help me stop making med errors!

[BulkyMonster]

I keep identifying new ways to prevent them, but someting always slips through.

Most commonly, an order will say something like: Tylenol 325mg I-II tabs PO Q6h prn. I will only see the 325 and not the "1 to 2" part.

That's just an example. I have also missed a couple things outright. A few weeks ago I nearly gave the wrong heparin due to miscounting the zeroes... the patient would have got only a fraction of the dose.

A nurse at work has been on me about it, a bit overly so. Okay, a lot overly so. I feel like she's obsessed with everything I do. She has taken her concerns to our boss, and wasn't happy with her response so is taking it to the next higher boss now. Our direct supervisor is trying to help me but has advised me not to make even the tiniest mistake while I'm under such scrutiny, and yesterday, I made a mistake. She's fed up with me even though she agrees that my coworkers is overstepping her bounds.

In the past month I've made probably 4 real mistakes:

-one near underdose of heparin, caught by the other nurse

-one missed order which the MD did not flag (I was off the floor though on an ACLS run and left my patient in the care of another nurse for a while)

-one wrong route of an antibiotic.

-one antibiotic that didn't infuse, which I caught later and corrected, on an abnormally busy day... but it took me a long time to catch it

I have been trying SO hard not to mess anything up. I've become nearly obsessive compulsive, checking everything over and over throughout the day. Even after I've already seen it. And at the end of the day I check over every bit of paperwork and the patients themselves, with a second set of eyes to help me. But this overzealous nurse has written up, along with these errors which were true errors that needed to be adressed, about three times as many things that never happened. For example I had a detox patient with a high BP and she thought I never gave him his blood pressure medication. She asked him and he said nobody had given him any pills all day.

He also thought that something that had happened 4 hours ago, had happened "yesterday" (and this was day shift), that there were women in the bed near his, and that his walls and window were moving! Yet she is writing this up as an incident report, using sketchy circumstantial evidence to paint me in the most negative light possible. Even if most of them are false, enough write-ups and you look bad.

I can't afford to make a single mistake. Even non-mistakes are getting me in deep hot water. I am utterly desperate and trying my hardest to do everything perfectly, but I am in a job where neither of us are likely to be fired or transferred, and I can't quit.

Maybe I'm a terrible nurse for making these mistakes. All I can say is that I am doing my best. I am not stupid, careless, or lazy. For some reason I just keep messing up. And with this obsessive woman relentlessly breathing down my neck, it's so bad that I am losing confidence, losing sleep and losing weight from all the anxiety.

Can anyone help?

How do you prevent med errors?

Why do I keep making them? I've been a nurse for almost 3 years now.

How many med errors do you think each nurse makes on average anyway?

Am I just in the wrong career field? Should I not be a nurse?

[Metron]

I can definitely relate to you bulky. I've had my ADHD diagnosed since April of last year. I never knew why I made so many med errors. It was very discouraging to fill out those Med Error Report sheets and come to the question - What steps could you take to prevent this from happening in the future? - and I always had to write - "look at the order more closely".

Right now I am working at night in a drug rehab and I'm on call at a nursing home. I try to work night shifts whenever possible - less distraction, fewer people to clash with, etc. I've also decided to get my RN (I'm an LPN) through Excelsior so I don't have to go through the agony of nursing school again. (I always made good grades, but had a lot of difficulty getting along with everyone - I didn't know about the ADHD back then. And all the deadlines and the evil instructors.)

My best advice - find a specialty and a shift that work for you and be assertive about advocating for your own needs.

[chris_at_lucas_RN, RN]

Make sure you keep breathing. When you go to the med room, take five seconds to close your eyes and calm your spirit. Tell yourself you can do this.

Keep a 3 X 5 card in your pocket. When you are reading the med sheet (MAR), put the card over the order and advance it one component at a time. This should allow you to see each element of the order. It should also help you count zeroes.

At least for while, double check those 5 rights. If it wouldn't make you look nuts, read the order out loud to yourself. But at least do it in your head.

