Med Error Question

Nursey103, ADN, RN · Jul 3, 2009

Hmmm...lots of factors count.....has she had previous errors? What was the med error exactly? Need more info please...

Jolie, BSN · Jul 3, 2009

Most nures are employed "at will," meaning they can be fired for any reason (or no reason) as long as the reason doesn't violate certain protected circumstances such as race, religion, etc.

So it is not out of legal bounds for a nurse to be fired over a med error.

In my experience, there are relatively few meds that require double checking per hospital P&P, and these are meds with the greatest potential for harm in the case of an error. When 2 nurses verify a med, they share responsibility for it. If they both OK the dose, and it turns out to be an error, they are equally responsible, even though only one of them actually administered the drug.

Please forgive me if I am mis-interpreting your post, but it sounds like you believe that the nurse who checked but didn't administer the drug should be held less responsible for the error. If that is your belief, I disagree.

I can't speak to the appropriateness of the nurse's termination. I have no idea what her previous work record was, whether or not she had ever been counseled for medication or other errors, what her response to this error was, or the seriousness of the error.

And yes, a report to the BON is possible, depending upon the circumstances and the mindset of the Director of Nursing.

solneeshka, BSN, RN · Jul 3, 2009

This kind of thing is exactly why more med errors don't get reported. At my facility, we have a policy of treating med errors as a procedural problem, not a performance issue. If there is a mistake, then the approach is from the perspective of how did our system break down, and what can we do to create a system that is less prone to breaking down? Rather than, fire the nurse that made a mistake. The reason is that fear of being fired because of making a mistake keeps people from reporting mistakes, which can unfortunately discourage nurses from doing what is necessary to correct the mistake, which obviously jeopardizes patient safety. I'm not saying if someone made a gargantuan error that they couldn't be fired, and certainly if there was a pattern of errors, then job performance would be questioned. I know that the nurse shouldn't have verified a med that she hadn't reviewed carefully, but don't even tell me that management doesn't know that it happens *all* *the* *time*! They would rather have her take the fall than implement a system that requires careful review (which would better ensure patient safety).

Just requiring the input of a password (which is what my facility does) isn't enough to accomplish what risk management would like to think it accomplishes. I'm a former auditor, so this is a touchy subject for me! A control that people don't use isn't a control. If they had a system where the 2nd nurse had to independently input the medication/dose/route/etc. of the medication that the 1st nurse had handed to her, and then the system did a match to compare the verification to the order, now that would be far more fool-proof (or "I have 5 patients who all need meds now and a new admit and two discharges"-proof). There is so much pressure not to stop and do the careful review, even if time isn't an issue because you can look like you don't trust the 1st nurse if you do review carefully. I know, this is not supposed to happen, and it's not supposed to stop the 2nd nurse from doing the right thing, and protecting the patient, and being ethical. But the point of a control is that it is supposed to remove the element of independent action from the process, precisely so that things like peer pressure or a time-crunch don't affect the accuracy of the process. The quick sign-off or passcode entry don't accomplish that. Your facility can fire her, but they're going to have to keep firing people who keep doing the same thing because the problem isn't going to go away just because they fired her. All they'll do is end up with patients who have bad outcomes from med errors that go intentionally unreported.

ChristyRN2009 · Jul 3, 2009

Really depends on the med and the outcome of the patient. But in reality I'm sure management would say any nurse could be fired for a med error, even one involving something small like giving a med 5 minutes outside of the time allowed.

Virgo_RN, BSN, RN · Jul 3, 2009

It would depend on a lot of factors, I would think. What was the med? How wrong was the dose? How great was the potential for harm? Did the nurse accept responsibility or make excuses? Does the nurse have a history of making mistakes? These are just a few questions that would need to be answered.

Jolie, BSN · Jul 3, 2009

If you are the nurse who verified a wrong med dose because you werent being careful and the pt. was given too much of a drug?

I think this is the critical point. The OP seems to indicate that the medication error did not result from a systematic problem, but from sheer carelessness.

I may be assuming too much, but this doesn't sound like a matter of the wrong drug being placed in the Pyxis by a tech, the confusion of look-alike or sound-alike meds, or a string of errors including the ordering physician, the pharmacist, the stock clerk and culminating with the administration of the wrong med or wrong dose by a staff nurse.

It sounds to me like a nurse flippantly "looked at" a med without taking the time to truly double check the 5 rights, because she didn't perceive any real responsibility, since she wasn't the one actually administering the drug.

VTBabyNurse · Jul 3, 2009

Thanks for all of your feedback.

I can't discuss the details of the situation in too much depth in case someone is familiar with the situation...but the nurse never had a history of med errors. I wasn't implying that she wasn't equally responsible. Both of the nurses made a mistake and on a hard, hectic day like this was one, it can happen very easily if you aren't careful.

I do think the situation could have been handled better. At my facility we have a computerized method of giving meds...verified by several people before actually administering the medication. This is much safer for patients, but not all hospitals have adopted this way of medication administration.

I think it was a good point made that you feel pressured to not take your time and verify the 5 rights with your co-workers. You don't want to insult the other person, however, we all know you should CYOB.

I guess it surprised me you can be fired for any reason, or no reason. Just wonder if this person is going to have trouble getting a job now.

solneeshka, BSN, RN · Jul 3, 2009

OP, just curious, can you tell us what happened to the 1st nurse? Did she get fired, too?

To be clear on my previous post, it's clear that the error happened because of flippant double-checking. My point is that it's possible to make controls that prevent even that kind of thing from happening, particularly in light of the fact that one shift on the floor will easily demonstrate how common it is. It's too important to get the drugs right to allow an ineffective control to stay in place! Just my two cent. Let's all make a pack to be the geeks on our unit who always check for real! :-)

lamazeteacher · Jul 18, 2009

Really depends on the med and the outcome of the patient. But in reality I'm sure management would say any nurse could be fired for a med error, even one involving something small like giving a med 5 minutes outside of the time allowed.

I'm not sure if this is the policy of the facilities where I've worked, but a med needs to be given within an hour of the ordered interval, unless it's a very frequent prn or fragmented dose one.

JomoNurse · Jul 18, 2009

Well, this is exactly why nurses make medication errors and don't report them. Let me tell you something... the amount of med errors that are reported is tiny compared to the amount of med errors that go unreported. I guess to me you should also have a little common sense about it too... are you really going to report that you accidentally gave 2 doses of a multivitamin to someone? Ick!

There are some medicaitions you'll be administering that CAN NOT be administered by mistake.... like blood, platelets, certain cardioversion drugs, etc. But usually in order to administer those, a lengthy verification process is required so you had better not get those wrong in the first place. I think this would be grounds for termination just because there were so many levels of screw-ups.

Anyway, to answer your question directly, I think we would all need to know what drug it was. But you said you didn't want to say that and that's understandable.