Need to be on my toes...

RN-PA, RN · Oct 14, 2003

No, it's not just you. I see a lot of carelessness and potential mistakes where I work, too. Part of it is, I think either you are detail-oriented (read "anal") or you're not. That shows in whether the person you follow has messy rooms as well as messy documentation and care. I'm sure you don't have the time to go over stuff with a fine-toothed comb, but it means being a little more alert and careful as you work.

If your manager is throwing away incident reports, I would first speak to her about it and if you get no satisfaction from her response (or you don't trust it), please go over her head to her supervisor. Throwing away incident reports is unacceptable and risk management should also be made aware. The nurses who are being written up need to be held accountable for their errors and care problems and it sounds like your manager isnt doing her job.

sixes · Oct 14, 2003

I had that today. We are changing pharmacy so our MARS are being change over the new one starts tommorrow. the Doc writes an order to decrease ASA 325mg to ASA 81 mg . I happen to be at the desk with the new Mars and I say to him " this man isn't on ASA he is on Tylenol 325mg od

So he d/c's the order go to the old Mars and His chart sure a Sh** he is on ASA. doc comes back to the desk I have to apoligize and ask him to rewrite the order. Boy and I PI**ed. It happens all the time

I think today I'm just tired have a bad cold showed up for shift was only to be charge nurse on One floor and ended up being Charge on two florrs

Sorry if I sound cranky but I am.

MandyInMS · Oct 14, 2003

Same story/diff day..guess this happens everywhere.

I HATE writing an incident report..because the nurse who made the error seems to take it as a personal attack..which it's not.Incident reports are MEANT to help us learn from mistakes so we don't make them again(hopefully).I'm guilty of the 'fix it and go on mentality' just to avoid the conflict between staff.Wrong maybe..but you get so tired of the flack you get from them...It would be great if we all have time to double checks our charts before ever seeing our pts..but 6-7 pts all buzzing wanting this or that NOW makes it rather hard.And you're right debbie..things don't seem to change no matter what you do/or don't do..makes it very frustrating sometimes :/

sjoe · Oct 15, 2003

"I HATE writing an incident report..because the nurse who made the error seems to take it as a personal attack..which it's not"

Not necessarily true. I have worked in facilities where incident reports were frequently used as passive-aggressive attacks agains other nurses. Rather than simply pointing out a missing set of initials or absence of a checkmark so they could be easily corrected, nurses would let the lapse linger unnoticed until the "offending" nurse left, then several would write her up. This kind of thing happened over and over.

Passive-aggression will always find a way....

"I think either you are detail-oriented (read "anal") or you're not."

And for those who are, be aware that at least SOME of those who are not are providing some very important components to their patients and to the healthcare situation that YOU may not be providing.

Being careful sometimes means double checking with the original orders. Sometimes means thinking through and planning for acts before carrying them out. Very few people working the front lines have extra time to write unnecessary reports or make sure nobody else on the floor makes any mistakes, so you just have to make your choices and give it your best shot--as MOST co-workers are also doing.

Often it is easier, more productive, and more respectful to quietly and supportively point out significantl errors to the person who makes them, that they may be corrected before any problems have resulted from them.

And so far as going over your NM's head and accusing him/her of throwing away incident reports--this is a well-deserved and direct way to the unemployment line if one has not done thorough homework on the subject and can concretely substantiate such an accusation.

IMHO.

Erin RN · Oct 15, 2003

Hi Webbie Debbie

I review med mal on the side for a large ins co that covers many hospitals and MDs..alls I can say is that if it happens on your shift it is going to fall on you..I remember being on the floor and having that sort of thing happen and it is crazy making, I agree..I just reviewed a case where the RN gave a dose of IV abx that the pt had a documented allergy to. There were stickers on the chart and an allergy band on yet, someone took the order from an on call and transcribed it and she gave it..wala..anaphylaxis..he ended up fine but then died 2 days later from what appeared to be a CVA however, the family and the atty are trying to say it was due to that dose...wouldn't want to be that nurse, know what I mean?? Your manager should be VERY concerned..would it be totally bad for you on the unit if you made some copies ( evidence) and took it to your risk manager?? Erin

Tweety, BSN, RN · Oct 15, 2003

Everyone is human. Once a shift, look at your orders, compare them with what is actually being done, check the MARs against the orders. This is good practice. I find a lot of mistakes this way. Don't get caught up in fine tooth combing everything, just be wary and double check.

oramar · Oct 15, 2003

The increase in errors is directly related to the fact that acuity has sky rocketed without a concurrent increase in staff. I usually have about 10 patients but frequently it goes as high as 13 or 14. Now I have an LPN and aide to help me but when it comes to all the RN stuff there is a lot of things only I can do. How anal can you be in a situation like that? I want you all to think about the bigger picture when you deal with these situations. Just blaming yourself or others will not really change things.

webbiedebbie · Oct 15, 2003

Hey, thanks for the responses. I was very tired when I submitted the thread. That seemed to make it worse for me. I am grateful that it isn't only happening to me. I will be more conscientious when I work and I will submit reports to my manager as well as to Risk Management. I will also document that I sent one to both. I will also keep a copy for myself in my locker at work. (Don't want to bring them home and risk breaching confidentiality).

I just felt I wasn't doing my job well enough and I know it IS my responsibility to make sure that orders are carried out correctly. I just don't understand why others don't feel the same way (some of my coworkers and my manager). Yes, I guess I really am anal. I drive myself nuts, sometimes.

RN-PA, RN · Oct 15, 2003

Originally posted by webbiedebbie
Yes, I guess I really am anal. I drive myself nuts, sometimes.

Speaking as a fellow anal (icky word-- I prefer "detail-oriented"), I'm sure we drive others nuts, too. I know I do; just ask my husband.

Edited to add: I agree with your plans to give copies of incident reports to your manager AND risk manager. Please let us know what happens.