Medication Errors....

[momandstudent]

I am the occ. health/education/infection control nurse at a SNF and I am trying to come up with some material to help alleviate medication errors among our nurses. Right now, when an error is found, a form is filled out and the nurse and DON discuss what happened and what steps will be taken to prevent further mistakes. Many, many times, the nurses say, "Will pay closer attention or will take more time during the pass." Our DON is new and would like me to come up with some sort of "homework" for the nurse(s). She did give me a packet to go through this weekend which is about 60 pages of combined reading and essay questions. I have not thoroughly read it (it is the weekend ) but I was wondering if anyone else had any good ideas. I am going to post this in some other areas on the board but thought I would start here as it gets more traffic!!!! Thanks for any input.

[ktwlpn, LPN]

Let's face it, some nurses are too lazy (flame away) to pass meds the way they were taught....oh wait....maybe in the 10 months they spent in LPN school they weren't taught enough.

I'm not going to "flame away". I'll just point out that I've worked with plenty of lazy ,careless nurses,both RN's and LPN's. I'm surprised a comment like that would come from a nurse of your caliber-I suspect you might have had a really bad day.

[CapeCodMermaid, RN]

You're right...it was a horrible day. All the nurses on one unit hung the incorrect tube feed for 3 months because they didn't bother to read the label and compare it to the MD order. There is no excuse for this.

[ktwlpn, LPN]

You're right...it was a horrible day. All the nurses on one unit hung the incorrect tube feed for 3 months because they didn't bother to read the label and compare it to the MD order. There is no excuse for this.

You're right, there is no excuse. We can tell horror stories all day long recounting tales from various settings of egregious errors committed by fellow LPN's and RN's. Bottom line is a lack of responsibility and accountability and that runs across the board and sometimes even up the food chain. If you can't get the basics right in your LTC you better look closer because your problems likely go much deeper then nurses with a cavalier attitude towards the med pass. If the staff sees that the admin don't care enough to really make some changes for the better then they won't care. Simple basic crap like a broken fridge on the unit that the DON can replace with one phone call but doesn't because she is acting in a passive aggressive manner towards her staff really can bring down morale. Maybe the staff has sensed an attitude change .I don't remember ever seeing that type of disparaging statement from you-maybe you have a few you need to weed out and they have soured your mood.I used to get really offended when a supervisor felt the need to speak to me like I was an idiot until I realized I happened to work with a few and they NEEDED a roadmap to find their butts. But I can't say it was mostly LPN's.

[systoly]

i think your nurses have already isolated the most common problems

distraction, time constraints

paying closer attention and taking more time is fine, but

how will they do that?

what caused the distraction and how can it be avoided

as someone posted, some studies/facilities have recognized that

distraction is one of the leading causes of med errors and have implemented

plans to avoid such distractions

[BrandonLPN, LPN]

You're right...it was a horrible day. All the nurses on one unit hung the incorrect tube feed for 3 months because they didn't bother to read the label and compare it to the MD order. There is no excuse for this.

And I'll bet some of those nurses were RNs....

I do know what you mean, though. When I floated from unit to unit in a 13 unit facility, I saw some horrible things. A lot of them were due to poorly written MARs, but that's only part of the story.

The nurse is still responsible to READ the MAR. More than once, I saw residents getting a Mon-Wed-Fri every day because someone forgot to box off the days. When confronted, the nurses would say it was the secretary's fault for not boxing off the days. Yes, the secretary should be held accountable for that, but the med order on the MAR still read Mon-Wed-Fri.

Not reading the MAR is just laziness. No way to sugar coat it or shift the blame.

[CapeCodMermaid, RN]

All our equipment works perfectly well. The staff know I care about them and their working conditions and I care about the residents which is why it's so distressing to me that the mistake was made. Certainly there were RNs on the floor. And certainly there ate medication errors made because of systems problems. In this case, the mistake was one of simply not following process and there is no excuse for that.