Wake up your brain by using the notecard to read the order backwards. Sometimes I think we get so conditioned by what we expect to see that we just slide right over changes.

Document (for your own purposes) any situation you believe is being written up and record the circumstances so you will have the facts at hand if you are accused.

Along with the above suggestion, make your own action plan and implement it unofficially. Then if someone approaches you with accusations, you will be able to say, "That might have been a problem in the past, but I have taken the following measures to improve my skills and ensure patient safety." If I were a supervisor, I'd be impressed with someone who was making positive changes without being forced to.

Be absolutely scrupulous about signing for meds and treatments. Doing things is only half the task. Documentation is the other half.

As I'm sure you've learned, be very careful about informing others of your weaknesses. Sad as it is, there are those who love to feel better about themselves at someone else's expense. Don't provide them with ammunition. If you must address an area of need, do so from an attitude of strength. Don't say, "I have ADHD and sometimes make mistakes." Instead, say, "I've learned some tricks to make sure I'm being accurate." Stress the compensations rather than the deficiencies. Then others will see you not as having a problem but having overcome a problem. That can make a big difference.

Most of all, de-stress as much as possible. The more wired you become, the greater chance there is you're going to mess up. If the nurse who is writing you up is a complete whack job, treat her with utter courtesy and avoid her as much as you can. If she's a decent sort who just has her undies in a twist, approach her at a quiet moment and ask if she would share her concerns with you and offer any hints or advice for you to become a better nurse. Again, do this with the attitude that you are a strong, capable person who is mature enough to accept constructive criticism, not as someone who is defective.

Tuck a Reader's Digest in your work bag and at those moments when you just want to tear your hair out and cry, take one minute to read a selection from their various humor pages and feed your spirit a little treat. This will help you break the downward spiral and give you a few seconds of a better perspective. Sneak a little piece of chocolate. Give someone a compliment. Do anything and everything to carve happiness out of your shift and pass it on to others. Pretty soon, you'll be so busy you won't be worrying.

I hope some of this helps.

Excellent suggestions.

I would add one thing that I notice I do. As a permanent full time float, I am usually the med nurse. Thankfully we have electronic MAR and everything (including the patient) gets scanned, so I catch my own errors.

What I find myself doing is talking myself through pulling my meds. If I hear my own voice saying what I need to concentrate on and focus on, I am much less likely to be distracted.

Good luck. Slow down. Focus on your task and on staying internally calm. Check your five rights (drug, dose, route, time and patient) immediately BEFORE you administer.

[organichombre, ADN, BSN, MSN, LPN, RN]

Hey Bulky,

Sounds like you are a bit stressed to say the least and along with the ADHD, it must be overwhelming. I live with a 14 yo with ADHD, and know how easy it is to wonder "what the hell was she thinking". The replies are all well grounded and you should take a good look at what is going on around you. Also, find a mentor, someone who you trust and feel is a "good" nurse (whatever that is!lol), and voice your concerns. As a male in a female dominated profession, I see how nurse "eat their young" everyday and will jump on a bandwagon to protect their own asses. Your errors are indeed cause for concern, so take a vacation if you can and find a quality mentor...and make sure you do something to get away and really relax. I ride the horse when it all gets to be too much!

Rick

[marylyric]

listen. dont tell people your weakness, some people will take advantage of it

which is whats going on. Find yourself another job before they build a case against you, and start fresh. dont tell.

[BamaBound2bRN]

I know I am not an RN (yet), and this may sound naive, but is 4 med errors in a month -that you know of, and no telling how many unaware of- common? This sounds very dangerous and scary as hell!

[mjhale,rn]

Hi,

Everyone had really good ideas for you. One that I didn't hear was to pray. Ask God for help. Before each shift pray to God that he protects your patients and gives you the strength and wisdom to do your job without med. errors. He'll cover you with confidence and is the best destresser I know.

