callienewh

I will try to make this short and cut right to the chase: Nurse in a long-term care facility. Normally work the day shift. Very fast pace, working short-staffed is the norm, but that goes without saying in LTC. I'm juggling admissions, getting breakfast and lunch insulins/CGBs done, passing meds, residents falling ass-over-teakettle, handling the phones, call docs and waiting for call-backs, advocating for families, and trying to do the charting/assessments for 38 people...you all know the LTC drill. At the end of the day, it's typical for 3pm to come and no docs have called me back, which is sometimes no big deal, but 9 days ago, around 2:45, a doc calls me back to give new orders for coumadin based on INRs that I had faxed over earlier in the day. The way it works at my place of employment is this: we have a little 3 ring binder where we put the INRs of the day that are awaiting callbacks from docs. Once we get the new orders, we write them in the binder, put the order into the computer (we use and eMar) and obviously schedule the lab for the next draw. Guess what I didn't do? I missed entering the new Coumadin order AND never scheduled a lab draw for one of my residents. It was written in the binder, but I must have spaced out or gotten pulled in another direction. No real good excuse at all. So, here we are, 9 days later, and the pharmacy sends us an alert stating we haven't ordered a new dose of Coumadin for this resident. That is when my co-worker and I discover my BIG mistake. So this resident hadn't gotten Coumadin for 9 days. Naturally a med error, DON and family contacted. Bed bound resident with Afib, assessment showed no glaring issues, MD was contacted and ordered for INR to be drawn in the morning and resume the last dose resident was on (4mg). What I'm trying to figure out is how I can avoid this from occurring again. In reading up on other's posts here regarding med errors/order errors, it seems as though my facility would benefit from some kind of system where orders are checked by another person...particularly Coumadin and other high alert meds. I take full responsibility for flubbing this one, and I'm certainly going to make sure I drop the multi-tasking mentality when handling INRs and other essential labs, but what are other's thoughts on checking orders in LTC, and how is it done in your facilities?