Preventing med errors

nyapa, RN · Jul 5, 2007

I sympathise big time re: the machine. But not all technology is correct, and I suppose we have to be more vigilant. Thanks for sharing that experience. Also, I love your idea re: the cheat sheet and allergies. I'll start that too.

Mommy TeleRN, RN · Jul 7, 2007

Well I'm still pretty fresh myself..but my preceptor is very strict about taking the MAR to the bedside and not opening meds until you get there (unless you have to draw it up, then I have to tape it to the syringe) Of course this is the way we are taught in school but most nurses do NOT do this from what I've seen. But she is adamant I make this a habit to avoid med errors.

I also have a spot on my "brain" where I jot the allergies just to help me be more aware, plus I try and make it a habit to check on those that DO have allergies to make sure they have bracelets.

I guess we have to be even MORE super vigilant on orders that don't go through pharmacy first..because they are an extra layer of protection.

traumahawk99 · Jul 7, 2007

there's really not a lot you can do after a certain point. there is an error rate, and that's it. when you look at something in the mar in a wrong way, you can look at it 50 times and you'll still see it wrong.

the only thing you can do is remember to be extra vigilant if you're giving meds that can be dangerous, like heart meds. giving someona a senna s by mistake won't hurt them.

in a hospital, you've got a pixus, which prevents a lot of med errors.. in long term care, you've simply got a medcart, and you give hundreds of pills in a shift while you're under tremendous time pressure.

medication errors happen, even to good nurses. i wouldn't worry about it.

medchick · Jul 7, 2007

I have one question...did you give the patient 4mg instead of 2mg of Dilaudid??? That wasn't very clear in your post.

RNsRWe, ASN, RN · Jul 7, 2007

I'm guessing you already know the answer to this by now :)

The first error was made because you didn't check the medication taken from the machine against the order (MAR). Had you done that, you would have seen the discrepancy. Our Pyxis has been known to be filled with the wrong meds in the wrong slots, so we ALWAYS ALWAYS look closely at the label before proceeding.

The second error was made because while you drew up the med based on the verbal order, you did not then verify the patient's allergy to the med. This could have been done by checking the med that was just ordered against the MAR (don't they all have the allergies listed on them?). It could also have been prevented by you checking the patient's wristband/allergy band before administering the drug. I don't know of a facility that doesn't have patients wearing a special wristband or color-code for allergies; is yours the same?

So, how to prevent med errors? By checking, re-checking, and then checking again before doing anything to a patient. If you've done that, your chances of having a med error have gotta be tiny tiny.

Kat Mandu, BSN, RN · Jul 7, 2007

..... I love your idea re: the cheat sheet and allergies. I'll start that too.

I love that idea, too. We don't get many orders during the night, but still a good idea for when going over the daily MARS, even tho it's there in front of me. LOL. Sometimes I remember better if I write it down.

SuesquatchRN, BSN, RN · Jul 7, 2007

This thread gave me a lot of useful advice. Now, I'm an LPN banging out meds in a nursing home for 30 - 40 folks at a time, but the principles are the same.

https://allnurses.com/forums/f22/im-medications-menace-219773.html

EmmaG, RN · Jul 8, 2007

I don't know of a facility that doesn't have patients wearing a special wristband or color-code for allergies; is yours the same?

The one I'm working at now doesn't have allergy bands for patients. And in almost all cases, the charts aren't noted either (i.e. allergy stickers on front, for example).

Makes me nervous as hell. I have always made it a practice to ask a patient before administering a new med if they have any allergies. I also ask about iodine/betadine/shellfish and latex allergies in patients going for scans and procedures, and before starting IVs and ports, placing foleys, etc.

Since I've been here, I'm especially careful to do so.

RNsRWe, ASN, RN · Jul 8, 2007

The one I'm working at now doesn't have allergy bands for patients. And in almost all cases, the charts aren't noted either (i.e. allergy stickers on front, for example).
Makes me nervous as hell. I have always made it a practice to ask a patient before administering a new med if they have any allergies. I also ask about iodine/betadine/shellfish and latex allergies in patients going for scans and procedures, and before starting IVs and ports, placing foleys, etc.
Since I've been here, I'm especially careful to do so.

Holy Cow, that's a disaster waiting to happen! Every place our school had clinicals (6 hospitals) the MAR showed allergies on every page (as was the addressograph on each page). And in each hospital, patients wore wristbands denoting the allergies; one of them had color-codes for different things (like DNR was yellow, allergy alert was red).

