Each facility has its own method of tracking errors in drug administration. Unfortunately, many errors aren't documented because the administering nurses are afraid to report them or don't recognize the event as an error. What they fail to realize, however, is that tracking and documenting errors allows the performance improvement (quality assurance) team to recommend ways to prevent future episodes, thereby benefiting both nurses and patients. If you notice an error, made by yourself or another nurse, you must report it–even if you like the nurse who made the error. It's all about patient safety. Hiding errors benefits no one.
On a more personal level, you can take several steps to help decrease your risk of making drug errors. Perhaps the easiest way is to strictly adhere to your facility's policies, suggested safety precautions, and performance improvement recommendations.
Other measures you can take include being especially careful when transcribing orders from the doctor's order sheet to the administration record, being aware of your right to refuse administering potentially dangerous drugs, and maintaining a calm and professional demeanor.
Keep in mind that despite the best intentions and circumstances, mistakes are bound to happen eventually. You may very well find yourself in a situation where you caused or contributed to a medication error. If this occurs, you'll need to swallow your fear and take the proper measures and report the incident promptly. Many errors are the result of a system error. By reporting the error, you may prevent other nurses from making the same error.
Taking the time to carefully document drug orders is one of the easiest ways to prevent errors. To avoid transcription errors, follow these incredibly easy guidelines:
Transcribe all orders from the doctor's order sheet to the administration record in a quiet area, where you can concentrate without interruption.
Before signing the order sheet and initialing the administration record, carefully check both forms to make sure that you've copied the orders accurately.
Follow your facility's policy for reviewing orders. Some require nurses to check all patient charts for new orders several times each shift. Others require checking all orders written within the past 24 hours. (In many cases, this responsibility falls on the night-shift nurses.)
On rare occasions, you may be asked to administer a drug that you know you'd feel uncomfortable giving. Be aware that you can legally refuse to administer a drug under these circumstances:
If you think the dosage prescribed is too high.
If you think the drug might interact dangerously with other drugs the patient is taking, including alcohol.
If you think the patient's physical condition contraindicates use of the drug.
The right way to just say “No”
When you refuse to carry out a drug order, follow these steps:
Notify your immediate supervisor so she can make alternative arrangements (such as assign a new nurse or clarify the order).
Notify the prescribing doctor if your supervisor hasn't already done so.
Document that the drug wasn't given and explain why (if your facility requires you to do so).
Many drug errors occur because nurses are in a hurry, are under a great deal of stress, or are unfamiliar with a drug. Try to take your time, and do what you can to avoid distractions and stress. Remember that many drugs are derivatives of other drugs, and so they have similar names. If a drug is new to you, use available resources, such as drug references and online medical services, to find out all you can about it. (See Conquering confusion.)
Whenever you're involved in a drug error—regardless of whether you or someone else caused the mistake—you need to report it immediately and meticulously document what occurred.
The right response
If you make an error, follow these steps:
Notify the doctor and your supervisor immediately.
Consult the pharmacist. He can provide information about drug interactions, solutions to dose-related problems (such as what to do about an overdose or an omitted dose), and an antidote (if needed).
Follow your facility's policy for documenting drug errors. You may have to complete an incident report for legal purposes. If so, clearly document what happened, without defending your actions or placing blame. Record the names and functions of everyone involved and what actions they took to protect the patient after the error was discovered. Do not document in the patient's chart that an “incident report was completed.”
Here's a complex scenario involving some of the medication errors discussed in this chapter. See if you can unravel what went wrong.
All the wrong moves
The nurse pages the doctor to ask if he'll order an antiemetic for a patient who's complaining of nausea. The doctor calls the nurse back from the hospital cafeteria, giving a verbal order for the antiemetic prochlorperazine. The nurse documents the order on a patient chart; however, it's the wrong patient's chart. She then receives a call to report to the emergency department and asks another nurse to administer the drug before leaving the unit.
The second nurse reads the chart with the order for prochlorperazine and administers the drug to the wrong patient. Fortunately, the patient was not harmed after taking the prochlorperazine; however, the patient who should have received it continued to suffer from nausea until he was administered his dose of the medication.
No hits, no runs…and how many errors?
This situation shows how carelessness and failure to follow proper procedures can lead to various errors, in this case involving two patients: one who received a drug that he shouldn't have, and one who failed to receive a drug that he needed.
Starting from the beginning of the scenario, the verbal order should never have been accepted from the doctor, because this clearly wasn't an emergency. Having the doctor write the order on the patient's chart or enter it into the computer system could have prevented the medication error.
This case also involved a transcription error; no matter how busy the nurse was, she needed to take the time to make sure that she was documenting on the correct patient's chart. It also demonstrates a compound error because of the number of practitioners involved, each of whom could have taken an extra step to reduce the likelihood of error.
Outline