights and triple check each pass even if it puts you behind.

Hppy

Penelope_Pitstop, BSN, RN · Jun 24, 2018

NEVER rush any process related to medications.

You can always redo a dressing, go back and listen to lung sounds, break out your pocket guide when looking over your tele strips, but you can never UN-GIVE a medication.

Once it is administered, there is no turning back, it's like ringing a bell. So take all of the time necessary.

This includes any and all assessments/measurements/tests required to administer said medication.

Mr_Edwino · Jun 25, 2018

Isn't that an NCLEX question? Seriously. Assessing the patient is the first thing you are supposed to do and the first thing you learn in nursing school.

Ddestiny, BSN, RN · Jun 25, 2018

I've never heard of not taking a "CNA's word" on a blood glucose. I work in a hospital and our CNAs get most if not all of the BGs, depending upon the floor and unit culture. In that case the result does flow into the chart. However, when I was a CNA in LTC we always just took the BG and wrote it down for the nurse to administer their insulins. If you're concerned that someone is not doing their work and is falsifying numbers then I think that is a separate issue. CNAs are taught how to take a blood glucose.

JadedCPN, BSN, RN · Jun 25, 2018

Just remember that you are ultimately responsible for your patient, and are often the "last line of defense" when it comes to patient safety, med errors, etc.

Regardless of whether it was a CNA or even another RN who checked my patient's blood sugar, I wouldn't give Insulin based on a verbal number - I would need to see it for myself on the glucometer or when it gets wirelessly uploaded into the system. And obviously if it was a significantly abnormal number, I would likely double check it a second time to be sure. The reason being is that we are all human and make errors - there have been times when I was told one number, but the person accidentally misspoke and it was actually another number.

Same thing goes for vital signs. I've had someone tell me Room 19 had a temperature of 101.8, when in actuality once they sat down to chart they realize it was actually Room 18 who had that temperature. Mistakes like that happen especially when we are all trying to get their work down, but ultimately I am responsible for my patients and their safety, and for justifying why I am giving a medication.

Meriwhen, ASN, BSN, MSN, RN · Jun 25, 2018

How do I keep from making med errors when I don't know information? As an example, I didn't know we were not allowed to take the CNA/CAPs word for the blood sugar. Is this common knowledge? Where can I find information regarding medication administration that relates?

1. It's on you to find out the information you need to know. Look up results in the EMR, or visually see the results on the glucometer/VS machine/the patient. If a result is very abnormal, double-check it yourself. if a result is missing, get it. If you are not familiar with a medication, grab your drug reference and look it up. Most EMRs will have a reference feature in their MARs so you can look up med information.

2. Remember the 5/6/7/however many rights (the number varies depending on who you ask, but there's at least 6 IMO--almost everyone overlooks the patient's right to refuse).

3. Don't allow yourself to be distracted during medication preparation and administration. Focus only on the meds.

4. Don't rush either. Unless it's a code (and that's a whole other ball of wax), there's no need to do things as fast as possible.

5. Check, double-check, and if necessary, check again.

6. Also, if necessary, have a second nurse double-check. In fact, it's standard operating procedure in many facilities for 2 nurses to verify high-risk medications (insulin, heparin, et al.) before administration.

7. Last, be sure you're on top of your facility's P&P regarding medications. For example, I worked at one facility where it was acceptable to mix compatible medications in one syringe to give IM, and at another facility where medications could not be combined and each had to be administered as a separate injection. So mixing Haldol and Ativan IM would technically be a medication error at the second facility.