Never make these drug errors: They're indefensible
Which medication mistakes are the most indefensible? "Those which are ordinarily avoidable, and simply the result of poor attentiveness on the part of the nurse," says Ann Robinson, MSN, RN, CEN, LNC, principal of Robinson Consulting, a Cambridge, MD-based legal nurse consulting company.
For example, when a patient is given an incorrect dose of insulin or heparin, both considered to be high-volume, high-risk medications, "these are often indefensible mistakes," she says.
"In recent years, what I've seen is incidents where the wrong type of insulin was given, more so than the wrong dose," says Robinson. For example, ED nurses give regular insulin instead of Novolog. "Some nurses and physicians, as well, are not aware of differences, however minor, between types of insulins, or are not aware of how many types there are, such as 70/30, 50/50, 75/25 mixes, and so forth," she explains.
Dosages are the biggest medication error issue for lawsuits involving ED nurses, says John Burton, MD, residency program director for the department of emergency medicine at Albany (NY) Medical Center. "This tends to come from a nurse incorrectly following a protocol, for pressors or continuous sedation drugs for instance, or a nurse giving a dose of a medication that has been improperly interpreted from a physician order," Burton says.
In recent years, Robinson has seen more mistakes that, had they become part of a litigation process, would be indefensible. "One was an instance where a new nurse added Pedialyte to an IV line," says Robinson. "Having new nurses with little experience with patients is certainly a high-risk venture, but a necessary one in these times of nursing shortages."
If you see a dose that looks "out of whack," you need to question that, says Christine Macaulay, RN, MSN, CEN, nursing practice and safety specialist at The Children's Hospital of Philadelphia. "I've seen cases that went through several shifts of people before the patient's overdose was recognized," she says. "Even though you didn't write the order, you need to be sure the dose is correct."
Macaulay says what she hears most often when nurses are sued for medication errors is lack of knowledge. "When I hear nurses explain this in depositions, they either say that they didn't recognize the dose or they were afraid to ask someone else," she says. "Before online formularies, we used to always call the pharmacist. This is still a good practice. There must always be a mechanism for the ED nurse to get the information they need about a drug before they give it."
Do this first when a drug error happens Ann Robinson, MSN, RN, CEN, LNC, principal of Robinson Consulting, a Cambridge, MD-based legal nurse consulting company, says that if you do make a medication mistake, your "immediate — and I do mean immediate — steps to take should be full disclosure." Robinson advises you to follow these steps: 1. The first person in that loop of communication should be the prescriber. 2. Next, whoever the next "chain-of-command" individual is in the department should be notified. 3. "Depending on the severity of the mistake and the patient's response, a call to the risk manager would be in order as well," says Robinson. 4. It also might be appropriate to notify the patient. "Often, the patient is left out of the information loop," says Robinson. "When there is no adverse event expected, this may be an appropriate option. However, I have seen situations in the past where a patient has a poor outcome, and then it is discovered that a medication error occurred and was likely responsible. After the fact is never a time for the patient to find this out." In fact, Robinson says in her opinion, full disclosure to the patient and/or family is the best way to avoid a lawsuit. "Mistakes are much more forgivable when patients are told by the nurse making the error," she says. "In one instance, I was the nurse giving the incorrect medication dose. The patient was the first person in the loop of communication. The others followed in quick succession." The mistake, made many years ago when Robinson was a new nurse, involved an incorrect dose of heparin. "I took a phone order from a physician who, as I understood it, told me to administer a heparin drip at 5,000 units/hour. I mixed the drip, as was customary in those days, and hung it." Because Robinson was caring for nine other patients at the time, it took her more than an hour to verify the proper dose for the patient. She discovered that what was being administered was four times more than the upper limit of a therapeutic dose. "As I read the information, I remember the feeling that came over me. I felt nauseated, cold, then hot," says Robinson. She rushed to the patient's room and turned off the infusion, looking her over for any signs of bleeding. "Fortunately, there were none, then or later," she recalls. "I instantly told her what I had done, and told her I'd be right back. I called the physician to report it, ordered coagulation studies as directed, and started the paperwork to report the error." Fortunately for the patient and the nurse, there were no true negative outcomes, only a valuable lesson learned. "I share this story with new nurses as I caution them about being rushed to get tasks completed, without regarding the gravity of what they are doing," says Robinson. |
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Tell patient what drug you are giving them Before you administer a medication, check with your patient or their parent. Tell them, "We are going to give you X medication at X dose," says Christine Macaulay, RN, MSN, CEN, nursing practice and safety specialist at The Children's Hospital of Philadelphia. "I've had a patient tell me, 'Another nurse just gave me that medication,'" she says. "I had the chart with the order, but it was not documented. I then checked with another ED nurse and found that the medication had been given, but it had not been documented." |
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