God Bless,

Millie

[expatnurse]

I suggest a systematic approach. Furthermore might I suggest looking into the Disability Discrimination Act it is unlawful to make work extra hard Work must make (reasonable accomadation) Find someone you feel close to more experienced nurse/mentor and work with them in your off time. Do not get psyched out. You can do this. Do not give up and never let anyone make you feel less than!! I hope this helps and the best of luck. I also find that when someone is aware of there short comings that person in the end over excell at that area. Good luck. Keep us posted on how its going.

[almostthere06]

There are several things I learned in nursing school that might be of help to you.

First and foremost, I cannot concentrate on meds in a room full of people. So I take the MAR of each pt. into the clean supply room, and sort through meds in there.

I do not sign for a med until it has been double checked by my instructor (req'd for school, but could work for you.)

I do not take p.o. meds out of their packaging until I am in the pts. room, ready to administer it.

I bring the MAR with me into the pts. room, and do not give the pill until I check it again.

If I am uncertain about a med written on the computerized sheet, I will go back to the original order, and check it again. If I am still uncertain, I will call for clarification.

When reading a MAR, I will re-write the order in a notebook, and then compare what I have written to what is in the MAR.

The notecard is a great idea. Another is to cover everything else on the page except for the line/box you are reading. A blank piece of white paper makes it seem so much less daunting.

Ultimately, this is a huge responsibility, and you must find a way to resolve it. It is clear that you want to solve the problem, and are willing to do whatever it takes. Perhaps take a course or an inservice on medication administration. It may offer you more tips than can be gathered here. Good luck to you and God Bless.

[Hairstylingnurse]

hi bulkymonster,

someone may have already asked you this (i haven't read thru all these posts yet)have you had your eyes checked???????? you may just need glasses. i wear them just for reading and didn't realize how bad i needed thm until i got my eyes checked. good luck to ya.

[marylyric]

amen!!!! this is true

[brenzgrove]

Hello everyone,

I'm so glad that this thread is out here! I have been nursing for two years now. I've been working since i graduated. Nursing school was not easy for me. I have tonnes of knowledge, but have always had trouble applying my knowledge in a clinical setting.

I can relate to the med errors. I have made so many more than what you have revealed, some worse, some i was wholly responsible for, but a lot due to meddling co-workers. Staff nursing has not been easy for me.

The first floor i worked on post-grad was a medical/nephrology floor. I was casual but worked more than full-time hours. Everyone loved me because i allowed them to take vacations, days off, etc. All the nurses saw me as a "sweet kid". They knew i was just starting out. It wasn't long before my med rounds were taking me twice as long as everyone else. my 8:00's were taking me till 9:30 or sometimes even 10:00am. I had made a couple of minor errors (and yes i know there is no such thing, but the type of errors most nurses make early in their career where no one gets hurt) I know everyone noticed, but i honestly believe that they were not talking behind my back. I received a couple of truly helpful and concerned comments, and even suggestions to be quicker, which i took no offence to. I struggled a lot to do my own duties, and wasn't able to help much with the RPN's on my team. I know they talked here and there, but it never got back to me. I could tell sometimes, they were less than excited to be working with me, though they never really let it show. I had a real hard time prioritizing my tasks, and organizing my day.

The nurses continued to treat me like a good kid and unfortunately, while i continued to work there, these issues improved only slightly. There was one nurse there who really had it out for me. She was constantly watching what i was doing, even when we werent working together. She was a real know it all, and not in the good way (I compliment anyone who has a lot of knowledge, applies it and shares it with co-workers). This nurse just really wanted to be more than a staff nurse i think, and acted like she was in charge. she was always the first to answer a question that was directed at a group of us. I believe she came from Europe and held a slightly higher position or was more specialized there. anyhow, she made complaints about me to the manager, talked down to me like i was a child, pulled me aside to tell me i was endangering my patients and the like, and did it in front of other staff members, who she would bark at to leave us because "we had something we needed to discuss".. I really felt that it was a form of harassment (but i respect her at the same time for voicing concern for any patient).

