Medication errors, advice.

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Hello everyone, wanting some insight, I've been an RN in a LTC for almost 6 months. I've had 4 med errors, first one I accidentally gave someone levothyroxine that wasn't suppose to get it, 2nd had a R come to my hall that had a 12a narcotic, I didn't see it and missed this. 3rd was a order said 1.) D.C. Mylanta, Tyl then had a small 2 beside tyl and said 145mg fenofi rate HS. I misinterpreted the order and thought it wanted to D.C. Fenofibrate, I even had a nurse double check me and still was not caught. I forgot to give a xanax for a R, I swore I gave it, but she only gets it once at night and the count was off on me. I reported 3/4 of those on myself, the fenofibrate was caught on change over but I wasn't given the med error til 1/2 a month later. I'm just feeling hopeless, I've learned from each error.. but I feel like maybe LTC isn't for me? But then it seems everyone is making med errors, mainly not giving narcotics, one nurse even missed 3 in one night (not found by me). So I know I'm not the only one, but I feel we could improve the system. Just looking for insight.

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Are you on paper still or on an EMR? I have done both types of charting in LTC and both come with their own challenges. If you are doing an EMR, which one? You should be able to avoid missing certain med times by checking your overdue meds. The error I would pay the most attention to is giving the Synthroid to a patient that wasn't supposed to get it. How are your meds set up at this facility? In a cart or in a locked drawer in their room, etc?

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Are you on paper still or on an EMR? I have done both types of charting in LTC and both come with their own challenges. If you are doing an EMR, which one? You should be able to avoid missing certain med times by checking your overdue meds. The error I would pay the most attention to is giving the Synthroid to a patient that wasn't supposed to get it. How are your meds set up at this facility? In a cart or in a locked drawer in their room, etc?

We are paper MAR, in a cart. I feel the last med error I missed from people continuously coming up to the cart during my med pass and having to stop what I'm doing. I have 28 R, two of which have g tubes.

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We are paper MAR, in a cart. I feel the last med error I missed from people continuously coming up to the cart during my med pass and having to stop what I'm doing. I have 28 R, two of which have g tubes.

I know it can be difficult to have people interrupt you during a med pass but you can't let that be your excuse for med errors. You could always say "Do you mind to wait just one minute while I finish gathering these medications? It needs my full attention and I would like to give you my full attention when I am done". If your interrupted, re-check the MAR and the meds you have before you take them into a patient.

28 patients is the normal load and it is heavy. You will get a routine down and it won't feel so overwhelming soon. The good part about LTC is that it is predictable and your able to get a fairly standard routine down with your residents since they will not change often. Use that to your advantage!

Are you delegating to your PCAs? I always struggled with this because I like to do things MY way. But you just don't have the time so use them if they are available and also help them in return when you can.

At the end of you shift, go through the paper MAR and see if there are any missing signatures for that day so you can see if you missed meds that day.

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Specializes in Med/Surg/.

First and foremost make sure the medication instructions are written properly. I am seeing Nurses writing some to where even I today do not understand.(this is on written Mars). If an order is written to where you question it you can either call the Nurse or call the Doctor and verify. He might get P&*% but so what that is what he gets paid for...If you have to read an order 3 times or more get it verified. If this was the way that order was written any of us could have done the same thing. A good way to get around all narc orders is to go through them and make a list of who gets reg Narcs. Watch where they write those orders. If it's the last little space at the bottom bring it to there attention to stop writing in that space....This where many are missed as they are too lazy to get another sheet. I have seen this over and over. Make a list of your thyroids. If you will do this then it is a one time list and use every day until all are memorized as NH meds are. I have worked with Nurses who never looked at the book and never missed a beat. There is always some back up for you to do. If you like it other than the med error situation here are a few suggestions to might try....

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Specializes in retired LTC.

I found TIME was my biggest enemy doing med pass. I was never fast. Like you, I just couldn't figure out how come others were so quick (altho I have my suspicions). But I would feel like I need to be speedier!

And one time-killer having the potential for med errors was my unfamiliarity with containers for meds NOT blister-carded. Like what does a bottle of Lasix look like or where are the nitro patches? Eye oints? And stock bottles? My pet peeve was searching high & low for eons for a med and then learn it was in the med refrig in the med room.

Those were agonizing for me.

It would also blow my cork when I'd find no glucometer sticks, or the meter was low-battery. Please! Just tell me if you can't get to it yourself and I will!

I also kept a large page of note paper for me to make notes. I wouldn't stop a med pass to check out something (unless I absolutely had to). I'd flag the med to come back to. That scribble note sheet was my invaluable BIBLE memo.

I was always finding discrepancies when I did meds, esp on a new team/transf pts/diff floor. Maybe I was just super diligent, but I felt it was my absolute obligation to investigate & correct any discrepancy I found. Maybe because I usually was supervisor (and would have to do the investigation anyway) I always had a page full of 'things' to check out. Like after my med pass, I would be doing the chart check to figure out why the MAR listed 'lisinopril 20mg', but I had a brand new, UNOPENED, new current-dated card for 'lisinopril 40mg'.

Here's the sad thing - although as knowledgeable and experienced I was/am, I realize it is next to impossible for a staff nurse to take the TIME and steps to make corrections on a LARGE SCALE. It's 'WHAM, BAM'. A quick fix.

Even I had difficulty doing the documentation for an investigation & plan of correction. I would resent the TIME I'd be spending.

So to OP - that's where the change needs to be made. Fixing the system RIGHT. Which needs time & effort.Easier said than done.

And for those who'll bemoan the need for improved staffing - it ain't gonna' happen!!! I wish it would.

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Specializes in Education, Informatics, Patient Safety.

I have so much support for you! You are not alone - this happens to nurses all the time. What we do is so difficult. Please take a look at my blog - I think it will provide you with some healing and some resources. I have SO much support for nurses involved in medication errors - due to the shame and blame environment we work in, it an incredibly stressful experience. The system CAN be improved, and we need you - nurses who have made errors and admitted them are the safest nurses I know - we get it. You are not a bad nurse, you are human.

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