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?

[Horseshoe, BSN, RN]

I did not know about the insulin needle thing. My classmates acted as if I was stupid to give heparin in a insulin needle. Also the charge nurse did scan the patients bracelet and the label on the package before she administered it at least.Plus, when she scanned the medication label she did have to click "ok" on the box that kept poping up on the screen after every scan, so I guess that also helps.

Discuss these issues with your clinical instructor, not with other non nurses who do not have the experience/education/credentials to critique the nursing practice of an experienced RN.

[nursej22, 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?

Pointing out that the Johns Hopkins report ( I hesitate to call it a "study" for the reasons given by KatieMI) refers to medical errors, that is, errors in medical practice, not medication errors, which I believe is the topic here.

[Forest2]

Yes it could be a problem at some point when the incorrect med or dose is given. This is the real world, nurses do all sorts of things that are not best practice. When the hospitals refuse to hire enough help this is what happens, of course sometimes it happens because a nurse doesn't give a fig too.

[Horseshoe, BSN, RN]

Yes it could be a problem at some point when the incorrect med or dose is given. This is the real world, nurses do all sorts of things that are not best practice. When the hospitals refuse to hire enough help this is what happens, of course sometimes it happens because a nurse doesn't give a fig too.

I think 99.9999% care very much, at least about keeping their licenses and jobs. I would be willing to bet that the most common reason for med errors is unreasonable nurse to patient ratios and lack of sufficient ancillary support, as you alluded to above.

[AusSRN]

I think it's great that you are thinking about patient safety. Going home and questioning nurses practices isn't a bad thing. definitely take bad practices as a learning opportunity of how you don't want to practice.

I don't think this is you being a know it all student, it is something that should be checked. How does this nurse know what dose the tablets are if she isn't checking packaging?

For example I did a patients medications two days in a row and one of the medications was 100mg so I had to half a 200mg tablet. In my head I thought "**** I didn't half this yesterday", so I dug through the drawer of meds and found that there was 100mg tablets and 200mg tablets and realised that the day prior I had used the 100mg. It's a bit different, but still proves that need to check.

[Feelgood RN]

I'm going to admit I usually only get through MAYBE the first page of comments before I post something. Most people feel learning is what people show you and teach you through verbal, written, or visual means. When I was in school and shadowing nurses I learned just as much from what they didn't say. I learned that there were nurses that I wanted to be like, and there were nurses I didn't want to be like. I wanted to be the nurse that took time for patient education and family discussion. I didn't want to be like the nurse that straight up refused to help the aide change and move a patient. Not to say that the second nurse didn't actually have good nursing skills, she was probably the best teacher I had for IV insertion tips.

Anyway, take what you want from each preceptor that you have and discard all the crap that you don't feel fits your nursing style. Obviously you need to be within the bounds of patient safety and professionalism. Every nurse is an amalgamation of the nurses they learned from, good and bad habits combined.

[Orion81RN]

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?

Television. I specifically heard it on The Resident recently. Eyeroll.

[quiltynurse56, LPN, LVN]

OP, I don't know about the PYXIS works at your clinical sites. At the ones I had, once you selected the med, the drawer popped open as well as the one spot that particular med is in. It is easy to see that is is the correct med when one is removing it.

You do it how you were taught while in school. You can't take from your clinical experiences ideas of what to and what not to do for you future.

[akulahawkRN, ADN, RN, EMT-P]

I have worked in a couple of Emergency Departments. One didn't have any sort of Pyxis or Omnicel to pull meds from, just a couple of carts with drawers full of meds. We did have a computer terminal in the med room for us to use and we all generally used the terminal to help ensure that we were pulling the right meds but we also had to actually look at the medications to ensure that we actually were grabbing the right stuff. The current place where I work uses Omnicel dispensers. We do have computer terminals in the med rooms, but I always go in to pull meds for ONE patient at a time and I either know exactly what I'm looking for or I bring a list with me. Then I have to select exactly the meds I want from the patient's med list and each med will have a drawer, cabinet or refrigerator unlock and it'll usually tell me where that medication is supposed to be with a flashing light. Even then I'll actually look at the medication to ensure that the medication I'm grabbing truly is the right medication I wanted.

I actually do my checks, it's just that it's done very quickly. My first and second checks are done before I leave the med room. My third check is with the patient at the bedside. I try to use the EMR to scan all meds whenever possible but occasionally I do not have a working computer in the patient's room nor do I have an available mobile workstation. When that happens, I actually do four checks. In that instance, I do my third at a workstation that works and I recheck that I have all the correct meds and doses for the patient and then I do #4 with the patient at bedside. Personally I very much prefer having the ability to scan the patient's arm band and meds because then the computer is also doing a medication check too.

While it's more efficient to pull meds for more than one patient, doing so also allows for a much higher chance of a med error. This is why I NEVER pull meds for more than one patient at a time, why I verify that I've got the right meds for that particular patient, and go directly to that patient when giving meds once I'm absolutely certain that I have the right meds. I may be very speedy in other areas of nursing but when it comes to meds, that's the one area of nursing where I deliberately go slow. Rushing is a quick way to a mistake.

[sallyrnrrt, ADN, RN]

I was not teaching anything to the charge nurse as I was just shadowing her. Plus, I did all what she wanted me to do. And you are very rude. I guess the saying is true that nurses do eat their young...

Grasshopper, you have much to learn

When you come on an Internet site, seeking input.....you receive a little, that you don't like,and bring out the NETY......

My 45.5 years as RN, I have observed special snowflake, melting in the sun

[Agatha12]

I always check the name and dose of medication even if I thought I know the package. As recently there was a change of supplier in our hospital and suddenly many common medication changed their packaging. I spotted numerous potential medical errors with IVs as some nurses just took the vial based on their look not reading the label. However throught thw shift I ask about name on the beginning on shift, by the end of the shift I know all my patients so I do not see reason to ask again unless I have new admission.

[Crush]

So I recall a night that I pulled a medication from our Pyxis ( after we select the med we want the bin automatically pops open to that med ). It was the wrong medication in the right bin for the med I wanted to pull. As soon as that happened I thought about this thread. Anyhow, I am sure there are times when someone may think I have not checks but that may be because I have been at this a while and have smoothed out the process of doing my checks. But you better believe I am doing my checks.