Medication errors

[Buffy]

I'm Director of Nursing in a Long Term Care Facility, I would like to know what some other facilities do for positive reinforcement to their staff.

[nightmare, RN]

I am a Charge Nurse where I work. I am currently having problems with my CNAs. Lately we have a new group of young girls, and I am having trouble gaining respect. Any ideas out there? I don't want to be known as "------"

One way to gain their respect is to work with them,one to one,when they see that you can do what they do and know the "job" then ,hopefully ,you will get some respect from them.I realise this can be difficult for you what with the time constraints of your other duties but it works for me.

[marjoriemac, LPN]

I like to say thanks to my staff at end of each shift, I buy the staff I work with over Christmas a wee gift too. I've been lucky with employers and most are good at letting you know you have done good albeit in private as heaven forbid people knew you were doing good!

[nightmare, RN]

Welcome back to Scotland ,Marjorie. I also buy something for the carers at Christmas because without them we would get no where!

[SuesquatchRN, BSN, RN]

We get written up for med errors. Any 3 write ups pertaining to the same offence, then gets a counciling slip. 1st counciling slip is a written warning, 2nd one is 3 days off (no pay) 3rd one is 5 days off (no pay) 4th, your out the door.

Where do you work? We'd have no nurses left!

Don't do what my facility does. The oncoming nurse is expected to police the previous and write up any of her errors. Nurse narcs.

[nightmare, RN]

Your reporting of med errors sounds really punitive!Not that we don't take errors seriously,of course we do,but usually if errors occur they are pointed out.If it is just a case of forgotten signatures we remind one another to sign drugs given sheets.Obviously if there are more serious omissions then the manager gets involved and a period of supervision happens to brush up on medication policies and procedures. If in doubt we often phone each other to double check that a drug has or has not been given especially between night and morning shift where the night staff start off the morning drug round and the day staff finish it.

[SuesquatchRN, BSN, RN]

If it is just a case of forgotten signatures we remind one another to sign drugs given sheets.Obviously if there are more serious omissions then the manager gets involved and a period of supervision happens to brush up on medication policies and procedures.

Signatures aren't an issue.

As an example, ystdy I worked a unit I haven't been on in three weeks. Changes happen.

I missed a sucralfate on a dialysis patient - one for which she has two orders, on different pages. Missed phoslo for one dialysis guy who was not on the "cheat sheet," which I had asked the charge nurse to check for accuracy before I used it. Had activities haunting me about people leaving the facility for lunch - no notice - so I banged out meds for the four of them quickly. One of them gets TWO comtan and sinemet, not one. And I gave a tramadol am instead of pm. So I'm in deep doo-doo because the nurse who follows me wrote it all up.

[nightmare, RN]

What do your drug prescription sheets look like? Ours are one sheet alphabetically A to Q and any changes are written in then the original scored out.If we have to use two sheets they are positioned in the kardex so they are one above the other so that you can see at a glance if there is more to give out.We use flip over kardexs with the drug prescription sheet at the top and the drug giving sheet at the bottom so that you can write in the codes at a glance.We have two kardexs one for each side of the building and two drug trolleys.Once the doctor has been he either writes in the changes himself or the RN taking the doctors round writes them in.They are never written anywhere else.

[SuesquatchRN, BSN, RN]

We have loose leaf notebooks with sheets for each patient.

[nightmare, RN]

Does this mean that you have to look through more than one sheet to find what they are prescribed?

[SuesquatchRN, BSN, RN]

Yup.

My favorite is ONE prescription that requires two pills and is not only on two pages but separated by other drugs.

God, I'm down, S. I feel so incompetent.

[nightmare, RN]

I don't think your incompetant, but it sounds like your drug sheets are difficult to use!!I'm not criticising, I suppose the same system is used all over US?I'm just used to the kardex system where if a drug is changed the original is scored out.If the sheet becomes too untidy with scored out drugs we rewrite them so they are clearer.Having one script on two pages sounds like a recipe for errors.

[SuesquatchRN, BSN, RN]

Having one script on two pages sounds like a recipe for errors.

Heh. Ya think? I like the scrips that change on different days *and* are on different pages. But most of all, I don't think there's another facility on earth that does what mine does in tracking.

We're not allowed to erase anything legally.