View Full Version : Triple check that medication vial!


Terry
06-25-2007, 09:52 PM
Next time you are drawing up an IV or IM medication, always check the vial three times:

Check before you open it
Check while you are drawing up the medication
Check after you have drawn up the drug

You will NEVER pick up the wrong medication this way. Plenty of mistakes are made with wrong medications. So many drugs come in similar looking vials, with same-colored caps, too.

Triple check. It takes no extra time or effort.

KimRN
06-26-2007, 03:17 AM
Next time you are drawing up an IV or IM medication, always check the vial three times:

Check before you open it
Check while you are drawing up the medication
Check after you have drawn up the drug

You will NEVER pick up the wrong medication this way. Plenty of mistakes are made with wrong medications. So many drugs come in similar looking vials, with same-colored caps, too.

Triple check. It takes no extra time or effort.

I can't even tell you how many times I've found the error on the third check!!!!!!!!:eek:

They teach this for a reason, and there have been many times I was glad it was branded into my brain!

Oh, and welcome!!! I just put two and two together! :)

PICURN
06-30-2007, 04:26 PM
because a nurse doesnt triple check. That include triple checking your MAR too and your patient.

I saw a nurse trying to break another nurse who was supposed to give Dig to a patient. The offgoing nurse asked if the breaking nurse wanted to see the MAR and vial it was drawn up from. She said no and headed over to give it to the patient, as the offgoing nurse walked to the break room. The off going nurse just happned to be walking back in for her jacket and saw that the break nurse was about to give the dig to the wrong patient!!!!

Check EVERYTHING!

P/J
07-01-2007, 11:38 PM
We are taught these and it is the only thing that will definatly be on the exam.
Right Pt
Right Time
Right Drug
Right Route
Right Dose
AND 6th
Right to Reject (from pt).

The first time I was allowed to give meds as a student, things went wrong. Had been nursing this pt for a few days and knew what they were on and why, so with my nurse buddy I measured out the meds and gave them, and they were signed off. A couple of hours later I heard that the pt was over dosed, I found my buddy and asked 'how, why, what!!!' It turned out that another nurse thinking that the pt was theirs, re-did the drug round (with the wrong date)after me, so it was not my fault.

The overdose was not too bad, and no effect was seen, however 6 hours later the pt was transfered to ICU for tachycaria (not related to overdose). So make sure the pt is actually assigned to you and you have the right date.

KimRN
07-13-2007, 09:13 AM
We are taught these and it is the only thing that will definatly be on the exam.
Right Pt
Right Time
Right Drug
Right Route
Right Dose
AND 6th
Right to Reject (from pt).

The first time I was allowed to give meds as a student, things went wrong. Had been nursing this pt for a few days and knew what they were on and why, so with my nurse buddy I measured out the meds and gave them, and they were signed off. A couple of hours later I heard that the pt was over dosed, I found my buddy and asked 'how, why, what!!!' It turned out that another nurse thinking that the pt was theirs, re-did the drug round (with the wrong date)after me, so it was not my fault.

The overdose was not too bad, and no effect was seen, however 6 hours later the pt was transfered to ICU for tachycaria (not related to overdose). So make sure the pt is actually assigned to you and you have the right date.

Whoa!!! This was a scary one! :eek: Such an unusual situation, but it will make me look twice!

kate loving shenk
07-14-2007, 08:52 PM
we have a "bridge" device, a computer system, that in addition to doing all the checks, helps to further reduce medication errors.

you simply scan your id badge, then scan the patient and then the medication. and there's alot more to it, like linking medications, and dealing with pharmacy errors ALL THE TIME!!

however, this computer system is far superior to a system we had recently for 31 days called: IPROB.

it's a special computer program for labor and delivery.

we had it for 31 days before the hospital had to call it quits. the doctors boycotted the damn thing! these are conservative people who actually took a stand because the system was telling them how to practice medicine.

those 31 days were very painful, watching grown people one by one having psychotic breakdowns.

the nursing staff tried to help everyone use the system. we worked together as a cohesive whole for the good of all.

yet it was not to be.

jen
07-23-2007, 04:59 PM
we have a "bridge" device, a computer system, that in addition to doing all the checks, helps to further reduce medication errors.

you simply scan your id badge, then scan the patient and then the medication. and there's alot more to it, like linking medications, and dealing with pharmacy errors ALL THE TIME!!

however, this computer system is far superior to a system we had recently for 31 days called: IPROB.