[ktwlpn, LPN]

And there is also no excuse for an administrator of an LTC to post a clearly inflammatory and derogatory statement condemning an entire group of people here on a forum that is typically populated by that very group of people.It makes me think that most of the staff in question are feeling that prejudice and their morale is suffering. It's similar to the folks who come on here and bash the medical community and nurses in particular. And I'm sure we'll be old,grey and half dead before an apology is issued for a remark that borders on a TOS violation, IMHO saying "flame away" in the post reveals the clear intent behind it.

And I'm done-I'm exhausted and embittered because I'm embroiled in a mess at work in which a supervising RN failed to follow through per policy and protocol after a matter was documented and reported to her, she dropped the ball and now it's a BIG hairy,scary deal. An RN... So,I done.

[CapeCodMermaid, RN]

It wasn't a question of LPN vs. RN. Part of the reason this forum exists is for us to be able to vent. I don't belittle or disparage any of the nurses who work for me. I am NOT an administrator...just the humble DNS who has as much or more stress than anyone else in the building. Apparently, if one is a manager, one is not allowed to vent. If I were a new grad, I could say whatever I wanted and no one would care. We should ALL be free to say what we feel on here.

The flame away comment was said because I knew people would take offense. Unless I point my finger at you, don't be taking offense when I vent on here.

yowza

[BrandonLPN, LPN]

It wasn't a question of LPN vs. RN. Part of the reason this forum exists is for us to be able to vent. I don't belittle or disparage any of the nurses who work for me. I am NOT an administrator...just the humble DNS who has as much or more stress than anyone else in the building. Apparently, if one is a manager, one is not allowed to vent. If I were a new grad, I could say whatever I wanted and no one would care. We should ALL be free to say what we feel on here.

The flame away comment was said because I knew people would take offense. Unless I point my finger at you, don't be taking offense when I vent on here.

yowza

I'm just curious why you would single out LPNs if, clearly, some of the nurses who hung the feeding were RNs.

[ktwlpn, LPN]

It wasn't a question of LPN vs. RN. Part of the reason this forum exists is for us to be able to vent. I don't belittle or disparage any of the nurses who work for me. I am NOT an administrator...just the humble DNS who has as much or more stress than anyone else in the building. Apparently, if one is a manager, one is not allowed to vent. If I were a new grad, I could say whatever I wanted and no one would care. We should ALL be free to say what we feel on here.

The flame away comment was said because I knew people would take offense. Unless I point my finger at you, don't be taking offense when I vent on here.

yowza

The post clearly made it an LPN vs RN thing when it was stated that the 10 months of LPN school was not enough to teach one how to properly pass meds.

There are forums for managerment to vent in freely but I imagine it feels really good to come on here and "vent" the insults that one can't let fly at the real time objects of your anger.

There have been many instances where new grads post comments in an inappropriate manner and they are shown the error of their ways by the membership here-it happens all of the time. And sometimes it's ugly.

We are ALL free to say what we feel. It's funny when someone makes such a comment with a clear intent to insult and inflame and then backs down and claims "that's not what I meant".

Back to the topic at hand-speaking of med errors-I don't really know of anyone who makes a mistake on purpose, then it wouldn't be a mistake.

[thenursemandy]

If its a matter of being interrupted.... My institution has a policy that visitors and other staff are not allowed to interrupt nurses who are doing med passes unless its an emergency. We have a sign we put up on the med cart that basically says do not disturb and we have a pad of paper on our med carts that other staff and write on for us to see after our med pass.... We also use eMAR and I find this has been extremely beneficial in allowing me to stay organized manage my time and check check check before I walk off to administer![/quote']

Those sound like good interventions. I've never worked at a facility that implements not disturbing during med pass unless its an emergency. It sounds nice.

[thenursemandy]

Let's face it some nurses are too lazy (flame away) to pass meds the way they were taught....oh wait....maybe in the 10 months they spent in LPN school they weren't taught enough.[/quote']

I've never heard of becoming an LPN in 10 months! It took me 16 months full-time. I'm an RN now and don't think there is enough difference between the two to make one more proficient at med pass than the other. Med errors are often due to not paying attention to the 5 rights, something taught in ALL nursing programs. Besides playing the blame game is divisive and not constructive.