I recently wrote a paper in my Intro Nursing Class on Medication Errors. I included numerous studies, and general information on the what, when, why, when and where. I'm now going to be doing a group presentation on the topic, and I thought it would be a nice addition to the project to get input from actual nurses on the Why.
So, if you wouldn't mind obliging, could you please share why you believe that medication errors are still such a problem today?
Most of the "reasons" listed so far are not reasons, but excuses "too busy/many/much". The reason every med error is made is carelessness. Not just on the part of the RN but and the whole system.
from the physician who scribbles something
to the RN and pharmacist who guess at what it is
to the pharm tech who places the wrong med in the wrong drawer
to the RN who gives the wrong med/dose at the wrong time to the wrong patient
Each of these breakdowns in the system probably occurs in every hospital everyday and careless or lack of attention to detail is the main contributing factor
Specializes in Tele, Renal, ICU, CIU, ER, Home Health..
I think the majority of med errors happen because someone failed to follow policy and procedure. Sure, you didn't follow P&P because you were busy, over-worked, sleepy, stressed...etc. But the bottom line is, someone took a short-cut and made an error. Something that I have been guilty of as well.
i have made med errors giving an ace inhibitors and not checking a BP, patient BP dropped and needed volume expander. so although i used the 5 rights i had not paid sufficient attention as the patient was on that drug for a long time.
its taking short cuts and presuming that an lead to mistake, patients was ok i felt very guilty that i may have caused harm and learned a lesson the hard way.
Yes, and once again, WHY is there a lack of attention??? Because they're willfully careless? No.
YES you are willfully careless when you take a drug and inject it into another human being with out taking the 30 seconds to verify it is the right drug/dose/ ect. It is a decision that is made each and every time you medicate someone.
I believe it's listed as a med-error if the med isn't given within the hour-before and hour-after listed on the MAR?
When I was working (I quit last year) many of my errors were lateness (the right med and right dose would be given in the right route to the right patient, but not at the right time). We didn't have any high-tech methods for telling if a med were given late-- you'd have to carefully scrutinize the paper MAR to notice.
Some of the reasons for this include: med not sent up from pharmacy; my poor time management; my being overloaded with work; our techs for the day hiding in the lounge (I've seen my share of great techs but believe me, by the time I left this unit....never mind. If you've experienced bad techs, you don't need any explanation).
If I had decent ancillary, families that didn't deliberately get in the way, few or even no missing meds, and patients who didn't constantly go off the floor (oh, off the floor for tests so missed dose), then my meds were on time.
My trying to get too much done at one time was behind my other med errors. Once I crushed a continous-acting narcotic and put it down a G-tube (patient fine, pain not even well relieved). A few times I'd incorrectly rope the piggy-back antibiotic so it never actually started to drip.
I don't miss nursing. I know it doesn't sound like it much misses me either but I was actually a very caring, patient-advocate, thinking, trying-to-do-the-impossible, fine with missing lunch nurse who had some really great "saves" (not lives but moments I know I made a difference). On the other hand, I'm distinctly not super-human and I felt bad by the end of every shift at the end b/c I had not done the job I wanted to do. Some of it my fault (I never was the best at time management) and some of it a system problem way bigger than I knew how to address.
I find it ridiculous that it is considered a med error if a med wasn't given in a certain time frame (1-2 hrs), when you consider everything else that nurses are supposed to do in that same time frame and since the time many meds are given isn't all that important (Colace for ex). I'd like to see stats on how many med errors there are when you take the time frame out of the stats.
I haven't had any errors in a long time but I have had close calls.
For me it was mostly interruptions. Another thing I noticed is when something went wrong and you couldn't shake it off it interfered with concentration.
But, interruptions is a big thing. They teach you in nursing that you shouldn't be interrupted and with reason. It is dangerous.
Checking the bracelet is a simple check system.
The other thing that I have been in the habit of doing is pulling each med out one at a time and checking it against the MAR. Then I take them in the individual packages to the bedside, check the patient's arm band and check them again one at a time to the MAR as I open them and put them in the cup. I leave the wrappers out until after the patient has taken them. If the patient questions if a med was given to them I have the wrapper to show them. I also think about what important things like heart rates, BP's, electrolytes, etc with each med as is pertinent to the med when I am going through them in the room and double check that I have covered all bases.
Add as posted in another reply "moving as fast as you can" - overworked and micro-managing
"I believe it's listed as a med-error if the med isn't given within the hour-before and hour-after listed on the MAR?"
Most of the nurses I worked with have all admitted that they are passing 9 am meds from 8am til lunch with all the interruptions and responsiblities. I don't know of any nurses that counted it as an error.
This whole problem stinks. The real sick thing about it is how unrealistic the administrators have become. As long as you don't get busted or harm any one they ignore it. When something goes wrong you go down and it is no fault of theirs. People keep hush hush about it to keep their jobs. This one didn't and didn't keep her job.
but, interruptions is a big thing. they teach you in nursing that you shouldn't be interrupted and with reason. it is dangerous.
so the next time i am opening pills one at a time, at the pt's bedside and a code blue is called then what? oh i am sorry i can't respond to the code cause it is interrupting my med pass and this is dangerous!! come one, we all know what is real world nursing verses school and book nursing!
checking the bracelet is a simple check system.
yes it is a simple check and only suppose to take a minute, but then again when you have a dementied pt that scratches and tries to bite only cause you need to look at their id band, lets see that minute check now turned into 5 minutes and when you have 6 or more pts like this and their room-mate is saying what about me ? how about the pts with dementia that always seem not to have their id bands on so you have to stop, get interrupted go and get the pt a new id band after you have verified it is the correct pt with another nurse cause the pt can't tell you thier correct name, date of birth!!
so tell this to the nurses who work long term care, a very busy med/surg floor that have to pass meds, change dressings, tube feedings etc etc, etc. for 6 or more pt's that they are not suppose to be interrupted!!
most of the nurses i worked with have all admitted that they are passing 9 am meds from 8am til lunch with all the interruptions and responsiblities. i don't know of any nurses that counted it as an error.
.
try telling that to the stupid computer when you scan the meds, then the pts' id band and this little box pops up saying that this med should have been given at 10am:nono: it is now 1115 cause dear miss j takes 12 pills at 1000( and has to take 1 pill at a time, with a bite of cracker and a sip of water in between each pill! and you have several miss j's to still give meds too)( nope can't give at 8:59 0r 11:01) and then you have to stop and fill out another little box explaining why it wasn't given in the time frame of 1 hr before or 1 hour after cause now it show up as a med error:cry:
med error! that's what the computer system records and then management wants to know why, cause an incident report is also generated from the same system!!
it is now 1115 cause dear miss j takes 12 pills at 1000( and has to take 1 pill at a time, with a bite of cracker and a sip of water in between each pill! and you have several miss j's to still give meds too)( nope can't give at 8:59 0r 11:01) and then you have to stop and fill out another little box explaining why it wasn't given in the time frame of 1 hr before or 1 hour after cause now it show up as a med error:cry:
berry
169 Posts
Most of the "reasons" listed so far are not reasons, but excuses "too busy/many/much". The reason every med error is made is carelessness. Not just on the part of the RN but and the whole system.
from the physician who scribbles something
to the RN and pharmacist who guess at what it is
to the pharm tech who places the wrong med in the wrong drawer
to the RN who gives the wrong med/dose at the wrong time to the wrong patient
Each of these breakdowns in the system probably occurs in every hospital everyday and careless or lack of attention to detail is the main contributing factor