med error?

On the floor where I work if the wrong medication does not actually go into the patients body then it is not considered a medication error. We do consider it an incident and it is tracked by QA. If a nurse has multiple incidents then questions are asked such as: do they know the 5 rights? do they know how to use the equipment? are they just careless? Then this is followed up on with intruction, mentoring, or disciplinary action depending on the case.

Good question. In my SCHOOL program, up until and including the last day, students would bring to the clinical instructor the MAR and each medication they were about to give a patient. Student had to show every vial used to draw (ie: insulin) and if there was a mistake there, then it was considered to be a med error--since you were, in fact, about to GIVE that set of meds to the patient. There was no room for the patient recognizing a problem and then it getting corrected.

However, I don't know if this is the case in the "real world"....would seem to me that you might make a med error, but not one that isn't corrected before administration, which would then make it an "untrackable" med error. But I don't know for sure, I'm just thinking out loud with you!

A "med error" occurs when a patient is given the wrong med.....be it a wrong dose, at the wrong rate, or wrong medication altogether. The 5 rights are perfect checking tools....use them!

Catching yourself before you give a wrong dose/ med.....will shake you up, but for the good!

I always used to prepare the meds before bringing them to the patient. I observed my preceptor doing it differently, and I liked how she did it. Now I keep them in their unit dose packaging and open them in front of the patient. That way I remember what I'm giving, I can tell them what I'm giving, and they can let me know if they think something's not right before I've wasted a pill or potentially given a wrong medication. Already I've found this of benefit.

Who says old cats can't learn new tricks?

I always used to prepare the meds before bringing them to the patient. I observed my preceptor doing it differently, and I liked how she did it. Now I keep them in their unit dose packaging and open them in front of the patient. That way I remember what I'm giving, I can tell them what I'm giving, and they can let me know if they think something's not right before I've wasted a pill or potentially given a wrong medication. Already I've found this of benefit.

Who says old cats can't learn new tricks?

That's how I do it, too. All those different shapes, sizes, and colors run together in my brain so I NEED the unit dose packaging to know for sure what each med actually IS before giving it to the patient. I'm so anal about making a med error that I keep them in order according to the MAR and give them in that order.

What you are describing is a "near miss" med error.

Our facility likes to documents near miss events, to watch for trends and errors before they occur, but we rarely, if ever report them.

http://krouwerconsulting.com/Essays/NearMiss.htm

The 3 checks also work for me.

First, I take the MAR to the pyxis, and check each med and dose against the PYXIS report as I pull them. Discrepancies are investigated, and unfamiliar meds are looked up.

Then, I check each individual med against the MAR as I prepare it.

Then, I check the MAR against the pt.s nametag at the bedside as I tell the pt. what the meds are for. (When the pt. is not sentient, I ask myself: What for, appropriate given condition, and allergies AGAIN.

Hope this helps.

I do lots of checks but I also verbally tell my patient "You had this ibuprofen at 1pm and its a six hour dose. Its now 7pm and its been six hours so you may have it again." Maybe its dorky but it works for me.

In nursing school, I got a write up for giving a 1700 po reglan at 1800. I know in school we are allowed a 30 minute window before and after, so the proper timing would have been 1630-1730. Because it was given an hour past the ordered time, it was considered a med error. My only clinical notification. What a bummer. Now that I am a "real nurse" my meds are late for at least one pt every day now...either an iv med couldn't be given d/t lack of iv access and need to restart, or a med is missing from the pt casetter, or PT is ambulating pt, or the pt is nauseous, or pt is off floor for testing...I could go on and on. I agree with the six rights rule...if it doesn't all check out, then there is an error.

Thanks to all of you. Your replies all made good sense. It was my understanding that if the wrong med went into the body, it was a med error. It is good to know the information about the incidents.