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.
I use to work in LTC many years ago. I remember that the LTC had a big 3 page medication error report form that needed to be filled out when a medication error occured. The DON said that whoever found the med error was responsible for filling out all of that paperwork. Nobody wanted to get stuck doing even more overtime by having to fill out these huge time consuming forms so the nurses kept quiet about finding med errors.
Yeah. This place is only assisted living and the med error sheet is only 1 page. Assuming I'm the one who made the mistake"s", I would'nt mind filling out the form and getting a write-up or whatever. But after talking to a family member who is also a nurse, they said something like this could get you fired or even put your license in jeopardy. Is this true? After all it was only a mistake, but I can see how it could look like somebody could have taken the half dozen or so narcs and signed for them, but that would have been stupid. But then again it was stupid to not read the MAR closer and this would'nt have happened. It is possible that nobody will find it or find it at a later date. I'm not sure how much better it would be if you came clean now rather than waiting to see if somebody caught it later? btw, this person cannot afford to lose this job as they are about to file bk and will not have any money or credit to fall back on so this is a very stressful situation.
Specializes in Management, Emergency, Psych, Med Surg.
I believe it is important to report all medication errors but the outcome does not have to be punitive. We have all been late with giving medication and probably most of us have made at least one medication error. As a former manager, the issue for me always was ..Did the nurse understand that he/ she had made an error and what did they do when they discovered the error? If a nurse makes an error and takes the necessary steps to rectify the problem then that is what is important to me in the work environment. Of course I want to track the errors to assure that there is not a pattern of errors with this particular nurse. There is not always a need to have formal disciplinary action. No nurse makes a medication error on purpose and everyone feels horrible when they do.
Now, there are exceptions. When a nurse gives a medication in error and he/ she fails to recognize the error or why it is an error, then that is another matter. I recently had a nurse on my shift give a scheduled dose of Oxycontin to a patient who was obtunded. I tried to explain to her that even though the medication was scheduled that she should have held it because the patient was so sleepy and could not be aroused (she had even given this patient Narcan). She had no grasp of what I was trying to tell her. She told me that one can never hold a scheduled medication. I reported the incident because it was obvious that she needs some retraining on her role as an RN with regard to medication administration and safety.
In a word, distraction. This is why when I mentor new nurses or orient experienced ones, I introduce them to my own personal model of nursing. I call them the Five Commandments, and are listed in order of priority.
ABC's, Vitals Signs, Medications, Analysis, and Treatments.
Notice that medications is number 3. On most days, wherever you are, you can blow past the first two rather quickly. Is anyone on my watch having a respiratory problem or in need of an immediate intervention on vital signs? Most days, the immediate answer is no. This now brings medications and everything related to them quickly to number 1 by default. Now, isn't that interesting?
What I have found over the years is that most nurses are data, or information saturated. This causes the "chicken with the head cut off syndrome" that is so familiar. What do I do next when everything is so damn important, is a question that causes so much angst.
Essentially, what I am saying is this. I myself make plenty of errors in documentation or omissions altogether (my narrative charting is minuscule by design). However, those errors and omissions are focused onto things such as Nursing Care Plan, Education, Braden Skin Scale,..you get the picture. When management comes to me on one of these issues (rarely) my answer; "My apologies, I'll do better next time."
But, my interventions are always timely and appropriate.
Specializes in Management, Emergency, Psych, Med Surg.
I think your plan is wise and I agree that the major reason for medication errors is distraction. I am going to date myself here but I recall when we used to pass meds using a medication cart. Down the hall we would go with the MARS for every patient and our meds in the cart. I remember that this was known as the time not to interrupt the nurse because this task required so much concentration. In the hospital where I most recently worked, people are packed around the medication dispensing devices, everyone talking, medication room full of people. The machine does not have a place where you can lay your MAR to see it as you go down the document to look for the medications you need to give. And some of these people are on WAY too many medications in my opinion. It is so complicated. And when was the last time that anyone served on a committee regarding medication administration? When they bought the current devices for dispensing medications there was no input given by any nurse who actually works at the bedside.
Yeah, I think the main problem at my facility is too many patients for one nurse and always being in a hurry as there is no way meds can be given to all of them within the "one hour" that is on the MAR that they are supposed to be. I try to give them the quickest I can because I know most of them try to go to bed around the time I'm doing med pass and its much easier for everyone if you can pass them before they get to sleep. I know that's no excuse for the errors that were made during the month (from my previous post).
This nurse still isn't sure what to do and how serious this was and is conflicted as to whether its better to report it now (about a week or so after the last mistake) or wait and see if anyone catches it? After a little research it looks like something like this "should'nt" endanger their license, but not sure about the job. If you were to lose your job for something like this (involving narcs), it would most likely be very difficult to get another one in the field.
After a little research it looks like something like this "should'nt" endanger their license, but not sure about the job. If you were to lose your job for something like this (involving narcs), it would most likely be very difficult to get another one in the field.
My feeling is most admins would prefer not to further anger a fired employee by reporting them to the BON for something minor (and really, in the grand scheme of things, this is minor.) After all, do they want to basically publicize that they don't have measures in place to prevent these sorts of things? And most employees have a little dirt that they can throw back at the facility to make their lives difficult too.
What tends to get reported? Trying to cover up your mistakes. I make mistakes. I'm human. I don't try to cover them up. Heck, the last time I did something that I consider REALLY stupid, I told everyone I work with, because I'd rather my coworkers learn from my mistake that in the end didn't cause harm, than they make the same mistake on a patient that might be harmed from it.
Nobody's perfect. With my guilty conscience, I couldn't handle worrying about being caught. Fess up, get it over with, take the lumps, move on. If admin thinks it's worth firing someone, then that's an environment that I don't want to work in. Easy to say, hard to do with jobs this tight. But really, honesty is the best policy.
Blackcat99
2,836 Posts
I use to work in LTC many years ago. I remember that the LTC had a big 3 page medication error report form that needed to be filled out when a medication error occured. The DON said that whoever found the med error was responsible for filling out all of that paperwork. Nobody wanted to get stuck doing even more overtime by having to fill out these huge time consuming forms so the nurses kept quiet about finding med errors.