it's a special computer program for labor and delivery.

we had it for 31 days before the hospital had to call it quits. the doctors boycotted the damn thing! these are conservative people who actually took a stand because the system was telling them how to practice medicine.

those 31 days were very painful, watching grown people one by one having psychotic breakdowns.

the nursing staff tried to help everyone use the system. we worked together as a cohesive whole for the good of all.

yet it was not to be.

if myhospital ever gets oneof these iwill have to go work elsewhere... it would make me feel like a chimp...just performing a task...as a patient i wouldnt like it either

MyOwnWoman
09-11-2007, 09:53 AM
I worry about the PO medications we send home with the patients. Have you ever stopped and looked at some of these meds? For example, metoprolol looks exactly like Lipitor. They both have the same football shape and about the same size. The only difference is the small etching on each pill is different. Now, take an elderly person who is dispensing his own medications into a "weekly" pill holder to help remind him to take his medications. He looks into his pill holder and says to himself, "Hmmm, it looks like I already put the Lipitor in there and then proceeds to double dose himself for 7 days on metoprolol because he thinks the other pill is Lipitor. Do you think it doesn't happen? Think again.

I can't imagine that drug companies can't alter the look of their medications not to look so alike. For those of you who are muttering to yourself, "he should have been more careful," you may be right, but eyesights fail and the elderly still want to be independent. We should give them that opportunity to be independent....safely.

(She now steps off her soap box and hides in the corner.):nurse:

geenaRN
09-11-2007, 01:03 PM
Why hide in the corner? It's a very good point. There are so many drugs out there, I'm sure most of the shapes, sizes and colors have already been used. :) That said, I don't know why the name of the drug can't be stamped in big black letters on the pill. :dontknow:

I agree with you completely.

Jess
09-16-2007, 12:34 PM
That is exactly what our instructors want every student nurse to be doing. As a student nurse, I have to tell my instructor that "I'm checking to see if it's the right medication." *look at patient meds on the sheet/computer* Then I have to communicate to the instructor what the meds do, why I'm giving them, etc. The 3 checks are so important. The 5 (or 6) rights are very important too.

starkissed
09-16-2007, 01:47 PM
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.

Marachne
09-16-2007, 02:29 PM
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!

Jess
09-16-2007, 04:11 PM
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.

Marachne
09-16-2007, 04:16 PM
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.

Jess
09-16-2007, 04:22 PM
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.

jojodow
09-16-2007, 04:36 PM
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. :banghead:

Jess
09-16-2007, 04:39 PM
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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Mother Jones, RN
02-22-2009, 02:47 AM
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P/J
02-22-2009, 07:11 AM
No don't remove it yet. But it proves that it is sometimes worth reading these posts!

Julie
02-22-2009, 05:54 PM
Makes me laugh, and we DO have a sense of humour!!

AtlantaWalter
04-28-2009, 06:09 AM
I also use a marker to write on the syringe what the med is. You can't take it back once you put it in.
ALWAYS triple check.

Dutchie
05-01-2009, 03:34 PM
We have scanning on the floor and it's awesome. For the past 3 years I've been working in medical imaging and we don't have scanners. Our medication inventory is Versed, Fentanyl, Lopressor, and Demerol and therefore we have a much smaller chance of picking up the wrong medication when we get it out of our pyxis but ever aware that it could happen I still do check the bottle several times as well as the expiration date. I also always look for the words "single use vial" on the bottle. Pharmacy could accidently fill it with a multi-dose vial. I agree, you can never be too careful when it comes to medications.

BethKKG
05-08-2012, 04:20 PM
As a educator who teaches clinical skills - we require our learners to check each medication 3 times for 8 rights

Right Patient
Right Medication
Right Dose (including doing the med math 3 times)
Right Route
Right Time
Right Frequency
Right Site
Right Reason

They hate us at first until one comes close to making an error and them they are thankful for the way we harp on "doing you rights".

danielle5454
01-01-2013, 02:31 AM
I agree that medication errors is one of the most common errors ever and all nurses are committing it, which is why I we really have to be vigilant about it all the time!

jasaka
01-05-2015, 04:20 PM
I have worked in areas where it has been hard to read Doctors writing and seen mistakes in medications by nurses for that reason.
I approached a Doctor and asked him to write me a new order he was not impressed but did it. I am a senior nurse and made to feel inadequate just think of our junior nurses feel