How to prevnt Medication Administration Errors

[NurseMike9111]

I need some help. The administration at my facility is looking for ways to cut down on the amount of Med Admin errors. We're not going to computerized order entry yet and no bar coding is on the horizon so were trying to focus on the nurse directly.

One of the biggest issues we seem to have is distraction during the Med Admin process. Does anyone have any ideas on how to minimize these distractions. We have talked about signs, and orange bands and the like but im looking to my colleges for any input.

[talaxandra]

I was going to suggest identifying where the errors occur, but reading your full post I see that's not the problem. Can you look at what the most comon interruptions are, and by whom? Obviously you'll never be able to eliminate them, but f there are some common issues (like pharmacists doing a round at med time or something) you might be able to address at least some of the problem.

I'd be very interested hearing how you progress - distraction during drug administration's an issue for a number of our more junior staff members, too.

[geocachingRN]

Someone here posted that their facility now requires that the nurses wear a special vest. Staff know not to interrupt when a nurse is wearing this. She indicated in her post that it seems to be working.

[Zana2]

In England we have bright yellow vests, can't remember what it says on the back, something along the lines: DO NOT INTRERUPT, you just turn your back and don't answer. it's made of cotton, and there were infection control issues with them. On one ward they were hanging in the stock room, I personally think they should be hanged on the drug trolley

I also tend to anounce my bay that i'll be doing a drug round and any requests non related to the medicines have to wait until I finish or they can ring the bell.

[Zana2]

Sorry about the spelling mistakes:imbar

[RedCell]

You can wear a red, yellow or hot pink hypoallergenic antimicrobial vest all you want. If you truly want to cut down on med errors you need to cut down the nurse/patient ratios. THAT is the distraction. Decreasing the amount of patients a nurse is responsible for will decrease the distraction. All these annual med error classes, group hugs, bar coding, etc... are for the most part a waste of facility funds. Nurses who graduate and become licensed should understand pill passing and they should have an understanding of the 5 right gimmick. These "mandatory" classes do nothing more than rehash what nurses have already learned. It is unfortunate that hospital administrations do not do the right thing. Unfortunately, because nurses are a negative cash flow for healthcare institutions, I believe it is something that will never be adequately addressed.

[NurseMike9111]

RedCell,

Thanks for the input. Although the ideal would be to have a smaller nurse/patient ratio, i live in NY and we all know thats not going to happen. 7 is the minimum for us and 10-11 is not uncommon. With that said, i need real suggestions. How do we keep a family member from constantly interrupting. Emergencies aside, nurses need to be left alone when participating in the very dangerous task of administering medications. 5 rights aside, we have to fix this.

[BrnEyedGirl, BSN, MSN, RN, APRN]

I made a huge med error several years ago on a too busy cardiac step down unit. This was before we went to computerized MAR's and scanning the med and bracelet of the pt. I was interrupted on my way into a pts room and when I went back I gave the pt another pt's meds. I knew the moment he swallowed the pills what I had done and freaked just a bit,...all was well and no harm was done but I had to make certain that never happened again. For awhile it was a big joke on my unit "RN-Cardiac is passing meds...stay away from her!" Well as funny as it was to all my co workers, we all soon learned that it was safer and made my med pass much quicker! I also never took meds out of their labeled container until I got to the bedside,..I would open the med and say "this is your coumadin 3mg, this is Metoprolol 50mg,..etc",..this gave the pt the option to say "what is x and I don't remember taking that before" or "I thought I was supposed to hold my coumadin tonight" or what ever. This doesn't help so much with confused pts, but it helped me tremendously. The whole unit ended up having a sort of "quiet time" at med pass and the aides and secretaries began to tell pts and families "the nurse is passing meds right now and unless this is an emergency she will be with you when she finishes". It worked well for us.

[talaxandra]

How do we keep a family member from constantly interrupting.

Can you post signs and/or include it as part of patient/family orientation that nurses doing medication rounds must not be interrupted? If you combined this with a vest...

[patwil73]

Serious suggestions:

1) Can you close your unit during the busiest med times - say 0800, 1200 and 2200 for an hour. This would cut down on the number of visitors around that could interrupt you.

2) If you do go to some vest to identify med passes make sure it is taught on admission.

3) Do you use single med packages or those bubble sheets? With single med packages you keep the meds in them until you are beside the patient with the MAR. Utilizing the 5 rights here should cut down on mistakes - also when coming into the room let everyone know you are giving medications so please hold questions until the end.

In all reality you are probably not going to significantly cut down on distractions - nursing has evolved (or perhaps devolved ) towards a customer oriented care which means when someone stops you and asks for something, you will mostly need to answer them.

Kidding suggestions: (maybe a bit serious also)

1) Carry a gun on your med cart - shoot the first person in the leg that interrupts you. Afterwards say loudly "please don't interrupt me until I am done dispensing medications." Continue with your med pass.

2) Switch all meds to night shift. Close the unit to visitors after 2100.

3) Have 2 nurses on every med pass - one dispenses while the other answers any questions that come up.

4) Place large headphones on during med pass. Have the MARS prerecorded onto a player that you listen to while dispensing.

5) Practice the mystical art of ninja nursing. Be invisible. Sneak into the patient's room. Slam all meds in at once. Throw down smoke bomb to confuse visitors and allow you to "disappear" from the room.

Hope at least some of these help

Pat

[Rockhopper]

Pat, LOL, I like kidding suggestion #1. Thanks for the laugh!

[ayla2004, ASN, RN]

we wear red aprons it only lets the staff know although there are signs pt don't seem to care.