Med errors

I have been a nurse for 2 years. I know alot of us have made our share of med errors. How does this affect our jobs? Meaning is there a set limit and then you get suspended or have the State boards revoke your license? Or, Is it up to the manager you are under? Does it depend on the level of harm done? I never got a write up for mine. 2 my first year, and one after that. but it was mentioned as a performance improvement on my review. just basically reminding me of the "5 rights" kind of thing. But I have heard of nurses who got suspended or fired after 1 !! I don't know if this varies state by state? In NC, we are required to fill out an incident report, but it says on there that it is not to be used in a punitive manner against the responder. I almost wish it was more clearly defined as to what will happen, after so many etc... so at least people will know what to expect. Obviously if its bad enough, they have to act. But with minor mistakes, it seems they are and can be used against you if management decides it wants to. Again, safety is a big issue. But this seems unfair. I know some Rns who have made many, and not one thing shows up on their file, others get beaten to death over 1. Surely there is a better and safer way to deal with this! Any managers out there who have insight on this matter? Just wondering?

[tonchitoRN]

you are right, this is confusing. i have a feeling it is the whim of the nurse manager and administration. i would be curious what others say.

[jenac]

We had an agency nurse give the wrong resident the wrong meds once. It was brought to her attention by another resident. I don't believe any formal disciplinary action was done. I think the agency was asked not to send her again though.

[Ruby Vee, BSN]

I think it's an individual thing. If the nurse involved has a habit of making drug errors, one small and relatively harmless mistake may be the straw that breaks the camel's back. Especially if the nurse doesn't seem to "get it." (Laughs it off, doesn't understand the potential seriousness of the error, doesn't apologize profusely and take steps to do better . . . you catch my drift.)

On the other hand, a nurse who makes a relatively serious error, but understands the ramifications and is serious about taking responsibility for his/her error and ensuring that it won't happen again probably won't face any long-lasting or serious consequences from his/her employers. Unless of course a patient is harmed and a lawsuit ensues.

A pattern of drug errors is more of a problem than one real obvious error. A pattern of not owning up, making excuses, blaming someone else is more worrisome than someone who immediately takes steps to rectify the problem.

[CseMgr1, ASN, RN]

I worked with an L.P.N. once, who gave a patient a double dose of Dilaudid, with disastrous results, sending her into respiratory failure. The dose was supposed to have been gr. 1/32...and the nurse gave her gr. 1/64 (added up 1/32 + 1/32, when she should have just given her half that amount). I think that the patient survived, but the nurse was demoted to an aide after that.

It was scary, and I felt badly for both the nurse and her patient, for it could have happened to me...or anyone else.

[Tweety, BSN, RN]

I worked with someone who gave a med to a patient that was allergic to it. Gave Unsayn to a person with a pcn allergy. The patient coded and was immediately brought back and had a good outcome. But she was reported to the state and had to defend her license.

I wonder that if the error is so bad that it doesn't get reported to the state as a matter of law, or at the whim of the manager.

But usually nurses are counseled on the five rights, or if it's an MD or Pharmacy error that is address.

Bottom line though it's always the nurses fault because we're the ones who give the meds. A scarey and awesome responsibility.

[Trixie01]

Wow, still sounds very vague to me. I appreciate your responses.

So it sounds like if your nurse manager does not like you, you better be extra careful in not making mistakes. Not that we wouldn't anyway, but somehow this seems so unfair, because it all goes back to politics. Who's scratching who's back, you know?

I mean they can yank your license or fire you for a mistake???

[ainz]

I don't think it is as simple as if you are liked or not and just a matter of "politics." I think Ruby Vee is on target. Some hospitals have policies that are crystal clear in writing, many do not. It depends on the severity of the error, the patient's outcome, the nurse's attitude about it, the nurse's past performance, and how focused the management of the hospital is on reducing medication errors. With the current emphasis on medical error reduction and the national patient safety goals from JCAHO, med errors are being looked at more closely but with emphasis on the process and not necessarily the person making the error. Many hospitals are trying to encourage increased reporting of errors and have made a commitment to not be punitive toward the nurse making the errors. But it goes back to the things mentioned earlier--patient outcome, nurse's attitude and performance. Some states have language in their nurse practice act that requires you to report incompetent practice so a "gross" med error with a bad patient outcome could result in being reported to the board of nursing, others are not so strict but any grossly negligent med error with a bad patient outcome has the potential to be reported and the board take action on the nurse's license. There are just many variables to consider and it is handled on a case-by-case basis usually.

[geekgolightly, BSN, RN]

Originally posted by CseMgr1

I worked with an L.P.N. once, who gave a patient a double dose of Dilaudid, with disastrous results, sending her into respiratory failure. The dose was supposed to have been gr. 1/32...and the nurse gave her gr. 1/64 (added up 1/32 + 1/32, when she should have just given her half that amount). I think that the patient survived, but the nurse was demoted to an aide after that.

It was scary, and I felt badly for both the nurse and her patient, for it could have happened to me...or anyone else.

i havent worked with grains, but don't grains work in fractions? clarification, please.

[sympathoadrenal]

Originally posted by CseMgr1

I worked with an L.P.N. once, who gave a patient a double dose of Dilaudid, with disastrous results, sending her into respiratory failure. The dose was supposed to have been gr. 1/32...and the nurse gave her gr. 1/64 (added up 1/32 + 1/32, when she should have just given her half that amount). I think that the patient survived, but the nurse was demoted to an aide after that.

It was scary, and I felt badly for both the nurse and her patient, for it could have happened to me...or anyone else.

Ok, CseMgr1-

1/64 gr is a half of 1/32 gr.

If it's easier to understand, 1 grain equals to 0.0648 gram and

approx. 1/32 gr = 2 mg and 1/64 gr = 1 mg.

Anyway, 1/32 + 1/32 = 2/32 = 1/16 (not 1/64!!!)

Yes, it is scary. We better caliculate correctly or sorry.

[bedpan]

i am just a student and am maybe misunderstanding what is being said but - I was under the impression that it was only the state board who could suspend or take away your liscense and during that time you were not allowed to work period?

How did anyone get "demoted to aide" and who did that?

[TeenyBabyRN]

Originally posted by CseMgr1

I worked with an L.P.N. once, who gave a patient a double dose of Dilaudid, with disastrous results, sending her into respiratory failure. The dose was supposed to have been gr. 1/32...and the nurse gave her gr. 1/64 (added up 1/32 + 1/32, when she should have just given her half that amount). I think that the patient survived, but the nurse was demoted to an aide after that.

It was scary, and I felt badly for both the nurse and her patient, for it could have happened to me...or anyone else.

This post confused me as well. (Then again, I dont use grains much either. We use mg and mcg, mostly... I just remember 15gr = 1g from school, which would make 1gr = approx 66.67mg.) Wouldn't double the dose of a med orderd as 1/32 gr. be 1/16 gr? (1/32 + 1/32 = 2/32 = 1/16). 1/64 gr. would be half the correct dose instead of double it if I am reading the post correctly.

But, as I said before, I am not familiar with grains. Therefore, I have no idea how an order for a medication ordered in grains should look (should it be a fraction?, etc). Just goes to show how easy it is to get confused and how important it is to clarify unfamiliar orders.