Posts Tagged ‘medication errors’

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That Acute Attention to Detail, Bordering on Wariness…

November 21, 2011

via Wikimedia Commons

By Kinsey Morgan, RN. Kinsey is a new nurse who lives in Texas and currently works in the ICU in which she formerly spent three years as a CNA. Her last (and first) post at this blog can be found here.

It seems that nursing schools across the world subscribe to certain mantras regarding the correct way to do things. Different schools teach the same things with utmost urgency. Hand washing is one of the never-ending lessons that comes to mind. How many times do nursing students wash their hands while demonstrating the correct way to perform a procedure? I vividly remember actually having to be evaluated on the skill of hand washing itself.

Another of the regularly emphasized points of nursing school is double-checking. One of my first clinical courses required students to triple-check patient identification before giving medications. We were to look at the medication administration record, the patient’s wristband, and then actually have the patient state their name.

As a new nurse learning several new computer systems for charting, etc., I’ve noticed that the old attention to detail, ground into my soul during my school days, now seems easy to overlook, since computers do so much of the work. Of course, computer charting and electronic MARs* have simplified tasks and made time management much less daunting. But sometimes I worry about the hidden cost of such improvements.

I intend, vow, resolve to make an effort to remain aware of how easily errors can happen when we don’t double- and triple-check things. I want to always retain that astute attention to detail, bordering on wariness, so that I can practice as safely as possible, even with the advent of electronic methods.

*MARS = medication administration records

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Posted in health information technology (HIT), nursing students, patient safety | Tagged , , , , , | 2 Comments »

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Memorial Day Weekend Notes from the Nursosphere Blog Roundup

May 27, 2011

As I walked into the exam room and introduced myself as a nurse practitioner, the patient announced she was “forced” to come to our clinic and “wasn’t allowed to see a real doctor” downtown. I was slightly taken aback. Here I was, running on time, in a pretty good mood and ready to assess and treat to the best of my abilities, and then WHAM. I took a deep breath and realized she wasn’t slamming NPs; she had a grudge against military providers, regardless of education background.

That’s from a recent post by a U.S. Air Force family nurse practitioner (NP) who’s been blogging from Afghanistan. She’s home now, and the post, about being discriminated against by a patient—not because she’s an NP, but because she’s a military provider—is worth noting as we prepare for another Memorial Day Weekend.

Memorial Day Flags/Eddie Coyote, via Flickr

Are you a nursing student, or just ready for a change in your nursing career? Curious about various nursing specialties and what they really involve? Codeblog has been running a helpful series of posts, each of which focuses on an interview with a particular type of nurse. The latest is with a cardiac catheterization lab nurse.

Nothing like a medication error to ruin everyone’s day. Lisa at In the Round has a useful post that lists the eight “rights” of medication administration.

“So there is very little, in the end, I won’t share. There are some things, however, that are beyond the pale. Here’s my short list of ten things I will never, ever tell you, my patient.” That’s from a recent post at Those Emergency Blues: “Don’t Tell Your Patient This. Or That.” Have a look and see if you agree.

Lastly, an article today on the NY Times “Well” blog summarizes the findings of a new report on the activity levels of Americans in the workplace. The basic idea is that we’re less active at work, and since we spend much of our time and energy at work, we’re also increasingly obese. Many nurses might dispute this finding if they spend their days on their feet. But it’s worth considering, as many of us prepare for a long holiday weekend full of opportunities to eat, relax, and also, yes, to get a bit of exercise—even if it’s only a matter of taking a daily walk after dinner in the lingering late May light. Or, as Sean at My Strong Medicine puts it, a little bluntly: “What Was Your Excuse for Not Exercising?” 

Point taken.—JM, senior editor

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Posted in nurse practitioners, nursing perspective, patient safety, writing and nursing | Tagged , , , , | 3 Comments »

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Checklist, Please!

June 28, 2010

Christine Moffa, MS, RN, AJN clinical editor

It’s embarrassing to admit how many times I’ve either locked myself out of my apartment or arrived at work and realized I’d left either my wallet or cell phone at home. That is, until someone very close to me taught me to say, “wallet, keys, cell phone, Metrocard” before walking out the door. Little did he know he was using a very powerful tool, the checklist.

As part of my money-saving strategies this year, I’ve resorted to using the New York Public Library to support my reading habit, instead of going to the various megabookstores in my neighborhood (I always fall for the “buy-two-get-one-free” deal!). That’s why I’m late to the party for The Checklist Manifesto, by Atul Gawande. After three months on hold, my turn finally came up—and boy was it worth the wait. There are so many great anecdotes about success stories (and some failures) of checklists—including patients surviving accidents and surgeries against all odds, averted airplane crashes, and well-orchestrated rock concerts—that it makes me want to start implementing checklists in every aspect of my life (including some at AJN). In fact, if I’d had a checklist for packing my bag for this weekend, I’d have remembered my flat iron, amongst other necessities. Now I’m forced to go the next 48 hours with serious frizz! 

My favorite part of the book, though, is that Gawande gives credit to nurses for being the originators of checklist usage in hospitals, citing vital sign charts, medication administration records (MARs), and care plans.

