Is it a medication error if...?

Editorial Team / Admin · Jan 20, 2018

Well, if it wasn't documented, it didn't happen. Therefore, according to documentation, it appears as an error of missed dose.

Here.I.Stand, BSN, RN · Jan 20, 2018

Never scanned, or never documented at all?

MunoRN, RN · Jan 20, 2018

The commonly recognized definitions of a "medication error" requires that there be a potential for harm to the patient, what you're describing seems to be more of an administrative process error. Inpatients are no longer typically billed per medication, so it's unlikely that potential billing errors are the issue. The main issue is that it makes it unclear if the patient received the medication or not, which could potentially cause harm depending on the medication and clinical circumstances.

klone, MSN, RN · Jan 20, 2018

If it's not charted, it didn't happen. If it's not scanned and charted as given, then yes, it's an error. BCMA is there to provide another level of checks and balances and safety in medication administration. If you're bypassing this system, you're putting your patient at risk.

meanmaryjean, DNP, RN · Jan 20, 2018

Pulling a med and not giving it is theft.

klone, MSN, RN · Jan 20, 2018

Is that a true medication error or just a financial error since they just want the patient to be charged if that pulled medication was given or not?

If it was not given, then the patient would not be charged. If a med is not given, it should either be returned (if unopened) or wasted (if opened) in the Pyxis/Omnicell. Either way, the patient's account would be credited. So if you're pulling a med and not giving it, then the patient's account is erroneously/fraudulently charged for a medication they did not receive.

MunoRN, RN · Jan 20, 2018

If it was not given, then the patient would not be charged. If a med is not given, it should either be returned (if unopened) or wasted (if opened) in the Pyxis/Omnicell. Either way, the patient's account would be credited. So if you're pulling a med and not giving it, then the patient's account is erroneously/fraudulently charged for a medication they did not receive.

CMS and all insurers have moved to bundled billing for inpatients, so there are no longer individual charges for medications. There are other potential problems with a conflict between the pyxis record and the EMR, but billing errors is no longer one of them.

BSNbeauty, BSN, RN · Jan 20, 2018

It is a medication error by omission . I definitely don't think it's theft unless the nurse actually took it herself or took it home on purpose. Is it possible that staff aren't making sure the medication is scanned appropriately? Our emar scanner is faulty and if a nurse isn't careful when scanning then it looks like it was never given when it was.

JKL33 · Jan 20, 2018

What is happening to all of these medications that are pulled but not given? Are you saying people aren't wasting or returning them appropriately?

Or are you saying people are actually giving them but are bypassing the scanning process?

People need to waste or return appropriately, period.

Next thing to do is write up every incident where meds won't scan appropriately and CYA as far as how those instances are handled. Get an RN cosigner, etc.

SpankedInPittsburgh, DNP, RN · Jan 21, 2018

Why would you pull a med from the omnicell if it wasn't ordered unless the order was changed? If it was changed and the med wasn't returned then what happened to the med that was pulled? I don't think I understand enough about the facts of what happened

KelRN215, BSN, RN · Jan 21, 2018

What is the reason that these meds are A) not being given and B) not being returned or wasted after they're not given?

We generally only wasted controlled substances in the pyxis but if something else was pulled and not given, we'd at least chart it "not given" and the reason why it wasn't given on the MAR.