Where I work has a separate red wristband with the allergy stamped on it, so you'd have to be blind to miss it. Or, I guess, not blind but not verifying your patient either.... :uhoh3:

Hygeia79 · Jul 9, 2007

I was curious if some experienced nurses can help me or give tips/advice. I am a nurse with about 6 months of experience. I work in oncology. I have had two med errors since starting, nothing that has done much harm, but I feel guilty and wanted to see if there was a way maybe prevent future ones. I know we are all human, but I really feel guilty.
My first med error was more of a narc discrepency. My order was to give a pt for Dliaudid 2mg IV. The machine dispensed Dilaudid 4 mg. I entered in the number of vials, but the machine failed and never told me there was an error. My charge nurse caught the error and was really nice about it. My pt actually benefited more from my error, but still. My charge nurse was good about it and we realized that there was something wrong with our machine.
My second error was a woman who had her bladder removed. She was on a Dilaudid Epidural PCA. She was in severe pain, rating it 8/10. She was obese and despite her using her rescue doses, it wasnt helping. No CABS were order for her either. I called the PA on our floor (thats who we go to since most of our docs are in surgery). When my PA called back, I was in the med room and she ordered the pt to get Morphine 5mg. I pulled it out, drew it up and gave the pt her meds. i didnt have my clipboard with me. About two hours later, the fellow saw the pt and realized she was given Morphine. The pt has a documented allergy to Morphine. The PA came and told me. she ordered the pt for some Benadryl and we both explained what had happened to the pt. The pt stated she was in the ER about 10 years ago, had been give Morphine and had gotten dizzy. She was told then she was allergic. The pt did not feel dizzy during my shift at all, in fact she was more comfortable and rated her pain at 4/10. So the PA didnt feel Morphine was a true allergy for the pt. The pt was good about the whole thing, but I apologized profusely.
I know you learn from your mistakes and I truly have. I now write things differently on my cheat sheets for allergies and triple check my meds coming out of the narc machine. However, I still feel very guilty. i dont want my mistakes to kill someone, and that is my biggest fear. Any suggestions???

Patient safety is so important thank you for this topic

kanzi monkey · Jul 9, 2007

I think it's hard, especially when you're new, to keep straight who is allergic to what, etc. Where I work it is in our computers, so anytime we are signing out a med, we can see right in front of us what the pt. is allergic to. But, with busy pacing, or, god forbid, you give a med before you sign it out, it's amazing how easy it is to overlook something as important as an allergy.

A couple of the suggestions in this post are really helpful. I think when you are first talking to your patient, including the allergy question can really help. It's easier to remember information conveyed directly from the patient--there's some context (usually a story). Another thing that can be helpful is to learn what the allergic reaction IS when you are first receiving report on the patient. At my hospital that information is written in the orders. I think morphine is one of the most common reported allergies--because patient's report that it makes them nauseas or dizzy. Well, it makes lots of folk those things. But if I learn that morphine leads to anaphylaxis in one of my patients, I'm not likely to overlook that when I'm doling out the meds. Any time I see anaphylaxis, swelling, difficulty breathing, palpitations, etc as an allergic reaction, it sticks in my head.

Regarding the situation with the dilaudid, here's what my preceptor told me--when you are giving a narcotic, absolutely ensure the 5 rights every single time, without exception. Obviously this should be the case with any drug--but with burdensome case loads, and every single patient getting some variation of the "senna, famotidine, multivitamin, vit D, colace, calcium, folic acid" mix (at least where I work)--in addition to all their other meds, an occasional miss is to be expected. With narcotics, cardiac meds, and any other med that--if given improperly--can cause your patient to quickly find themselves having a very bad day, look at the order, look at the pixus, look at the med in your hand, and tell the patient what it is, what the dose is, and why they're getting it. Ask if they have questions. Ask if they've taken this med before. Same thing if the med you're giving has a narrow therapeutic window like lots of abx--or can become toxic quickly like tylenol.

I'm new to practice, and my manager told me when I started that I WOULD make a med error at some point, and part of my training is to learn how to resolve and document the situation. Luckily I haven't had to do this yet. But I feel like, just by paying attention to the question "what is this medication and what is it going to do to my patient?" will help me to prevent making a dangerous med error. 4 mg of dilaudid IV would be fine for some of my patients. For others, not so much. Keep in mind the age and condition of your patient as well. Some patients can't get enough pain relief. Others will, well, get a bit kooky on 5mg of PO oxycodone.

Anyway, these are just suggestions I'm trying to follow as a newbie myself. Hope they're helpful!

~Kan