Medication Errors

[Autumnovember]

Your right, Autumm, but just looking at the black and white, there is a HUGE difference between hanging the wrong IV antibiotic and giving the completely wrong dose of a narcotic or cardiac med that can cause respiratory depression and death. Each clinical scenario is different, so when the error happens, the team needs to look at everyone and everything involved to decide what to do.

I totally agree. I never see in black and white, thats probably what my issue is. It is such a huge gray area to me. Probably a reason why I think too far into nclex questions too =]

 

[kama_s]

Well, this is sadly what happens when you live in a sue-happy country. If a hospital were to be held legally liable for every error, it wouldn't last past a few years.

 

[iheartscience]

Well, this is sadly what happens when you live in a sue-happy country. If a hospital were to be held legally liable for every error, it wouldn't last past a few years.

Agreed. Honestly I don't expect humans to NEVER make errors, and doctors and nurses are human just like the rest of us. If someone dies as a result of a mistake, then yeah, I can see a lawsuit being in order. If the patient is fine (or even mostly fine) then I don't see the issue.

I actually doubt a patient could get a lawyer to take their case unless they were seriously harmed by the medication mistake. A family member who had a very bad experience with a hospital (and actually could have died) considered suing the hospital. But since the harm done was not really incapacitating they had a very difficult time finding a lawyer to agree to take the case. I'm not sure if that's because it would be difficult to get a decent amount of money so it wasn't worth a lawyer's time, or if it was because negligence (or whatever the technical term is) would be too hard to prove.

They did get the hospital CEO to agree to pay all of the bills above what the insurance covered, and it was quite a bit-around $20k or so if I recall correctly, maybe even more. To me that pretty much proved that the hospital knew it had messed up seriously.

 

[TooPatient]

My question to your nursing staff would be this.

Sitation A:

You make a mistake, tell the doctor and the patient, and everything is handled with transparency. Even if the patient is a complete JERK and tries to get your license pulled... any COMPETENT representation would be able to say "Mistakes happen, here are the stats, EVERYTHING was done to fix the error, and EVERYTHING was handled according to the best medical ethical standards across the board. We can't elimate errors as long as humans are in the equation, but this nurse accepted the responsibility and the consequences, and while we are sorry this happened, to pull her license would be to send the wrong message and would encourage people to cover up errors instead of reporting them and ensuring that any negative consequences are minimized and that the hospital's liability is as low as it can be."

Situation B:

You make a mistake. Then cover it up and are caught because something REALLY BAD happens that could have been COMPLETELY avoided if you had reported your error. Defend yourself now.

If only it WOULD happen like your situation A...

I think the system would be vastly better if this was how things were done. Unfortunately, this is not always the case.
There is a client I spoke with the other day who is an attorney and she as telling me just a bit about what happened with one woman -- it was absolutely outrageous. This nurse was put into a situation she never should have been in, bunches of things happened because of this, she gave a diabetic a medication and then found he'd already had it (so double dose), reported it correctly, the minor issues he had from the extra dose were resolved promptly.... then months later she got called to answer for it because someone's attorney needed someone to blame. BIG expensive (and upsetting) mess for her. (I know some more of the details and it REALLY was a case of them using her as the scapegoat for a bunch of stuff (including the death of a patient before she was even employed there!))

 

[Autumnovember]

So here is a little update:

I asked my clinical instructor today what the proper procedures are for medication errors.

She is a NP and also has her PhD in Ethics so she was the perfect person to ask.

She said that the patient (in most cases) is informed if there is a med error. She told me that if the doctor or NP decide that the patient will have anxiety as a result of knowing that there had been a med error/they will not have adverse effects from it then usually they will not tell the patient.

She said it is a very grey area and it is determined on a case by case basis but most of the time the patient is notified.

Coincidentally, I caught a med error today.

In my patients chart, two medications were supposed to be discontinued on April 6th.

When I printed off the medications that my patient was currently only, both medications were still listed and had even been administered prior to my arrival.

I pointed it out to the RN and she was sort of dumbfounded and later thanked me for catching the error.

 

[TooPatient]

So here is a little update:

I asked my clinical instructor today what the proper procedures are for medication errors.

She is a NP and also has her PhD in Ethics so she was the perfect person to ask.

She said that the patient (in most cases) is informed if there is a med error. She told me that if the doctor or NP decide that the patient will have anxiety as a result of knowing that there had been a med error/they will not have adverse effects from it then usually they will not tell the patient.

She said it is a very grey area and it is determined on a case by case basis but most of the time the patient is notified.

Coincidentally, I caught a med error today.

In my patients chart, two medications were supposed to be discontinued on April 6th.

When I printed off the medications that my patient was currently only, both medications were still listed and had even been administered prior to my arrival.