Checklists, it turns out, foster communication, which in turn leads to teamwork. Who knew? In this world of ever increasing complexity, there are so many details to focus on it’s easy for errors to happen. Often you have to focus on your own responsibilities and trust that your colleagues are taking care of theirs. The checklist brings us all back to the same page; if nobody can proceed until it’s confirmed that a particular task has been performed, we’re forced to check in with each other.

If you’d like to make a checklist of your own, you can visit Gawande’s  Web site and download a “Checklist for Checklists,” or see some examples of those used in the medical and aviation industries.

Do you have a favorite checklist that you find helpful either in your personal or professional life? Let us know about it.

Atul Gawande's "Checklist for Checklists"

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Posted in nursing perspective, patient safety, practice tips | Tagged , , , | 2 Comments »

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In Medicine as in Aviation, Communication Breakdown Leads to Fatal Errors

January 19, 2010

by dobrych, via Flickr

By Christine Moffa, MS, RN, AJN clinical editor

Lately I’ve had communication on my brain. I’m always amazed that we get anything done in this world at the rate that messages can get lost in translation. For instance, I recently had a phone call from a mother of two girls who was upset about a medication error involving her 12-year-old daughter. While the mother was at work, the child came home from school with cold symptoms and a temperature of 102.5. The daughter called her mother and was told to take two tablets of Sudafed, which she did. About an hour later, the babysitter picked up the younger child, age nine, from school. Concerned that her sister was sleeping unusually soundly, the nine-year-old called her mother at work. Realizing that just giving her older daughter Sudafed hadn’t addressed her fever, she told her younger daughter to wake up her sister and have her take “two Advils.” 

A few hours later the mother came home from work. As she was about to give her daughter another dose of medication before bedtime, she remarked to the children that she wished she had a combination drug containing both Sudafed and Advil so that the girl wouldn’t have to swallow four separate pills. The nin- year-old informed her that they did in fact have Advil Cold and Sinus; in fact, that was what she had given her older sister earlier when her mother told her to give her two Advils. The mother realized that her 12-year-old had ended up getting 120 mg of pseudoephedrine within one hour. Fortunately, her daughter was fine—before she called me, she had already called her doctor as well as poison control—but it did cause a scare for her family.

What went wrong?

  1. No adult was in the loop; at no point did the babysitter and mother speak about the plan for the child.
  2. The use of a brand name to refer to a drug instead of its generic name: the family had a bottle of generic ibuprofen in the house, but the mother used the word Advil.
  3. The person taking the medication was handed two pills without seeing the package that they came from.

It so happens that when I got the call I was reading a great book by Malcolm Gladwell called Outliers. According to the author, “A lot of the book is an attempt to describe the lives of successful people, but to tell their stories in a different way than we’re used to.” Read the rest of this entry ?

Posted in children's health, nursing perspective, practice tips | Tagged , , | 3 Comments »

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An End to Interruptions: Nurses Preventing Medication Errors

November 5, 2009

By Christine Moffa, MS, RN, AJN clinical editor

By NathanF/via Flickr (Creative Commons)

By NathanF/via Flickr (Creative Commons)

I have a hard time focusing when I am repeatedly interrupted. How many times have you walked down the hall to get something, met with an unexpected request or encounter, and then found you couldn’t remember where you were going or why?

A few years ago I was working as float nurse in an outpatient facility. One of the specialties I floated to was the pediatric clinic. There were seven or eight nurses (a mix of RNs and LPNs) working at the same time, with half assigned to administering medication, mostly vaccines, and the others performing telephone triage and monitoring patients in the observation room.  I can now admit that I used to pray to get assigned to the triage section—not because giving injections was a problem, but because the setup of their system terrified me. Read the rest of this entry ?

Posted in children's health, nursing innovations, nursing perspective, nursing research, practice tips | Tagged , , , | 7 Comments »

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Administering Drugs through a Feeding Tube—Are You Sure You’re Doing It Right?

October 5, 2009
Drug Administration through an EFT

Drug Administration through an EFT

By Sylvia Foley, AJN senior editor

Research indicates that a “surprising number of nurses”  fail to follow guidelines for preparing and delivering drugs through an enteral feeding tube. (Do you find this surprising? Tell us in the comments!) This can result in medication error and tube obstruction, reduced drug effectiveness, and an increased risk of toxicity.

In this month’s CE feature Drug Administration Through an Enteral Feeding Tube, author Joseph I. Boullata describes the factors to consider before doing so and examines the gap between recommended and common practice. He also explains what the most recent guidelines from the American Society for Parenteral and Enteral Nutrition (ASPEN) recommend and why.

The ASPEN guidelines include:

  • Do not add medication directly to an enteral feeding formula.
  • Administer each medication separately though an appropriate access site.
  • Liquid dosage forms should be used when available and if appropriate; only immediate-release solid dosage forms may be substituted.
  • Dilute the solid or liquid medication as appropriate and administer using a clean oral syringe.
  • Avoid mixing medications intended for administration through an EFT.

For the complete guidelines, check out Table 1 in the article. And for more on this and other aspects of  enteral nutrition, visit ASPEN to read the full 2009 Enteral Nutrition Practice Recommendations. (ASPEN guidelines are free, but site registration is required.)

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Posted in nursing research, practice tips | Tagged , , , | 2 Comments »

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