Med Error Perspective

[takoluka]

Hey , I'm new here and I just thought I'd make a thread because I had something on my mind and I could maybe use some others perspective on it. Basically I had a small med error today it was really stupid I accidentally gave a resident, another residents meds. I was lucky because he ended up getting the same dose of metopopolol that he would normally get just ended up getting a additional lortab when hes not on any pain meds and has no alergys too. I blame it on the fact that both residents meds were next to each other in the cart and there medications were so similar to begin with. This got me thinking because normally I try to learn from my errors but the odd thing was I had a similar error when I first started nursing where I gave the resident some one else's medications and it also was lucky because there medications were so similar the resident only ended up getting an extra vitamin so there was no major harm.

The thing is I feel bad because I've made the same error even thought there was at least 2-3 years in between and I wonder if I really did end up learning anything because of it. To give more background I'm LPN working in a long term care facility, Ive been working at the same ltc place for 3 and a half years it's my first nursing job. Our facility is about an 80 something bed facility where there are 3 nurses per shift who work 8 hours shifts for days and pm's and 2 for nocs. It's a pretty busy place its easy to see why med errors can add up and I know I'm not the only one who's had a few in the course of working at this facility and there have been pretty frequent complaints of under staffing. But our facility is a poorer one and the management tells us they can only hire as many nursing staff as we have now. In the course of 3 1/2 years counting about anything that could fall as a med error ive had about just under 10, including both of those errors as mention above. the others include:

- One time in my first month of working there I accidentally held a residents coumadin for the weekend when it should of been given ( the mar was very unclear on if it was to be held or not)

-Another in my first year when I accidentally gave a resident her PM meds later on that evening when I split a pm **** with another nurse and he had already given the resident her meds at dinner time so she was double dosed. ( no narcs or bp meds, I usually give her meds at 8PM and didn't think that she had already had them I didn't look at the cartage's well enough)

-Another time that had involved a transcription error traced back to me involving the resident receiving the wrong dose of a med for a few weeks

-One several months ago where I worked a 12 hour shift with a nurse and I assumed she didn't give the res. her evening pills and gave them to her when she requested them so another double dose it was more complicated because it involved coumadin but the dr.said to hold the next dose and her ptinr turned out just fine afterwords( she was alert and orientated and asking for her pills at that time. I was rushed at the time and didn't look into things well enough)

- One involving a medication that wasn't given on pm shift ( she refused her meds half the time) and I had a temporary don who was a stickler and made me go though the whole process and inform the dr. but she didn't make a big deal out of it or anything)

The other ones I could think of were minor and my don never had my fill out any paperwork regarding it, one involving a lovenox all the nursing staff was giving for and extended amount of time which should have been dc'd after 2 weeks. The last was another group error where the pharmacy had been sending out the wrong med for a resident for 3 months and anyone who worked on that hall had been giving it with out noticing it was the incorrect med.

Now I take full responsibility for what happened I try not to make any excuses but I also try to learn form my mistakes and move on but overlooking my past mistakes I have noticed there have noticed the two kinds that have repeated ( double dosing and giving the wrong med to the resident). None of the errors had any notable harm happen to the resident which I am very gratefully and lucky for because I don't know if I could live with my self if anything serious happened.

My facility has never taken any disciplinary action against me. Which I'm not sure if unusual or not. I talked to my don about it once and she made it seem like that would only happen if it resulted in a serious error that involved a residents health or making med errors constantly. Admittedly my errors were spaced between several months to almost a year at most in the longest. But I start to get depressed and feel like I've made too many errors already even though no ones been hurt and I've had no discipline and no ones even talked to me about this from what I understand this all seems " normal" .

I guess I just wonder is this normal? I know there's no real " average yearly med errors" a nurse makes but I hate to think I'm some how failing as a nurse because I've made this many already. Especially if it seems I've made many more then my coworkers. I also wonder is it unusual that my facility hasn't done any discipline against me ( I've read other threads about facility's alot stricter than mine) I wonder if I should think about working some where less busy where i can concentrate better and feel like I wont make as many errors. The facility where I work at now is too high acuity and had multiple staffing issues. I don't want to risk my license working at a place that might just have me more prone to make med errors.

I'm sorry if this was long I guess I just needed to vent , I'd love to hear some perspective might not be able to reply back right away I'm going to bed now but thanks in advance.

[Double-Helix, BSN, RN]

I'm not sure if there is a "yearly average" for med errors, but there is certainly no acceptable average for med errors. As nurses, we should strive for zero med errors. Med errors are very serious, no matter what the error and it's fortunate that no harm came from the ones you listed.

You have done a great job detailing what errors you made and some of the reasons why. Rather than trying to find a yearly average to make you feel better about this number of errors, focus on identifying and correcting the reasons why you made errors in your own practice.

In the examples you provided, it seems like a couple of things have contributed to your med errors: Pulling two patient's medications at one time and not checking the cardex or MAR well enough.

