Transcription Error- was I also in the wrong?

If anyone is transcribing from the original order then anyone who checks the transcribed order should always check it against the original order. So unfortunately, you are just as responsible as the person who incorrectly transcribed it! Many moons ago I used a system like this and I checked every order against the original and it is very time consuming. This type of system has a high rate or error and thus the policy of always checking against the original order is a must. It is also prudent,no matter what system to check chemotherapy,TPN and other high alert medications against the original order! Take it as a learning experience and change your practice if you need to do so to catch errors like this.

In my facility a transcription error was made so that a resident was getting twice the dose of an antibiotic than what he should have. I did my five checks with the medication and the MAR and did not catch the error. I ended up administering the second dose of antibiotic that day. My facility considered it my med error even though I did not transcribe the order. Everyone who gave the med regardless of if it was the first dose or second dose received the med error. I feel that since I did my five checks I shouldn't be held responsible for the error.

Since one of the five checks is to verify the correct DOSE, yeah, you and anyone else who didn't catch the error are equally responsible.

The purpose of writing up med errors is to see where the process broke down, and how it can be prevented from happening again.

Your manager should have discussed an action plan with anyone involved, and you should have a copy. Follow it, then give your manager feedback as to how effective it is.

So, iluvivt and Jensmom7, are you both saying that you verify all entries on the MAR, regardless of how old the order is against the original order?

So, iluvivt and Jensmom7, are you both saying that you verify all entries on the MAR, regardless of how old the order is against the original order?

Well, I don't pass meds anymore, I haven't looked at a MAR in years.

But when I worked the floor, you bet new orders got checked (OP said she gave the second dose), and I knew most of the dose ranges for the drugs we used commonly. If a dose seemed out of whack, the order got checked and the doc got called, if necessary.

Also, when I write orders for my facility patients, I give the nurse a copy, and next day, guess what I check? Yep. Med, dose, route and frequency.

One important thing to note however, is that I am cbrf certified to pass meds. I am not a nurse, nor have I had training beyond the basic med passing classes. Anything I have learned about orders and such have been self-taught. I give 40 kids meds every day and have never been told to check the orders before giving the med if the order is written in the MAR. I suppose if I was a nurse I might be more inclined to do so.

Yes, with certain systems I do check the original orders. I used to check every order on the MAR from the original hand written order. The most common mistake I found were medications that had a stop date that no one had caught and the next most common was a dose/amount error. Now, the original order is populated directly onto the MAR I know I am viewing it as ordered but I am still responsible to make certain everything is correct. For example, if the provider orders a dosage that is too high and I administer it I am just as responsible.

Here is the problem though: If you are being help responsible for any mistakes then it is wise to check all orders against the original unless you have an electronic MAR (EMAR). You also have an ethical duty to do right by another human being that is trusting you to care for them.

I don't check the meds listed on the MAR against the original order. The only time I might is when the med/dose is questionable. A new nurse doesn't always know when a dose is questionable. Checking every single med against the original order is unrealistic and not required where I work. The five rights does not include checking the original order for every med, on every patient, on every shift. How would we get anything else done?

My patients are mostly geriatric. It's common to give each one of my 5-6 patients 6-10 meds at each med pass. Are some of you saying that it's my responsibility to check each of those orders before I give the med as listed on the MAR?

Doesn't matter if you didn't check it or checked 10 times. You administered the medication. Any time you have a question about a medication whether it be the dose or an interaction with another med, you have to check the order. If you still have concerns, you need to call the doctor. Whoever did the transcription is at fault and whoever administered the medication is too. I hope the patient is okay.

I agree that it is not practical to check all medications against the original order. Impossible, especially in LTC where one nurse has 30 resident, all with at least 5 meds. Even on a medical floor where you have 5 pts, it would be impossible to do it before the am med pass. My floor has three checks of the original order. On a day shift, two registered staff check the original order and then night shift does a third check of the order.

Unfortunately, it does not matter if the system is flawed, impractical or time-consuming if you give it and it is incorrect in any way you are responsible! I do not write Nurse Practice Acts I just try not to violate them within the systems in which I work!

This is a peculiar yet not uncommon issue. I myself found myself in this same situation years ago. I was outraged when I had received a written warning (as did every nurse on every shift for over two weeks) in a nursing facility that I worked in as an LPN. I cannot recall the medication, but the physician had rounded the night of changeover. He had changed the dose on some medication that was not carried over appropriately. Over two weeks later, this order was caught by the ADON who reported it to the DON, resulting in everyone who cared for that particular patient receiving a write up.

A few years back, I was working as a Rehab Unit Manager and a situation arose once again where the order was not carried over during changeover, resulting in several days of medication errors. There was no harm to the patient and it was simply a change in dosage. I researched until I figured out where the original error was and I administered an "Opportunity to improve" or an episode of education to this nurse.

I believe that when an order is signed off by a nurse as complete, that it is unrealistic to think that each order will be compared to each written order every shift in any setting; let alone a nursing facility where the nurse is caring for 30+ patients at one time. The way this situation is handled would depend on the facility's administration and if any ill-harm came to the patient. In the court of law, I would hope that the court (and/or jury) would recognize that the transcribing nurse should be at fault, but unfortunately, it could very well hold each nurse liable for each dose administered inappropriately. This is a very gray area I'm afraid; but i would venture to say that each nurse will always be held accountable, although the error lies in the system or with the transcribing nurse.