Medication Errors

kaycee · Oct 2, 2001

I believe the majority of med errors are made due to being rushed.

Fortunately most do no real harm, missed dose here, forgot to chart, didn't read correct dose, order not taken off correctly, illegible writing by MD ect.

Best fix,adequate staffing to have the time you need to give the best darn care we all crave to give!!

P_RN, ADN, RN · Oct 2, 2001

IMO

There are so many reasons that can lead to error. The suggestion that the buck stops with the nurse kind of gets to me.

I think it is more of a systems problem. First you have a patient who knows nothing about their own health status, seen by maybe an HMO doctor who is too busy to learn much about this patient.

Then there is the hospital who wants them IN to get the $$ and OUT to keep from spending too many $$ on them.

Meanwhile there is the nurse who can only devote minimal time to said patient, because the hospital thinks that too much $$ is spent on THAT DEPARTMENT. SO now you have this patient in this hospital.....

DO you see where Im going with this. Forget about physician handwriting (terrible), time nurses spend doing other departments work, trying to decipher the order that the pharmacist can't make out even from the original much less a fax or carbon copy. The physician by now is back at work too busy......

It would take a bazillion "white papers" to even touch this subject, but meanwhile the popular thing is to "kick the dog"

(AKA the nurse)......for the $1.6Bn spent on "errors."

SYSTEMS SYSTEMS SYSTEMS

P

purplemania, BSN, RN · Oct 2, 2001

Being rushed is certainly the biggest problem. It is hard to concentrate when under stress. I have learned to "just say no" when I am in the med room and someone wants a pillow, snack, etc. I have even ignored the call button and phone. I can't be everywhere at once and my license does not cover unit clerk duties.

picu75rn · Oct 2, 2001

Several years ago I worked as an assistant nurse manager in a 20 bed PICU. We tracked all our med errors and tried to find a trend as to a specific RN, time of day, activity of the unit etc. Our final outcome was the fact that staff weren't following the 5 rights of giving meds. I don't think poor staffing or being rushed is the only link to med errors. Yes it contributes but we as professional need to be respondsible for following the 5 rights of giving meds. If there is an order that is unclear due to legablity of the physcian,give that person a call. It takes just a few calls in the middle of the night to help with that problem. Interesting enough, med errors increased in frequency when our census was down and the activity level was at a low point. One of our biggest errors was hanging the wrong IV solution. :rolleyes: And that was primarily due to a change in the standard physcian order.Staff were not checking the order carefully.

KRVRN, BSN, RN · Oct 3, 2001

It's true about the being rushed and stressed thing. Also, it's easy to make math errors when you rush, OR if you're not careful. AND you can always take a step back and ask yourself does this dose seem logical? Is the dose REALLY 15 pills or should it be 1.5?

Shannon13 · Oct 3, 2001

As a senior in nursing school, my biggest fear about graduating and practicing is med errors! And reading what you all had to say made me feel better, my instructors drill us with the 5 rights- more so than action/ side effects of drugs. so maybe if i get into that practice i'll be ok,

shannon

frustratedRN · Oct 3, 2001

when i was in school i had a diabetic patient and as i was getting her insulin together the hospital nurse came and told me that she needed 2 units of regular insulin. i wrote sloppily and when i was drawing it up i thought it said 20. my U looked like a zero.

i gave the insulin.

27 units.

i realized how big that dose was as soon as the plunger was flush with the syringe.

i didnt know what the heck to do.

should i tell my instructor?

should i just let it go and see what the outcome was?

i thought about the second part and the possible consequences of my actions. i decided that no license was worth somebody's life

and i went to my instuctor (of course most of the class was standing there at the time)

i told her right in front of everyone.

we told the staff

we called the doc

we took an accucheck

we hung an iv of saline

we filled out a report

and then....worst of all....my instructor and the staff nurse went in and explained what happened to the patient and asked her if she still wanted me as her nurse.

she said OF COURSE!

and asked to see me.

as soon as i got in the room i burst into tears and apologized a million times.

she said....

"honey dont you even let this discourage you. you are a very good nurse and these things happen. i make mistakes with my insulin all the time, of course not as bad as yours, but i do make mistakes and i give it to myself every day.

now you just go on and be my nurse. you are a very good nurse and im glad you are my nurse"

i cried the rest of the shift. nobody had ever touched me like that before. i didnt feel like i should be a nurse. i didnt feel worthy.

i carried that with me always and nearly quit school. coming back the next day was one of the hardest thing i ever had to do.

but i did it.

now im very very careful about passing meds.

ive caught myself a few times.

being rushed certainly is a problem but i find that when i do my near misses its because i have not looked at the doseage and just assumed the whole tablet was the right dose.

or i just assume that one tablet is the dose when sometimes its two or three or more.

i nearly gave the wrong patient meds once. i dont look at the bands but i always say something like ....mrs jones i have your insulin for you or whatever the med is.

one time i had a confused patient say "yes"? when i asked if she was mrs. jones....lol

now i make sure i identify the patient.

so best of my knowledge i havent made any med errors....yet

but ive come damn close.

Shannon13 · Oct 3, 2001

Thanx so much for that story- i had an instructor last year made me soooo nervous i stuck myself with a needle(clean) and once i refused to give a pt. her hypertension med- she had an epidural, and her pressure was runnignin the 70's all week, so the instructor yelled at me in front of the pt( boy that was embaressing) anyway the pt ended refusing the med- and called her dr- he came up and told the instructor - no hypertension meds are to be given til he sees her in the morning.

Thanx again- i have a question? why r u the frustrated nurse?

frustratedRN · Oct 3, 2001

because i am trying to do a job that cant possibly be done

BadBird, BSN, RN · Oct 3, 2001

I think the most common error is the "right time" due to the pharmacies thinking they have all day to fill orders, many medications are given late or a dose is skipped. Also another common error is that a drug was cancelled and replaced by another but the nurse is unaware as it is still on the mar, always check your chart coming on for new changes.

ClariceS · Oct 3, 2001

When I was in training, while they did emphasize the 5 rights, my instructors also harped (for our good :) ) on the triple-check rule.

1. Check what you're pulling. Look at what you are getting out of the drawer.

2. Check what you are drawing/pouring. Look at the container as you draw or pour the med.

3. Check what you're tossing. Look at the container/vial once more before it goes in the trash.

With a bit of practice, this triple-check rule becomes part of the natural process of getting a med (not extra time). It might not prevent all med errors but may help.