On the floor, it is very important to go through all of the medications with the MARs as you open them, much like we did as students, because at 0900, I can pass anywhere from 20-50 medications, depending upon my patient load. If don't have organization, check the meds/MAR/pt, then it could have very serious ramifications.

We use pyxis at our job too, but one of the things that I find that I have to really look out for is dosages that are different than what we are giving. We might pull the 25 mg Toprol from the pyxis, but only need to give 12.5 mg. So what we do is highlight those differences on the MAR so that we all notice the difference in dosages.

Kate loving shenk, your system sounds kind of like what we have in the VA, which was a system invented by a nurse, and has been shown to reduce medical errors. We don't scan our ID badges but log into a computer, then scan the patient's ID bracelet, look for medications that are due w/i a particular time frame, scan them and then administer them. There are several aspects to this system that is great:

1) Our charting is electronic: providers input orders (or nurses as either verbal or phone orders), the pharmacy receives the order and authorizes it (it's cool, when you order medications with certain flags you'll get a message that pertains -- either a drug interaction, or something like a creatinine level that is out of range or some such. If you still want to order the med, you have to give a reason). Once the order is authorized by the pharmacy it shows up on the medication software.

The medication software has 4 tabs, one shows all the meds ordered for that person, along with the last few times it was administered, one the PO, topical, etc orders, one the IVPB, one the IV fluids. You can right click and get the administration history for the med (including the initials of who administered it).

If have options such as "hold" with reasons (pt off unit, bp out of range, etc), you have options for refused (pt. request, pt. spit out, etc), and if it's an injectable, type (IV, IM, SQ) and site of administration. If it's a PRN med you have to give a reason for giving the med, and if it's a pain med, you have to put in the pain level (verbal or NV), which ties directly to the pt's chart so that that info can be tracked. You then have to enter an effectiveness into the same system. Oh, and the medication history also can be called up in the program that has the chart (when given, or if refused or held).

Besides cutting down on medication errors, it allows a lot of information to be shared between different people (including remotely!) and different shifts.

It's a far cry from feeling like a chimp!

I have to make sure I check my medications a lot! I know this is awful, but once I accidently put the wrong pill in the cup and my nurse told me! I felt so bad and I just wanted to start crying.

That's why I make sure I check my medications a lot. I don't care if I'm a few minutes late after 8AM meds or something, I check check check.

and yet, medication errors do happen. I think the first time it does feel devastating, but then you need to put it all in perspective:

Was permanent harm done?

If not, learn from the mistake and move on.

And remember, we're all human, which means we're not perfect and sometimes we make mistakes. Beating oneself up doesn't help prevent further errors.

I think when someone tells me I'm doing something wrong or I forget something, it sticks to my head and I will NEVER EVER forget about it. No permanent harm was done, but it sure made me feel stupid. I made so many stupid mistakes during my first year (forgetting to lower my patient's bed after a dressing change, etc.) and I will remember them forever.

One of my RN school classmates was booted out for giving the wrong dose of Metamucil (The hospital pharmacy equivilant)

You never know when it might matter.

I was accused of a med error by a doctor my first couple weeks after orientation. He had increased the patient's daily Lantus insulin over the weekend. The order was not changed by the pharmacy and several nurses missed it before me and by the time I caught it on my shift it was a couple days later. I was the one who had changed it and he yelled at me about it.

I guess to some doctors, we nurses all look the same.

__________________
~Jo RN
Endocrinology/Infertility
formally Internal Med Hospital nurse.
http://jodaya.blogspot.com/

Ouch, that's harsh. We are definitely all human and we all do make mistakes. That's why one of my instructors told me to ALWAYS check the patient's information on the computer. If the patient needs a catheter out and my nurse just tells me, I'm going to check the patient information and not just do what the nurse tells me (DUH!).

Medication errors are I think, the most common error ever.

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Should remove the offending post? It's too darn funny to take down. SOFT indeed.

__________________
Sanity is madness put to good use. George Santayana.

http://nurse-ratcheds.blogspot.com