To correct this, make sure you only pull out one resident's medications at a time. It takes longer this way, but it is much safer and it completely eliminates the possibility of grabbing the wrong cup. You can even take your med list into the patient's room. Follow the six medication rights always.

Double and triple check the MAR. Check it with the physician's original order. Check it when you are pulling the medication, and check it before you give the medication to the patient. Yes, it takes time, but it's the standard of safe practice. If a MAR order is unclear, get the physician to clarify.

Don't assume. Even if you usually give meds at a certain time. Even if the resident asks for the medications. Even if the patient usually refuses the medication. Never assume that a med has/has not been given. Check the documentation and make sure. If documentation if not being done clearly or accurately at your facility, bring it to the attention of the DON.

We all know that LTC is busy. You have a lot of residents and very little time. But being busy doesn't mean we can compromise safe practice. I'm sure if you evaluate why you made the past errors and focus on correcting the reasons, you will start to see your med errors go down. Make zero errors your goal! :)

Ashley

[NurseLoveJoy88, ASN, RN]

In LTC everyone makes a med error every day. You have 20-30 residents, and a one hr. window for meds, if someone gets their meds 1minute before or after a minute its a med error. This is crazy.

Anyway OP, I digress. Just try your best with these medications, that is all you can do.

[jamielynne083]

I agree with above post but was wondering when were the medications due when you gave the double dose? Just curious. Was the other nurse giving them too early? We have times for medication and time frames that we are compliant for a reason. This is something that I would bring up with your DON if so.

[jamielynne083]

I agree with Ashley's post. We should strive for no medication errors. Sorry wanted to clarify which post I agreed with. :)

[Silverdragon102, BSN]

Striving for no med errors is nice however we are human and mistakes matter. I think the important thing when a error occurs is to accept ownership and look at ways to reduce or stop it happening again. I work LTC and pre pouring meds is a big no no and we dispense one client at a time and watch them take their meds. I also check the med against the MARS as I dispense as well as sign ensuring that med hasn't been given already if the client refuses then to take medication I go back to the MARS and circle as not given as per the facility policy.

A lot will depend on the type of med error but when they happen it should be a learning curve and a way to look at reducing the risk of it happening again

[takoluka]

Thanks for all the replies. It's good to hear others perspectives. It really makes me wonder if med errors can happen more frequently in ltc care facilities because of the patient load. At our facility we have been cracking down on pre dishing and more specifically to not give medications in the dining room, encouraging to give them before a resident goes down to eat. As far as the question about the medication times, basically, it was a common prative at least for pm's to give most medications during around meal time unless they were sleeping pills or meds specifically to be given at hs so I beleve most of her medications wer set for 7 pm ish. That particular resident had a hard time taking them at the table so would usually wait until later to give them and assumed that's the way the other nurse did it too there in lies the problem.

I guess I still feel bad about the med errors even though I know most nurses have them at some time in there carrers I've just heard some people say they've only had one or two and it makes me feel a bit inadequate like I must be a bad nurse to wrack up so many, but I am including real techanal ones too. I was told in school that it was important to report and for the most part unless it was a serious med error there would be no disciplinary actions against the nurse. But after reading some threads here're where some nurses had some actions against them it made me concerned. I'm not sure if my facility is more relaxed but it makes me a it nervous to work somewhere else. Especially if they have some 3 strikes and your out policy. But then again it be nice to work some where where I really feel that I can take my time and concentrate. It's unfortunate our facility doesn't want us to work overtime and be out ASAP so there is a feeling of being rushed sometimes.

Any way thanks for your advice if anyone could contribute more that be appreciated too thank you .

[catlvr]

Hi, i feel for you; ltc is no easier than a hospital, just different! I work in a nursing home and have 24 pts - half long term care (half of those are hospice) and half short term rehab. It is easy to make an error if you don't stay focused on what you are doing, but there are so many distractions. When I am pouring meds, I only pour for one patient at a time, and I do a mental "time out" before I give them - I look at the pill cup and ask if this is what I normally give to that pt, and take one last peek at the MAR. Then I give them, and while I'm on my way to give them, I smile and tell the folks who try to stop me that they gotta wait - and most of the residents now know that if I have water and a pill cup in my hand, that I am not going to talk to them until I get back (:

For the folks who are oriented, I tell them what is in the pill cup - htn, colace, etc; they should know what they are getting.

For new patients, the first time I give them meds, I take the MAR into the room and go over their whole day of meds so that they know what they are getting and we see if there is anything missing (assuming that they are oriented).

We had someone at our facility get the wrong meds last week, and the nurse - an excellent nurse! - is devastated. She's a BSN and very well-regarded. She knows how it happened - she was distracted - and that seems to be the way that these big med errors happen. If you can find a way to reduce your number of distractions, it might help. And when you find a way to reduce the number of distractions in LTC, please let us know! I search for that every day - because I fear making a med error.

I agree that zero errors is the goal, but probably not achievable. You are doing the right thing by learning from it.

e