Your funniest "are you serious?!?!" MIDAS report

Twinmom06, ASN, APN · Sep 23, 2016

I only ever MIDAS'ed someone once - for knowingly administering 30 units of Lantus at HS, with a BG of 85 (which was the highest it had been that day) and she told me she didn't feel like calling the doc to find out to hold it or not. 2am BG was 32.

djh123 · Sep 24, 2016

Yet another acronym I've never heard of... but there were Midas muffler places where I used to live. :^)

nutella, MSN, RN · Sep 24, 2016

This is probably going to be a really unpopular opinion
It is important to report 'near misses' as well as actual adverse incidents.... because THAT is where the real improvements come from. Serious events always get a lot of attention, especially "never events" and sentinel events. But those are usually about finding about what happened and taking corrective actions after the fact.
The 'near miss' information provides information about bad processes or systems... things like nurses skipping steps in order to cope with higher workloads; or inaccurate sponge counts because there aren't enough veteran OR nurses left to hold the line against impatient surgeons. Maybe nothing bad has happened yet, but it's probably only a matter of time until it does.
So, yeah, I would definitely take appropriate action if I saw someone doing an sterile procedure without gloves or other adequate safeguards. I hope you would too.

I agree with your statement all the way - investigating near misses and adverse events provide the opportunity to look at the system that is in place with the goal to create or improve a system that will be able to prevent near misses/ adverse events/ sentinel events because human's nature is to make errors. And it is also an opportunity to intervene if it turns out that the system in place is working but the employee is willfully not compliant (example "I do not like precaution gown because they make me sweat" as opposed to "there were no gowns on the floor, I would have to get them from a different floor but the patient had to go to the bathroom").

However, the goal to improve the system and practice is not always achieved for a variety of reasons, for example:

- Punitive culture in which employees are not encouraged to report those mistakes

- The system gets swamped with "revenge" motivated reports to "pay back" another employee leading to huge amounts of reports and it can be hard to find out which ones are the ones needing attention. A report that states that patient got a stool softener medication 40 minutes after the ordered time is obviously different from "the patient needed narcan " or "patient had the wron ID bracelet attached".

- The reporting system itself could be at fault because of the way it is designed, taking too long to use, or not user friendly and so on

- General culture of under - reporting, which often goes back to the punitive culture and mistrust in leadership but can also be based on "not wanting to alienate coworkers" .

The questionable part with the OP post is that leadership on the unit seems motivated to cut back on the numbers of reports to corporate because it also directly says something about the general performance and leadership. Employees usually need to be encouraged to submit reports. If there are concerns about using the system appropriately, the manager need to educate employees about how and when to use the reporting system. Just telling employees to stop putting in reports because it goes to corporate does not make any sense and it encourages behavior that works against the culture of safety that we need.

blondy2061h, MSN, RN · Sep 24, 2016

I write incident reports all the time and encourage others to do the same. I've been part of the post incident review process, so I know they're not viewed punitively. It only takes sitting in a few RCA meetings seeing all the smells cracks that led to the crater come together to wish people with vocalize near misses. People always look at me like I have 6 heads when I say "That's a near miss, we should write it up."

whichone'spink, BSN, RN · Sep 24, 2016

I only write incident reports if the situation calls for it. I am not one to write up every single stupid thing, like many nurses do. I have done it twice in the 3 years I've worked at my current facility.

Once, for a patient who had TPN running way too fast. TPN requires a double sign in the MAR, for initiation, and for hand off. So the TPN was started on the previous day shift and was double signed then. Then the day shift nurse did a hand off with the night shift nurse. Then the night shift nurse did a hand off with me, and I noticed it was running at the wrong rate. TPN runs over 24 hours and the bag was nearly empty. I checked the bag to see what rate it was supposed to be running at and it obviously didn't match what was on the pump. That situation needed a write up, because how the hell could the wrong rate pass twice through?

