Medication Errors and Write-ups

[skittlebear]

I have several friends at work who have had "write ups" for medication errors (1 was major...giving too much insulin and one of the others was forgetting to administer a Vitamin). At my facility, if you get 3 write ups you are fired!

I can understand the insulin error, but we are all human and make mistakes, especially when we are understaffed as we so often are. I would better understand an incident report being filled out for a medication error, especially if it wasn't a serious error...but to be written up over a multivitamin? I'm not going to mention the other errors but these nurses have come forward to our supervisors as they should do, called the doctor, and received a write-up the next day.

Is this standard? Just curious.

[Goldenhare]

Not standard where I was most recently. What would be the point of being punitive? If a mistake was made, it was reported to the supervisor and or attending if very serious. It would SOMETIMES be documented as an incident, but that report was used to improve the system, and try to pinpoint and problems. We were not written up.

[Virgo_RN, BSN, RN]

I've screwed up a few times, but have never (knock on wood) been "written up". I have been spoken to about my mistakes, and if necessary, incident reports filed. The incident reporting system is not meant to be punitive, but to help with systems improvement to prevent similar mistakes/problems in the future.

[meandragonbrett]

Currently work in a unit where med errors receive a formal written warning. I think it's ridiculous. Since when do we punish somebody for making a med error? Writing somebody up for making a med error is NOT going to make it not happen again.

[loriangel14, RN]

Where I work incident reports are filed out if a serious med error occurs but they are more used for tracking purposes and punitive action is not taken(although I guess if it was really serious they may take action). I have reported minor errors to my charge and she has told me to not worry about doing an incident report, I think once I missed a Tylenol.

[htrn]

Med errors are not supposed to be punative but it depends on where you work. I have worked at facilities that view all med errors as systems errors and the nurse is in no way punished for the error (unless it was blatent neglegence on her part.) I have work at other places that have done the 3 strikes and your out - even today they still have this policy. The problem is, all medications errors need to be investigated to improve the process to make the system better. Of course the hospitals that have the punitive policy have fewer med errors - because they are not reported unless they can't get around reporting it. I would be the non-punative hospitals have more "reported" med errors but not nearly as many "actual" med errors at other places.

[Vito Andolini]

Punitive is wrong.

A good way to handle an error is to ask the doc to give you an order to cover what you gave or didn't give. "Hold multivit today"

"Give multivit at 2100 with food" (some people get nausea if taking meds on upset stomach)

See? That will cover a lot of errors and is often used when the error caused no harm.

[Michigan]

I disagree regarding having Dr. write order to cover the error. If the med was given or missed prior to the order, then a med error occurred. An order after the fact does not change the timeline. However, I also disagree about med errors as a reason for firing- unless there is pattern or very far from normal. Med errors should be used to track why the error occurred and find / solve the problem to prevent another.

[leslie :-D]

i agree that sometimes incident reports are warranted...

but at what point should tptb, start becoming concerned and incorporating these errors into disciplinary action?

consistent med errors would set my radar off, for sure...

leslie

[Virgo_RN, BSN, RN]

To be honest, an incident report over a multivitamin does seem a bit extreme. On the other hand, if there is a pattern of missed medications, or a real problem with med errors at your facility, then the missed multivitamin fits into the overall picture, so I could see how it would be included.

[feebebe23]

Don't get me started on this one! GRRRRRR! Guess what happens when you start writing up, disiplining, firing nurses over med errors? They stop reporting med errors. Obviously, if you have the same nurse repeating certain errors (like not giving a vitamin) you have to address the problem. However, a supportive environment with proper education is much more likely to get the results you want.

[DPRN]

What about meds signed as given, but the meds were left in the med cart? The meds were signed as given, but not given. I believe incident reports are needed.