What is considered a Medication Error?

I agree that you were right in getting an accurate blood pressure first. It was not appropriate for her to yell at you. The correct size cuff is pertinent- too small or too large can produce inaccurate readings.

As for med error, I have to slightly disagree with siri. Yes, time is one of the five rights of medication administration, but there is also a window of time that meds can be given in. If 5 patients all have 10am meds, they cant all have them exactly at 10am. I think being within a half hour time frame is acceptable. The first hospital I worked at gave an hour time frame, half hour for antibiotics.

I'm actually curious on how she expected you to take a BP without a BP cuff.. any takers on explaining this?

I, too, would love to know how to measure BP without a cuff??

I've always had at least 30 minutes before or after to give a med. Of course, with insulin, for example, you'd want to give that pretty much on time (which is AFTER the meal trays are delivered)

Are you SURE she wrote you up??

I've always understood that on the floor that there is a window of giving meds, since obviously if you are assigned 6 patients and they all have meds at 10:00 am you can't really be giving them to each patient at the same time. The time before and after depends on the definition of the facility.

Taking a BP without a cuff is not a skill you have been taught nor is it really considered appropriate day to day practice in a hospital setting.

We could debate the "medication error" issue for quite a while. For instance, what is the window of opportunity? My facility policy allows medications to be given up to 1 hour before to 1 hour after the prescribed time. For example, 0900 meds may be given from 0800-0959. Yes, there are days that it takes this entire 2 hour window to pass 0900 meds on my unit. However, I don't deliberately give them 1 hour "early" to 1 hour "late." Also, if I am pulled to the CCU, I hold myself to a different standard and give my medications closer to the prescribed time. Much easier to do with 2 pts!

To the OP. Your instructor should have taken you aside to address this issue. However, I believe that the lesson to be learned here is that if an assessment is needed before a medication can be given or held, then the proper equipment should be at hand before the prescribed time. If you are unfamiliar with the unit where you are working, then be aware that you may need to allow for more time to find supplies, bp cuffs, medications, etc...

Hang in there. Learn from your experiences, and become a better nurse because of them.

On my floor (med-surg), according to policy and procedure we have a one hour time frame to give meds. Which means at 9 AM I give 8,9,10.

However, nursing judgement must play in too. Like s/o else posted, you'd be careful to give insulin on time, steroids, etc. As is med pass takes forever, imagine going into each pt's room at 12 pm, then 1 pm, then 2pm....

However, to give benefit of the doubt, I guess you're instructor wants you to at least learn how do it 100% correct, although on the floor I wonder who gives meds exactly on time, unless you have 2 or less patients...

We also have this window of time. I would think that she would be impressed with the fact that you realized the BP cuff in his room was not the appropriate size. I do not believe it was a med error. It would have been a med error if you skipped checking his BP and gave a med that you should have withheld, or if you checked his BP and gave it anyway if you should have held it. At my facility a nurse might have 30 residents, and there is no way that everyone can get their meds on time. We can give up to an hour early or up to an hour late. You should ask someone else (preferably the supervisor of this other nurse) what the policy of your unit is regarding the window of time to give meds, and then explain what happened and what this other nurse said to you and how it was said. I think the other nurse is a bully.

Thread moved to General Nursing Discussion forum.

You always have a window of time to give meds before or after

the scheduled time.

See what the policy of the unit is that you were working on.

And it was not appropriate for her to yell at you in front of

or NOT in front of the patient.

Personally, I don't think you did anything wrong.

Does not sound like a med error to me.

I think you've got one of those dreaded instructors that

some people have the luck to get.

I agree that you were right in getting an accurate blood pressure first. It was not appropriate for her to yell at you. The correct size cuff is pertinent- too small or too large can produce inaccurate readings.

As for med error, I have to slightly disagree with siri. Yes, time is one of the five rights of medication administration, but there is also a window of time that meds can be given in. If 5 patients all have 10am meds, they cant all have them exactly at 10am. I think being within a half hour time frame is acceptable. The first hospital I worked at gave an hour time frame, half hour for antibiotics.

I'm actually curious on how she expected you to take a BP without a BP cuff.. any takers on explaining this?

Giving a med during the window of time allowed by your particular institution (and this does vary, both by facility and by med) should not be considered an error. The entire window qualifies as the right time.

As for taking a BP without a cuff, you can, as Siri mentioned, palpate peripheral pulses and come up with some minimum numbers, but there isn't any way that I know of to spot an elevated BP. So, palpating peripheral pulses is useful when assessing for shock and worthless when assessing for hypertension.

You CAN get a BP without a stethoscope by palpating the pulse just distal to the cuff. (Maybe that's what the instructor was really thinking of.) This comes in handy in the back of an ambulance when there is too much noise to hear well. That said, I know of NO way to take an accurate BP without a sphygmomanometer of some sort.

At any rate, I'd look up the P&P of the facility where you are doing your clinical to be absolutely certain of their parameters. I'd also consult with those in charge of your nursing program. The instructor may just have been blowing smoke, but if, indeed, she did write you up, find out if you are allowed to submit a letter of your own. If so, include (verbatim) the P&P of the facility where you are doing your clinical, and a simple, straightforward account of the incident. Then, let it go.

I wish you well.