I pointed it out to the RN and she was sort of dumbfounded and later thanked me for catching the error.

Nice work!

 

[mcmfemme]

Medical error kills more people annually than many other major diseases and accidents combined, it's a serious issue.
As far as medicinal errors; if nurses were to ALWAYS follow the 5 Rights as they are supposed to do, the number of medication errors would be greatly reduced, but that's just one slice of the pie.
I'm very vigilant myself and have never given the wrong medication to date. I will say that one of the greatest distractions though is something that the general public may not be aware of and if I may address it. Please please, if a nurse is drawing, measuring or counting meds, unless it is a medical emergency, please wait for him/her to finish the task at hand, both you and the task of delivering meds deserve our full undivided attention, it's impossible to do both at the same time.

 

[SapphireLover]

I am a nurse working in the UK and have made a medication error. In fact I don't know any nurse that hasn't. I have never given a wrong dose (at least none that I know of) however have given a patient a wrong dose. It wasn't enough to do any harm and was still well within safe limits. What did I do? I owned up! It never occurred to me not to. I immediately notified my supervisor, contacted the doctor and then spoke to the patient with my supervisor and apologised. I was able to discuss what the possible effects would be and discussed the measures that we were going to put in place to make sure the patient was safe and monitored and that it wouldn't happen again. The patient accepted my apology and plans. I fully documented it in their notes and filled in an incident form to alert the hospital managers. The key to reporting and open honesty is that you learn from your mistakes. I will never ever do what lead to my error again. In fact 7 years on and I have never done it again.

What would have happened if I had tried to cover it up? Well, I could have ultimately been struck off. If I took option A and documented the error and didn't discuss it with the patient, I could have still been struck off the register.

As for medication errors being a hidden killer, I totally agree. But do you know what kills far more than giving people the wrong medication? Its actually missing doses of medication. There are far more deaths in UK hospitals from nurses failing to give insulin, epilepsy medication and digoxin than by people given the wrong type or dose of medication.

 

[Gypsy]

Your right, Autumm, but just looking at the black and white, there is a HUGE difference between hanging the wrong IV antibiotic and giving the completely wrong dose of a narcotic or cardiac med that can cause respiratory depression and death. Each clinical scenario is different, so when the error happens, the team needs to look at everyone and everything involved to decide what to do.

I totally agree. I never see in black and white, thats probably what my issue is. It is such a huge gray area to me. Probably a reason why I think too far into nclex questions too =]

This statement scares the crap out of me!! You know why? I'm allegic to 90% of antibiotics out there. I KNOW that people who don't have antibiotic allergies themselves don't understand the type of damage that hanging (IN AN IV! Just shoot me now and get it done with) the wrong antibiotic could do. And it could happen in minutes... as it is going straight into the vein. If you gave me penicillin you could kill me. In just a few minutes. No exaggeration need. I'm THAT allergic.

ANY wrong medication can cause a strong adverse reaction in the right person. Dani you know I heart you... but your statement gave me chills and is WRONG. You have no IDEA what someone is going to react to. And YOU have no right to make that call. None at all.

 

[dani13]

I'm sorry Gypsy but I was just giving examples. You are right in that giving a wrong antibiotic can cause death. But in reality only a very small percentage of people will suffer from true anaphylaxis from antibiotics. You may be one of them I guess, but it rarely happens. And in terms of common Med errors I would say that this is one of the most frequent.

 

[lulu]

Everybody makes mistakes and if I'm in the hospital I have enough on my mind. Keep it to yourself! (The lawyer in me says"really keep it to yourself"!) And maybe I'd lose 2 oz!

 

[Autumnovember]

Your right, Autumm, but just looking at the black and white, there is a HUGE difference between hanging the wrong IV antibiotic and giving the completely wrong dose of a narcotic or cardiac med that can cause respiratory depression and death. Each clinical scenario is different, so when the error happens, the team needs to look at everyone and everything involved to decide what to do.

I totally agree. I never see in black and white, thats probably what my issue is. It is such a huge gray area to me. Probably a reason why I think too far into nclex questions too =]

This statement scares the crap out of me!! You know why? I'm allegic to 90% of antibiotics out there. I KNOW that people who don't have antibiotic allergies themselves don't understand the type of damage that hanging (IN AN IV! Just shoot me now and get it done with) the wrong antibiotic could do. And it could happen in minutes... as it is going straight into the vein. If you gave me penicillin you could kill me. In just a few minutes. No exaggeration need. I'm THAT allergic.

ANY wrong medication can cause a strong adverse reaction in the right person. Dani you know I heart you... but your statement gave me chills and is WRONG. You have no IDEA what someone is going to react to. And YOU have no right to make that call. None at all.

