Nurses don't do their 3 med checks?

[OsceanSN2018]

I've been to two higher acutity clinical sites so far on a med-surge/oncology floor and a cardiac observation unit (step-down CCU), and some of the nurses seem to not do their three medication administration checks. I didn't give it much thought until my second clinical rotation and now I'm wondering if this is considered "normal" for some nurses? For instance, I shadowed a charge nurse in the CCU and she would just open up the patient records on the EMR then take medication out of the pyxis without even reading the labels on them. I asked her why don't she read the labels and she said that she been doing this for a long time and know how each medication package looks like... So then went to each of our patient rooms and gave the medication to them without asking for their name/DOB. She just scanned their bracelet and administered the medication without telling the patient about the meds. Plus, she made me administer heparin in an insulin needle saying it's "fine".

She is not the only nurse who I've have seen not doing their 3 med checks, and I wonder if this could become a problem?

[neuron]

I've been to two higher acutity clinical sites so far on a med-surge/oncology floor and a cardiac observation unit (step-down CCU), and some of the nurses seem to not do their three medication administration checks. I didn't give it much thought until my second clinical rotation and now I'm wondering if this is considered "normal" for some nurses? For instance, I shadowed a charge nurse in the CCU and she would just open up the patient records on the EMR then take medication out of the pyxis without even reading the labels on them. I asked her why don't she read the labels and she said that she been doing this for a long time and know how each medication package looks like... So then went to each of our patient rooms and gave the medication to them without asking for their name/DOB. She just scanned their bracelet and administered the medication without telling the patient about the meds. Plus, she made me administer heparin in an insulin needle saying it's "fine".

She is not the only nurse who I've have seen not doing their 3 med checks, and I wonder if this could become a problem?

I have to admit, I have worked in LTC for years, but also did my clinicals in a hospital.

I ALWAYS double check, sometimes not in the order that nursing school says, but on that last check, before the pills go in their mouth, I double check every single pill.

[Rose_Queen, BSN, MSN, RN]

What you have to also realize is that nurses with experience do things simply out of habit and don't have to make a fully conscious effort. When I was bedside, I didn't take the time to hold each individual vial up and read it after I pulled it out- I did it all in one smooth sequence of tap drug name, reading and picking it up at the same time. Students and beginners tend to need to break things into steps- read the screen for the exact spot in the Pyxis drawer, pick up the vial, read the label, move on to the next drug.

[K9lover, ASN, RN]

And medical errors have been shown to be the third leading cause of death in the US.

COPD is the 3rd cause of death, not med errors.

1.Heart disease

2.Cancer (malignant neoplasms)

3.Chronic lower respiratory disease

4.Accidents (unintentional injuries)

5.Stroke (cerebrovascular diseases)

6.Alzheimer's disease

7.Diabetes

8.Influenza and pneumonia

9 .Kidney disease (nephritis, nephrotic syndrome, and nephrosis)

10. Suicide

If someone who is about an hour from dying of COPD/PNA etc...and lungs are filled with fluid gets an accidental 2 litres of IV fluid when they were only supposed to have TKO it could be called death due to a medical error but it is not, it is still death from COPD; dying an hour earlier does not change that as there is no cure for COPD. Same with many, many things. If someone dying from stage 4 cancer had a week of Neupogen 'missed' and died from an infection which killed them one day before the cancer they did not die from a med error even if it was a contributing factor.

But if we really want everyone to panic and think the nurse/doctor is going to kill them we call it a death due to med error.

The COD is still cancer. Geeze, we have enough barriers to patient-provider relationships without this type of hyperbole.

[Mavrick, BSN, RN]

COPD is the 3rd cause of death, not med errors.

1.Heart disease

2.Cancer (malignant neoplasms)

3.Chronic lower respiratory disease

4.Accidents (unintentional injuries)

5.Stroke (cerebrovascular diseases)

6.Alzheimer's disease

7.Diabetes

8.Influenza and pneumonia

9 .Kidney disease (nephritis, nephrotic syndrome, and nephrosis)

10. Suicide

If someone who is about an hour from dying of COPD/PNA etc...and lungs are filled with fluid gets an accidental 2 litres of IV fluid when they were only supposed to have TKO it could be called death due to a medical error but it is not, it is still death from COPD; dying an hour earlier does not change that as there is no cure for COPD. Same with many, many things. If someone dying from stage 4 cancer had a week of Neupogen 'missed' and died from an infection which killed them one day before the cancer they did not die from a med error even if it was a contributing factor.

But if we really want everyone to panic and think the nurse/doctor is going to kill them we call it a death due to med error.

The COD is still cancer. Geeze, we have enough barriers to patient-provider relationships without this type of hyperbole.

Hey, thanks for taking time to correct this. I was not buying that med errors are the 3rd leading cause of death. Where did that even come from? A typo or misinterpretation of statistics?

