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askaham

askaham

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  1. askaham

    Have you ever made a med error?

    Oh...and PS...a great wealth of wonderful information on this very topic can be found on the Institution of Safe Medication Practices website http://www.ismp.org/Newsletters/nursing/default.asp
  2. askaham

    Have you ever made a med error?

    As an instructor, I would see this refusal to double-check alot. Even if not overtly, it was obvious b/c they were not really carefully checking independently. I agree that the nurse cochecking should have the responsibility to chart. I always charted next to my students who administered meds so why can't a coworker chart next to you on the MAR? In this day and age when JCAHO is so hot on preventing med errors, I would think that nsg mgt at your hospital would want to have that kind of double-check system in place. The old saying of, "if it's not charted, it's not been done", is still true today.
  3. askaham

    Have you ever made a med error?

    Narcotics and other high-risk meds (ie. anticoagulants, electrolytes, etc) should always be double-checked independently by another licensed nurse.
  4. askaham

    Have you ever made a med error?

    This whole discussion saddens me on so many levels. First, that so many of you have only owned up to one or two errors. Having been a nsg instructor and a clinical supervisor, I have caught so many med errors that had continued on, some for years. For instance, while giving meds with a student, I noted that the pt had an order on the MAR to give lubricating eyedrops to both eyes every 4 hrs. My student gave one drop to each eye and when we returned to the medcart, I noted that the MAR stated to give 20 drops OU. This order had been transcribed onto a computerized MAR for over 1.5 yrs and no one had ever caught it. We got the order clarified to read 2 drops but can you see how errors happen without you even being aware of the error. This same facility was notorious for documenting that they were administering meds by mouth when the majority of their pts were receiving their meds via GT. Many of these meds were ones that were not to be crushed or opened but they did it on a routine basis. Remember that there are now considered to be 6-7 rights of medication administration (right pt, right drug & right dose for right reason, right time/frequency, right route, and right documentation). I think it is terrible that a student should be dismissed immediately for one mistake. I would never fire a licensed nurse for a first med error. Med errors are usually system-errors not the error of one person. How can we grow as "practicing" professionals if we never get the opportunity to learn from our mistakes?
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