If you are allergic to anything and a penicillin IV was hung then you are completely right, thats a totally different ball game. Allergies in our hospital are put right smack on the front cover of the chart to help avoid that. That is a BIG mistake. There are so so so so many variables just like you pointed out thats why this is such a gray area. Maybe a better example is something like if you gave someone tylenol vs. cardiac meds.

Out of the 5 rights- right dose, right route, right person, right time, right medication, I was told by a few nurses today (might not be 100% accurate of course) that the most common error that occurs is not giving a patient the dose at the right time.

 

[Autumnovember]

Medical error kills more people annually than many other major diseases and accidents combined, it's a serious issue.
As far as medicinal errors; if nurses were to ALWAYS follow the 5 Rights as they are supposed to do, the number of medication errors would be greatly reduced, but that's just one slice of the pie.
I'm very vigilant myself and have never given the wrong medication to date. I will say that one of the greatest distractions though is something that the general public may not be aware of and if I may address it. Please please, if a nurse is drawing, measuring or counting meds, unless it is a medical emergency, please wait for him/her to finish the task at hand, both you and the task of delivering meds deserve our full undivided attention, it's impossible to do both at the same time.

Agreed. The hospital I am at tries to avoid having a crowd of people counting meds by having the door where the meds are locked with a code and its VERY tiny, where literally 3 people total can fit inside.

I think having BCMA implemented in hospitals could help tremendously. It sucks that the system is of course $$$$$$$$$$$. Lots more positive aspects than negative for BCMA as well.

 

[Autumnovember]

I am a nurse working in the UK and have made a medication error. In fact I don't know any nurse that hasn't. I have never given a wrong dose (at least none that I know of) however have given a patient a wrong dose. It wasn't enough to do any harm and was still well within safe limits. What did I do? I owned up! It never occurred to me not to. I immediately notified my supervisor, contacted the doctor and then spoke to the patient with my supervisor and apologised. I was able to discuss what the possible effects would be and discussed the measures that we were going to put in place to make sure the patient was safe and monitored and that it wouldn't happen again. The patient accepted my apology and plans. I fully documented it in their notes and filled in an incident form to alert the hospital managers. The key to reporting and open honesty is that you learn from your mistakes. I will never ever do what lead to my error again. In fact 7 years on and I have never done it again.

What would have happened if I had tried to cover it up? Well, I could have ultimately been struck off. If I took option A and documented the error and didn't discuss it with the patient, I could have still been struck off the register.

As for medication errors being a hidden killer, I totally agree. But do you know what kills far more than giving people the wrong medication? Its actually missing doses of medication. There are far more deaths in UK hospitals from nurses failing to give insulin, epilepsy medication and digoxin than by people given the wrong type or dose of medication.

Thank you for sharing your story! I too, think that when a med error occurs honesty is the best policy regardless of what medication it is.

Also interesting to hear what is the most common issue with med errors too!

 

[charbie]

One of the most common citations nursing homes receive is having medication errors >5%. Yup, you read that correctly.
So while I understand that this IS a problem, and we all recognize that no one wants to ever be given the wrong dose/med/whatever the mistake may be, it is a reality. I do not mean to downplay the severity of anyones health issues, that is not the point of this post. But while everyone says, "oh my GOD! A medication error! We are all going to die if we go to the hospital!" the nurses who spoke up are correct...the majority of the time it is a simple error. Not to say that major ones don't happpen, they do, but health professionals are humans, too.
My view is from nursing homes, because that is where i work. This can be very different in hospitals...but here goes...Most errors in nursing homes/hospitals I think happen in transcription. Meds don't end up discontinued when they are ordered to be (not usually a big deal...but of course can be) but think about it...every single month, every single patient's medication record has to be transcribed and verified in a "change over" process. This is done often during the "free time" a nurse has during his/her shift...often extra help is not brought in for the monthly change over to happen. And every shift, every day, medications are being changed, and when something is changed one shift, then a new nurse comes on, there are times that things don't make it from one shift to another. Now imagine having to keep track of that while you have a patient who is vomiting, another who needs to be suctioned, a family member in your face screaming, and a doctor calling. Im not giving excuses, but damn...I give nurses all the credit in the world.

To answer your question, AN, it is the state regulation in my state that when a med error happens in my states facilities that the md is notified, and the patient and or family member is notified of an error (at least in skilled nursing facilities). Again, most commonly it is that a patient did not receive a specific med, or had been given a med that had been d/c'd. Typical doctors protocol after a med error is to observe the patient for any signs or syptoms of distress or change in condition. Unless there is a major reaction, which would be to send the patient out...but I've never seen that happen in my time working in this profession. Typically I just see people who have adverse reactions to certain drugs, namely narcotics, and that often cannot be predicted before the med had been ordered in the first place.