[JKL33]

And medical errors have been shown to be the third leading cause of death in the US.

WADR, so far I think the (medical) people who believe that claim is unsubstantiated far outweigh those who believe it's true.

[KatieMI, BSN, MSN, RN]

COPD is the 3rd cause of death, not med errors.

1.Heart disease

2.Cancer (malignant neoplasms)

3.Chronic lower respiratory disease

4.Accidents (unintentional injuries)

5.Stroke (cerebrovascular diseases)

6.Alzheimer's disease

7.Diabetes

8.Influenza and pneumonia

9 .Kidney disease (nephritis, nephrotic syndrome, and nephrosis)

10. Suicide

If someone who is about an hour from dying of COPD/PNA etc...and lungs are filled with fluid gets an accidental 2 litres of IV fluid when they were only supposed to have TKO it could be called death due to a medical error but it is not, it is still death from COPD; dying an hour earlier does not change that as there is no cure for COPD. Same with many, many things. If someone dying from stage 4 cancer had a week of Neupogen 'missed' and died from an infection which killed them one day before the cancer they did not die from a med error even if it was a contributing factor.

But if we really want everyone to panic and think the nurse/doctor is going to kill them we call it a death due to med error.

The COD is still cancer. Geeze, we have enough barriers to patient-provider relationships without this type of hyperbole.

Correct.

It all, to certain degree, depends on what is going on and by whom. That aforementioned guy with terminal COPD/CHF can be brought in ER from ECF with chief complain on "lethargy" or "AMS" after his Lasix got missed once and his Bipap mask leaks. I wouldn't be surprised if he gets a liter of NS before ABGs get out for BP 80/45, then speedily tubed and moved to ICU where he gonna die. This death could be classified as "med error" times three (oxygen, Lasix and fluid overload from that saline), if one wants it to be that way, plus negligence and only God and DON know what else. Yet, if someone's heart cannot tolerate a liter bolus, it probably means that the Jesus' bus just here and waitin'.

[Julius Seizure]

...it probably means that the Jesus' bus just here and waitin'.

[Susie2310]

COPD is the 3rd cause of death, not med errors.

1.Heart disease

2.Cancer (malignant neoplasms)

3.Chronic lower respiratory disease

4.Accidents (unintentional injuries)

5.Stroke (cerebrovascular diseases)

6.Alzheimer's disease

7.Diabetes

8.Influenza and pneumonia

9 .Kidney disease (nephritis, nephrotic syndrome, and nephrosis)

10. Suicide

If someone who is about an hour from dying of COPD/PNA etc...and lungs are filled with fluid gets an accidental 2 litres of IV fluid when they were only supposed to have TKO it could be called death due to a medical error but it is not, it is still death from COPD; dying an hour earlier does not change that as there is no cure for COPD. Same with many, many things. If someone dying from stage 4 cancer had a week of Neupogen 'missed' and died from an infection which killed them one day before the cancer they did not die from a med error even if it was a contributing factor.

But if we really want everyone to panic and think the nurse/doctor is going to kill them we call it a death due to med error.

The COD is still cancer. Geeze, we have enough barriers to patient-provider relationships without this type of hyperbole.

Have you read the John Hopkins study that suggests that medical errors are the third leading cause of death in the US? You know that medical errors are not recorded separately on death certificates?

[Mavrick, BSN, RN]

Have you read the John Hopkins study that suggests that medical errors are the third leading cause of death in the US? You know that medical errors are not recorded separately on death certificates?

The Johns Hopkins study may suggest but it's really just a wild guesstimate without any statistics because we don't keep those numbers according to the CDC.

So it's not really "been shown."

[KatieMI, BSN, MSN, RN]

Have you read the John Hopkins study that suggests that medical errors are the third leading cause of death in the US? You know that medical errors are not recorded separately on death certificates?

Just to let you know - this article is currently one permanent favorite of professors of statistics all over the country to be used as an example how NOT to use or interpret public health data after you somehow got your hands into it. Unless you want to be a laughing body for everyone familiar with more stats than famous 3Ms, that's it.

Here is a nice summary of what is wrong with it:

http://www.amjmed.com/article/S0002-9343(16)30705-7/fulltext

I highly recommend you to read this piece as well:

/plosmedicine/article?id=10.1371/journal.pmed.0020124

[TriciaJ, RN]

I understand, this was a huge learning experience for me. And I do now see where Sour Lemon was coming from.

So can Sour Lemon take this as an apology?

[Susie2310]

The Johns Hopkins study may suggest but it's really just a wild guesstimate without any statistics because we don't keep those numbers according to the CDC.

So it's not really "been shown."

Well, regardless of what you want to believe, which is your prerogative, the study exists and anyone who is interested can read the study for themselves and inform themself of the data that was examined and the methodology used.