Published Jul 13, 2009
How comfortable do you feel reporting a medication error? How about a "close-call"? If you do not feel safe in reporting an error, or a near-miss/good catch/close call, why not? What if someone else made an error and you discovered it, would you report it?
I do feel comfortable about reporting because I worked on the other end and saw those reports. We never used it to punish. We also saw a lot of errors that went unreported. Those are the ones we worried about. The only time action was taken against an employee was if the same error kept happening. Then they'd start with re-education.
It has nothing to do with rather "your comfortable". :angryfire When you pass meds it is part of your job duties and that you are following the six medication "Rights". And when you do find a med error you can usually tell if it was just sloppy work on the part of the previous person passing, or if it was a blatent disregard to follow facility policy.
So to answer your question, I do feel comfortable with turning in med errors. I do this a lot in my current job and let me tell you I am not well liked because of it, however I am their to do my job and protect my patients. Plus my co-workers know I keep a close eye on it so it keeps them on their toes.
PICNICRN, BSN, RN
I always report an error and almost always a near miss- Like the other poster stated- it is not to get someone in "trouble" it is simply to learn from the situation and assure that is does not happen again. What could have been done to avoid this? Is there something wrong with the process? We can't learn unless errors are reported.
netglow, ASN, RN
What do you guys describe a "near miss" as? Do you mean you witnessed and stopped something that was about to happen?
It has nothing to do with rather "your comfortable". :angryfire When you pass meds it is part of your job duties and that you are following the six medication "Rights". And when you do find a med error you can usually tell if it was just sloppy work on the part of the previous person passing, or if it was a blatent disregard to follow facility policy.So to answer your question, I do feel comfortable with turning in med errors. I do this a lot in my current job and let me tell you I am not well liked because of it, however I am their to do my job and protect my patients. Plus my co-workers know I keep a close eye on it so it keeps them on their toes.Nina
I think you're missing the reason for reporting errors - its to identify patterns of errors and to improve systems to reduce them. You aren't "turning in" an error or a person. And everyone at some point in time is going to make an error. What is dangerous is when people are afraid to talk about them or to acknowledge them. Then nobody gets the chance to learn from them or to improve systems or working conditions to reduce them. I am comfortable reporting errors, including ones that I make, but I don't act like I am turning anyone in.
By the way, have you ever made a med error (that you know of)?
BittyBabyGrower, MSN, RN
Absolutely they should be reported! Near misses included. We consider near misses as wrong orders that have gone past a pharmacist, past the nurses who double check the meds, things similar to that. It isn't to punish anyone, but to target an area that needs re-education in most cases. Also, if it is a true med error, the report is also given to risk management who keeps it on file in case there is a repercussion (ie lawsuit) and they will pull it with the chart. It is used as an explaination many times (med timed for q18, given q12, med stopped 1/2 way thru infusion, dr X notified and random levels drawn, MAR time entered wrong by pharmacy).
iteachob, MSN, RN
There is an excellent website (ismp.org) that keeps records on errors and near misses. They have a monthly newsletter that issues warnings about these patterns of error. It is vitally important that med errors are reported; and yes, I have made and reported such.
Yes, generally a near miss/good catch is when an error could have occurred, but you caught it before it actually happened.
Actually, many, dare I say most, errors occur due to a systems failure, as opposed to a person doing "sloppy work" or "blatant disregard for facility policy". The question I am trying to get at is, does your employer/you/your fellow nurses view med errors as a product of "sloppy work", or as a failure of systems that should be in place to prevent errors from occurring? One indicator might be, if you report an error or near miss that another person did, does your co-worker give you the cold shoulder for "writing them up", are do they thank you for bringing it to light?
I would report med errors if the supervisors would fill out the many extensive incident reports that are required. In the past, when I use to report med errors, I was punished by being told that since I had found the error that it was "my responsibility" to stay overtime and fill out all of the endless paperwork. After being overwhelmed with too much unwanted overtime, I stopped reporting med errors.
To the OP I assumed you also meant is the environment in the facility one that would see reporting a med error as a "gotcha" type situation. Or an opportunity to teach and avoid the error in the future. I work in a facility that does the former so no, I am not comfortable reporting errors.
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