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How to prevnt Medication Administration Errors

Posted

Specializes in CEN, CPEN, TCRN. Has 9 years experience.

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

Specializes in Medical.

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

Specializes in Community & Mental Health, Sp Ed nursing. Has 3 years experience.

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.

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.

Sorry about the spelling mistakes:imbar

RedCell

Specializes in CRNA.

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

Specializes in CEN, CPEN, TCRN. Has 9 years experience.

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

Specializes in Cardiac, ER. Has 18 years experience.

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

Specializes in Medical.

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

Specializes in ICU/CCU, Home Health/Hospice, Cath Lab,.

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 :rolleyes:) 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

Specializes in Tele. Has 10 years experience.

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

ayla2004, ASN, RN

Has 5 years experience.

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

nurs4kids

Specializes in Pediatric Rehabilitation. Has 20 years experience.

I came here searching for this exact thread. My facility is researching "Med Admin Distractions" and we will initiate an action plan sometime this year. I found the attached file and thought you may find it useful. I too would love to hear what other facilities have done to address this issue.

Environmentworkflowstaffingpatternsmederrors.pdf

eriksoln, BSN, RN

Specializes in M/S, Travel Nursing, Pulmonary. Has 15 years experience.

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.

Actually, better ratios are not always the answer. We all know, this is the staff nurses answer to every problem.........better ratios. And we all also know, administration would sooner give you their first born. Its just not an option to have more nurses around with the way things are right now. The midical field is dollar driven, we are a debt in their eyes.

A place I worked at though focused a lot on leaving the nurse alone period, not just at med time.......to do NURSING duties (dressing changes, D/C planning, pain management......whatever) instead of playing phone operator and fetching Pepsi for family members.

First thing they did was create a phone number for families to use when calling to ask about patients. The line went to the operator first who made sure the call was connected to the proper unit (who among us has not picked up the phone and spent 10 minutes explaining to some lady who cant hear you that "there is not pt by that name here"). Then the secretary first gave the call to the charge nurse (this unit used charge nurses with no pt. assignment, but they received report on each pt. and could answer simplistic questions....."Is my father going to be D/C'd today?" and stuff.

Thats just one example of attacking one of the distractions off that was used. It cut down on phone time for the daylight nurses significantly. Secondly, the daylight nurses were more in control and less.............PO'd at family already.......when people came to the unit and the interaction with family there was better.

They kept analyzing and minimizeing the distractions one by one. Things did improve. :pThen, they saw how much better we were doing and raised the ratios. Typical.:banghead:

MomRN0913

Specializes in ICU.

Ok, seriously, we have the time to don vests so people don't interrupt? I think it is actually really ridiculous. How about a verbal "I'm passing meds now, I'll be with you when I'm done"

Angie O'Plasty

Specializes in acute care. Has 5 years experience.

How about a better way to identify patients/residents on LTC units? I am temporarily doing agency nursing in these facilities and this is a huge problem--the residents very often do not have their wristbands on (they take them off, especially the dementia patients who are the ones that NEED them on the most!!!) leaving me to rely on regular staff to identify patients which makes for a very inefficient med pass and is not foolproof in itself (had somebody mix up two residents with the same first name once...resulted in one of them getting the other's pills; fortunately no harm done. Probably didn't help that these two residents were roommates.). The facilities do put pictures of the residents in the MAR book but this isn't always reliable either, if the pictures aren't updated or even if the resident has her hair done differently, doesn't have their glasses on when they did in the picture...you get the idea. Short of tattooing names on arms (which obviously wouldn't work as there are problems with that idea), what can we do to fix this?

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