Though i really disliked her, i decided to try flattery, to see whether she would back off. I acknowledged her concerns about my work and told her that i would like to improve myself. She suggested that i take a course she had taken. we never really clashed too badly after that again.

I left that job to take on a full time med-surg float position.My only prior experience with surgical nursing was brief in level 1 of my program (when the most we could do was dressings!) The first floor i was oriented to (and ended up there for 4 months consecutively due to understaffing) was a surgical unit. the nurses there had all been working there for 15-20 years, never stepped foot on another floor, never interested. I had it rough from the get go. I was meant to be mentored, but due to self-scheduling on the floor i was paired with a different person every day. these nurses were very good at what they did, and very confident in their abilities. They all had unique ways of doing things, though i don't recall every questioning their methods. The problem began when i would try to apply something i had been taught the previous day with a different nurse. The nurse i was paired with would then say, "we don't do it like that here". I wasn't about to say "so and so told me to do it like this". Also any time i tried to use my judgement based on previous experience, i was told i had no idea what i was talking about and that i'd better ask someone with experience otherwise i might put a patient in danger. i soon began to keep my mouth shut. Well 4 weeks of orientation like this, all the RN's began to talk. There were some seriously hardened, bitter old nurses on that floor.

Reports began coming in to my manager from people i hadn't even been paired with or worked the same shift. There were a number who had it out for me. I knew i was being constantly watched, evaluated and judged by these nurse's own personal standards. There was no leniance, understanding or compassion when dealing with me. I began to have severe difficulty getting my tasks done, made med errors and again, wasn't able to help much with my team, and spent hours checking and double checking my work out of fear. its hard not to be paranoid, but i continued to do my best. I learned that i had to start asking for help and admitting when i didn't know the answer to things. Staff were openly annoyed with it, but what the hell, its better than making a fatal error.Doing that didn't help me at all.One of the nurses who didn't particularly like me or think me fit to work along side her (who thought she was charge material) was in charge for one afternoon had advised me on how to proceed with a complex patient situation, watched my performance, saw the job get done, then turned around and wrote a letter to my manager that i had endangered a patient by failing to ask for help. She literally turned the whole story backwards in order to get me in trouble. (BTW i still have her hand written instructions on how to proceed with said patient, because she was too busy to come with me). I insisted my manager get me off that floor immediately. I had been openly harassed (walked in to a group of three nurses openly discussing my performance in front of me, who wouldn't stop talking when i asked them to and another nurse who didn't want to take time to double check a spacing error on the narcotic sheet, when signing off, accuse me twice of "either fudging the number or stealing a pill to make the numbers right" and this last nurse who wrote complete lies...my manager wasn't interested in the evidence i had that the letter contained lies against me) When i told her i was going to start complaining about harassment, she decided enough was enough. I was moved to another hospital with an easier med-surg floor. Everyone there loved me and still loves me. they accept my shortcomings and are very patient and kind with me. They actually teach me things and are always prepared to back me up on those things they know i need help with (all but one who didn't like the way i did things and didn't want to work with me who has since moved to another hospital)

That same day i went to insist on being moved the manager asked me to stay just a few more days, and the complaints at that point, just kept coming in, whether they were based in reality, or just the nurses wanting me off of their floor. a few months later, when i had already moved on and was doing very well at the next place, my manager ambushed me with a pile of complaints she had received over months, literally, months, from the previous hospital and said she "didn't know what she was going to do with me". she waited till i was well into my first pregnancy, with husband away for several months, extremely vulnerable. a meeting was called with union reps and HR present. They bombarded me with even more complaints that i knew nothing about and expected me to comment on them. The union reps spoke not one word in my defense, nor even spoke for me, that i needn't respond to any accusations since they were all news to me. Very long story short, my manager tried to humiliate me into quitting, but i wasn't about to being 7 months pregnant and needing paid mat leave. Is that the type of conduct any one would expect from their manager? I know its not me who is un-professional.

