I am writing in response to an article that was posted on your website regarding nursing students and conditions that can lead to medication errors. I am a nursing student myself, and I found the article to be interesting. Although I agree that these conditions can lead to student nurse medication errors these conditions also could apply to licensed nurses as well. Nurses learn that by practicing the Five Right of Medication Administration you can significantly reduce the possibility of medication error. It does not always prevent medication error because there are conditions that are susceptible to causing medication errors.
First, I would like to mention that it has been my clinical experience to be supervised at all times during the process of administering medications. My preceptor makes sure that we know what medications we are going to be giving the patient and the reason for giving the medication. We also communicate with the staff nurses so that he/she knows that we will be administering meds to the patient.
An important point that was stated in the article was that errors can occur from student nurses misinterpreting abbreviations or illegible handwriting. I have to strongly agree that this problem can lead to medication errors. I believe something needs to be done so that a prescription is not misinterpreted. Instead of using a system of the prescriber writing with pen and paper, a computer generated prescription will reduce the risk of any errors. We currently use a computer based program at my clinical site and it’s easier to read the prescriptions without the use of abbreviations.
Documentation is an integral part of the medication process. The motto is that if it is not documented the medication was not given. It was mentioned in the article that nurses and students can administer meds to the same patient and this can lead to dose omissions or overdose. This is due to poor documentation or failure to review prior documentation of drug administration. In a situation like this I don’t think poor documentation is necessarily the problem but poor communication between the nurse and student. Both the nurse and student should discuss which meds they will administer and then document it as soon as administer the meds to prevent any harm to the patient. Sometimes nurses are too busy or too rushed to actually document sometimes because they have to make sure all their patients get their medications at the scheduled time so I can see how documenting can be missed. From my experience, the nurse was always present when I administered medications to their patient because a student should not be administering meds without the presence of a registered nurse.
Another good point that was brought up was monitoring issues. Students might not be aware of vital signs/lab values that should be checked before administering meds. As nursing students we are there to integrate what we learn in the classroom to actual practice in the health care setting. We are still learning when we are at our clinical, so I don’t think nursing students should be given the full responsibility of giving meds because a minor mistake like this can hurt the patient. I think that the registered nurse is still responsible for the patient even while the nursing student is caring for the patient as well and that should not be overlooked. I can also see this being a problem with registered nurses as well. This is a skill that is learnt over time as the nurse becomes familiar with certain medications. I don’t think that all nurses who are usually assigned to five to eight patients will remember to check the patient lab values or vital signs before administering meds. They are just too busy and overworked.
Preparing drugs for multiple patients was another condition mentioned that causes medication errors. Student being assigned to multiple patients is a good way for the student to become familiar working with multiple patients and time management. I think that this can problem can be easily avoided. Preparing medication for one patient at a time is the solution. I don’t think that students should be preparing drugs for multiple patients at a time. I have seen nurses doing this but I think with times comes experience. The nurse I worked with was able to prepare meds for two patients at a time and remembered which med to give to each patient.
Nursing student medication errors can be prevented by alterations in the system for ordering, dispensing and administration of drugs. I also believe that communication between the nurse and student is vital in the care for the patient. People need to remember that nursing students are still students that are still learning while at their clinical. We are still learning and making mistakes makes us better and efficient while preparing for the nursing profession.
The article mentioned many conditions that increase medication errors which was helpful to me as a student. Nursing students can utilize this information to provide safe practice to patients while in their clinical.
nurse student in a medication error. i think you are right, there are plenty of works to be done by RNs. preparing ourself with well known med will minimize that risk anyway. :typing
I experienced as a nursing student that, while we had certain responsibilities (a.m. care, bed linens, and vitals), we must either have our nurse retrieve the medications from the computer (which will not later release the same meds for the same patient twice), or if we have a code ourselves, we must retrieve the medications (again from the computer system which will not let us double draw even if not documented in the patient's file as administered) and then show our nurse what the medications are and tell her what they are for and why the patient is receiving them.
True, not all locations for nurses have this kind of computerized med system. It is certainly one which cuts down on double administration. Indeed, it becomes impossible.
I do agree that many of the errors addressed are not just student errors, but certainly regular nursing errors dependent upon too much patient load per nurse, lack of communication, lack of sleep (due to over work), etc.
Communication and support are key, plus documentation - whether students are involved or not. People need to be willing to ask for help if needed, to document when when what they needed was not available, how various situations make them feel on a daily basis, etc.
I understand some unit nurses will often feel so unsupported and understaffed and generally stressed, they start getting caged-rat syndrome: rats in too small a cage will begin biting and killing each other from the sheer stress. It is super important that we try not to take out frustration and worry on each other, but support each other and encourage and communicate - regardless of student or new nurse or long time nurse status. Patient care is not a competition; it is a goal we can all work toward and help each other along the way if we open ourselves to the experience.
I am in the last quarter of my first year of nursing school. In my program we have two clinical days per week and this quarter we get checked-off to give oral meds with our instructor. Then we are able to give oral meds on our own, but we still need our instructor present for sub-Q and IM. We do the first check on our own, draw up the meds, page our instructor, do second check with instructor, and third check in the room with instructor before administering injections. This is all possible because we have a computerized charting system with the MAR integrated with a bar code scanning system. Of course we still have nurses notes to maintain by hand too :bugeyes Three of the nine students in my clinical group are now up to three patients, and the rest of us have two patients. Just curious how we compare to other programs!!
I am also a nursing student getting ready to graduate. I had a one-on-one semester with a nurse on the ortho-trauma unit. We were very busy but I always looked up every drug I adminstered and if I had a question I ASKED. I took care of 5 patient's at one time and I made sure I did the 5 rights everytime. I think You need to take responsibility for your self and make sure and even double checks about medications instead of blaming anyone else. It is your job as a student to know the medications and the side affects. Get over your self and take responsibility.
My assignment is to find a source that states who is responsible for the errors of a nursing student...having a hard time finding a site to quote, anyone have that readily available?
bloomingdawn
6 Posts
nurse student in a medication error. i think you are right, there are plenty of works to be done by RNs. preparing ourself with well known med will minimize that risk anyway. :typing