medication error?

neneRN, BSN, RN · Mar 23, 2006

The routine in which you give meds in the beginning are the ones that you'll do for the rest of your career. i.e., its easier to start a habit than it is to break one....check your armbands/allergies/rights every time now and you'll make it second nature; if you start letting these things slide now, they'll be easier to let slip by later. In nursing school, they taught us to check the med when you grab it, check it again as you draw it up, and check it again before you toss/put back the vial; 5 years later I'm still doing that; its become automatic.

And my biggest pet peeve, DON'T GIVE ANYTHING UNLESS YOU KNOW WHAT THE MED IS AND WHY YOU ARE GIVING IT....They harp on this in nursing school over and over, but I frequently see students/new grads giving meds they don't know anything about. It's not up to your instructor/preceptor to tell you about the med you're giving; its up to you to find out; and I don't mean that in a mean way, its just that your license can't rest on what someone else is telling you. (Keep your drug book with you!) And I think this happens because when you're new, you don't want to seem stupid/ask a silly question. Often, I'll go over an order with a student, watch her prepare the med, and if she hasn't asked any questions about it, then I'll gently ask why she thinks we're giving the med. Often they don't know the med/side effects, etc., which is fine- I don't expect you to know all the meds, but I do expect you to ask questions/look up the med if you're uncertain; what's not fine is just blindly giving the med. My point is just to let you know that no nurse expects you to know everything about every med; so DON'T be afraid to say so.

rosemadder · Mar 23, 2006

Trust your gut also...if something seems wrong recheck it...if something doesn't make sense question it. Also, if and when you make a medication error own it quickly. Don't try to cover it up or let it slide...take responsibility and do what's necessary to make it right. Use that opportunity to learn and you will not likely make the same mistake again.

strawberry2006 · Mar 23, 2006

Thank you for your input!! I have read an article about 12 hr shift and med. error, where 12hr shift is increasing the rate of med. error than 8hr shift. is it really true? if so, should we go with 8hr than 12hr?? What do you think about that? Thank you

pricklypear · Mar 23, 2006

I've developed the habit of checking multiple times. Matching medication with medex, bottle with medex, rechecking the med books even if I'm resonably sure I know what I'm giving or how to give it. I always double check the dosages in case a med needs to be broken - sometimes phamacy will put stuff in the pyxis in the correct form, and other times they won't - lots of errors are made this way. If I'm drawing from a vial, I check it before I open it, and before I remove the needle, and I label it immediately. If it's a dangerous med, or a tricky calculation, I will leave the needle in the vial, and have it double checked by someone else. It's almost a compulsive thing! I always take the medex into the room, leave the meds in their packages, and go over the meds and dosages with the patient before giving them. I've had patients say, "I don't take that med," or, "I only take 50 mg of that med." I've found errors in transcription this way, or often it's just a new med or dosage that nobody told the patient about. It takes more time, especially if you have lots of pts to pass meds to, but you either spend the time checking, or writing yourself up.

Another big way errors are made, in my experience, is when giving meds for another nurse. If someone asks you to give meds, don't just take their word. Go through all your usual checks, don't assume they've been careful. I've seen nurses give meds to the wrong patient because they misunderstood who the meds were for, and didn't double check. Think twice about giving IV meds that have already been drawn up by someone else - you don't really know for sure what's in that syringe.

It's interesting that there may be more med errors on a 12h shift. Personally, I think med errors corelate more closely with patient load, acuity and chaos on the unit, than with fatigue. Of course, you simply give more meds on a 12 hour shift than an 8, increasing the chances of an error just by the numbers alone.

One more thing - don't assume that the doc, PA or whoever, knows what they're doing when they order a med. I've seen LOTS of bad orders written. As an example, I had a patient who was given digoxin. It was ordered by a PA as 0.25mg q 15 minutes X 4. Unfortunately, it was given exactly that way (by a very experienced nurse). The dig hit her all at once about 6 hours later and she became seriously bradycardic and hypotensive. She was also dangerously dig toxic and had to be given Digibind to reverse it. Loading doses of IV dig are usually given in 0.25mg increments Q 4 hours X 4 doses. Look it up, if it doesn't seem right, call and clarify.

Good luck in your future career!

strawberry2006 · Mar 23, 2006

Thank you for the reply, pricklypear! It will help me a lot! I was wondering one thing...

"It's interesting that there may be more med errors on a 12h shift. Personally, I think med errors corelate more closely with patient load, acuity and chaos on the unit, than with fatigue."

how does pt acuity affect med administration? simply, lots of meds to give? or something else? Thank you!

pricklypear · Mar 23, 2006

how does pt acuity affect med administration? simply, lots of meds to give? or something else? Thank you!

Yes, sometimes lots of meds. Sometimes you may be concentrating on a higher acuity patient, and make simple errors on another patient simply because you were distracted, stressed or hurried.

strawberry2006 · Mar 23, 2006

I see... I have seen many nurses have 7-8 patients with 15-20 meds each. It seems a lot to me though, is it normal? do we have any campaign/movement going on to improve this situation (reducing med. error?)? in any states? Thank you

carolyn2180 · Mar 23, 2006

Hi everyone I'm not an Rn yet hopefully soon but I'm a certified medicine aide and you should do The Five Rights: Rules for Giving Medications --

1.) Right Drug

2.) Right Dose

3.) Right Patient

4.) Right Route

5.) Right Time

I have had one med. error and I confessed about what happened. Although I didn't do any harm to the patient I learned a better way to avoid this error. CAROLYN

strawberry2006 · Mar 23, 2006

Thank you carolyn for your reply. so...what are you doing now to avoid med. error (if you don't mind sharing with me)? Also, anyone know how to update ourselves with current nursing or medical field news (i.e. new meds, new laws, etc...)? Thank you!

carolyn2180 · Mar 23, 2006

Well I make sure I do what I was taught in class for sure I never under estimate any more I do the Five Rights. I first thing I do before punching out meds from the card is to make sure the card matches the med book, then its the right dose, then you have the right patient and its easier knowing your patients in a nursing home than it is in a hospital. Then you make sure your giving the medication the right route, at the right time. And you have two different books the treatment book and the medication book. And if it says take pulse before administering then take the pulse because certain meds are required to be given over a certain pulse rate and not under. And the same with taking a blood pressure. If you follow the rules you will do fine and so will your patient. Good Luck! Carolyn

LPN1974, LPN · Mar 23, 2006

My job is in process of going over to a computer system of giving medications.

Each med card for each person will have a bar code on it and the cards will be scanned.

Our DON swears this is going to reduce med errors, but we'll see. Any computer system is really only as good as the person entering the data.

It is supposed to be turned on by April 1!