I'm sure some of you reading will think, how do they get themselves into such a mess? Believe me there are vindictive, petty, nosey, trouble-making co-workers at most nursing jobs. They see those who are lacking in confidence, and pounce on them. They have nothing better to do but make their lives miserable. No nurse, new or old would wish to have such difficult work relationships, There is little acceptance for learning difficulties, or being new period. Those nurses getting ready or past retirement, often expect us new nurses to have the same knowledge they do and can be extremely nasty if you show any sort of weakness or lack of knowledge. (Why do nurses eat their young!?!?!?)

My manager knew i had a learning disability and failed me by not giving me a structured learning environment, then allowed all kinds of humilliating harassment to occur uncorrected. In the end they wanted to get rid of me because they felt i was a liability. I was lucky enough not to be fired due to all sorts of reports made on me, some with a bit of basis in reality, many exaggerated and many more completely made up. They couldn't fire me because of our union. I was allowed to view many of the written letters which had very personal comments about my person, not my professional abilities. How were these personal judgements let to stand, i have no idea. There were sentences blanked out which started "i really like this girl but...."(how professional is that?) I've always taken responsibility for my errors or difficulty in getting the job done efficiently. I asked for help many times, it just did me no good. I was discriminated against, harassed and even asked not to return to my current post once my mat leave is over. How about that?

Any time i questioned another nurses conduct, witnessed mistakes, dealt with patient complaints about other nurses, I've always taken it directly to the person, allowed them a chance to discuss it with me and give me their point of view (based on severity of situation of course). I expect the same courtesy in kind, but have never ever gotten it.

Don't believe that you can't be discriminated against. If they really don't want you, they will find another way around it. I was so worn out by all of this degrading treatment i didn't have the energy to take any kind of legal action, though i would have been more than right to do so. I am only 3 months into my mat leave and i'm terrified to go back and do any type of nursing work. I have been so stripped of any confidence or self-esteem as a nurse, that i actually refuse to do any sort of hospital nursing ever again. and FYI i am being treated for ADD, not only with medication but also behaviour modification therapy. My confidence in my ability to nurse is coming back, but never again will i fully be able to trust and let down my guard with co-workers again.

I don't know if the thread starter is doing anything like taking meds or getting therapy, but i would suggest both, as well as considering what your strengths are as a nurse, and finding a more suitable job. ADD sufferers are not stupid people, as nurses should know, we are often highly intelligent, creative and compassionate people. This should be seen as an advantage. We would be great team members if only some of the team would take the time to get to know us, learn about the disorder and try to help rather than criticize and degrade.

My strengths as a nurse are in health teaching and dealing with family issues. I have had letters written about my great care and tact when dealing with difficult family situations, and been praised for my ability to health teach effectively. why these compliments are forgotten next to complaints of nurses who just don't like me, i have no idea. I don't think this kind of treatment is going to change any time soon.

Sorry for the long rant, but i'm tired of no one trying to understand. I really liked being a nurse, and if my rant helps other staff nurses to be more understanding and open to their co-workers experiencing similar problems or even shed light on the types of harassment and abuse that go on undetected, then i will be glad.

[sjrn85]

If a disability gets in the way of a nurse being able to deliver safe care (e.g. unable to administer meds accurately) then that nurse needs to understand that certain areas of pt. care may not be appropriate for him/her. There are many opportunities in nursing that may suit such a nurse better.

It's really not the responsibility of an employer/staff to have to continually double-check someone else's work for accuracy. Med. admin. is a very serious aspect of patient care, and when someone is unable to give meds safely, for whatever reason, that is a serious liability for both the patient and the hospital.

The ADA expectation is that "reasonable accommodation" be made for a worker with a disability. Allowing someone to make repeated med errors/having a nurse who needs constant monitoring is not reasonable.

I'm sorry if that sounds harsh; again, I'm not saying these individuals can't work in nursing at all. I just feel individuals with this sort of problem should look for areas of nursing where there is less risk to all parties.