The second time was for a patient with a PICC line in the right arm, and the blood pressure cuff was on that same arm for the entire surgery. I had to write up the CRNAs involved.

offlabel · Sep 24, 2016

MIDAS/incident reports are used as a cudgel by a small number of people to assert imagined influence and control, by a lot more people for whom not understanding something means that there is something wrong, and finally by a distinct minority that discern an actual problem for which the process of finding a solution begins with the write up.

DesiDani · Sep 29, 2016

Revenge Midas Reports. Hmm sounds childish, but it can happen.

NurseGirl525, ASN, RN · Sep 29, 2016

Never heard of Midas.

ladedah1, BSN, RN · Sep 30, 2016

For the most part, I feel like incident reports (I've never heard of MIDAS, but "incident report" I understand) are a vital part of fixing what is wrong. I can honestly say that I cant recall any silly ones being filled out... then again... I am not the one who sifts through them all either.

What I can say, is that I have sat in on quality improvement meetings which address them... and sometimes the solutions to the problems are quite humorous! If a problem results from nurses feeling rushed and overburdened with time consuming processes, how on earth does someone come up with a solution that equates to more charting? Likewise, if a mistake happens because you have people who decide to not use the scanning systems in the MAR, how on earth do you expect one more pop-up warning to help them avoid catastrophe? Personally, I always use the scanner (its a nice safety net)... but the problem isn't always just a lack of knowledge, sometimes its just that people choose to take the wrong shortcuts to save themselves time.

Nevertheless, quality improvement meetings almost always result in the addition of more charting... yet no one seems to ask themselves, "What can we be doing to save nurses time, so that they do not feel so hurried?" That is the unfortunate outcome of looking at each problem one at a time... each problem can be "fixed" with one more question... one more check box... but in the end, all of the problems that were just "fixed" will end up contributing to the larger (more relevant) problem.

**canoehead, BSN, RN** · Oct 1, 2016

This is probably going to be a really unpopular opinion
It is important to report 'near misses' as well as actual adverse incidents.... because THAT is where the real improvements come from. Serious events always get a lot of attention, especially "never events" and sentinel events. But those are usually about finding about what happened and taking corrective actions after the fact.
The 'near miss' information provides information about bad processes or systems... things like nurses skipping steps in order to cope with higher workloads; or inaccurate sponge counts because there aren't enough veteran OR nurses left to hold the line against impatient surgeons. Maybe nothing bad has happened yet, but it's probably only a matter of time until it does.
So, yeah, I would definitely take appropriate action if I saw someone doing an sterile procedure without gloves or other adequate safeguards. I hope you would too.

Aint nobody got time for that.

Our system has nine subcategories, and then 10-20 subcategories below those, and you have to find the correct spot to file your incident. If you don't enter the proper information, leave something blank, even if it isn't relevant, the system wont accept the report. So you can get 15min in and find the incident actually doesn't fit that category, reset, start again. I refuse to use it. I'll email my manager if I have an issue.

medsurgRNCali, ASN · Dec 18, 2019

I just got my first Midas against me or not putting a patient with a bacteria positive sputum culture on contact precautions. Honestly a heads up would have done. I thought it was a little extreme

KatieMI, BSN, MSN, RN · Dec 18, 2019

On 9/23/2016 at 11:52 AM, HouTx said:
This is probably going to be a really unpopular opinion
It is important to report 'near misses' as well as actual adverse incidents.... because THAT is where the real improvements come from. Serious events always get a lot of attention, especially "never events" and sentinel events. But those are usually about finding about what happened and taking corrective actions after the fact.
The 'near miss' information provides information about bad processes or systems... things like nurses skipping steps in order to cope with higher workloads; or inaccurate sponge counts because there aren't enough veteran OR nurses left to hold the line against impatient surgeons. Maybe nothing bad has happened yet, but it's probably only a matter of time until it does.
So, yeah, I would definitely take appropriate action if I saw someone doing an sterile procedure without gloves or other adequate safeguards. I hope you would too.

Intubation is not a sterile procedure.