The order for the that went to the pharmacist should have stood out as a Pediatric order. Due to the fact that is was a STAT order on a medication the Nurse or physician should of called the Pharmacy to confirm the order was received and that the medication was in stock. The nurse that did a second check on the medication should of found the book or reference ranges herself. If she was familiar to the facility then she would of known where the policy and procedures were and all the pediatric dosage ranges. She failed to help her coworker.…
If I were the hospital administrator, chief of the medical staff or the chief of nursing, I would implement stringent standards to follow that provide maximum protection which would ensure that the administering of medication is performed safely and efficiently. The most common errors reported by healthcare providers, are those that have to do with medication errors. The fact that nurses are often front line providers who are required to administer medication to patients (at the direction of doctors), it is imperative that instructions be followed to the letter and practices and procedures carefully executed to avoid medication errors, serious injury or loss of life. Some of the following practices could be seen as causes of medication errors; failure to notate an order change, negligence with giving injections, failure to administer the appropriate medication, medications with similar sounding names, the wrong dosage, the failure to cease or discontinue medication and administering medication to the wrong patient. According to Showalter (2017), Negligence occurs when a person fails to live up to accepted standards of behavior.…
There were many factors that contributed to that near miss. The LNP was working too fast in order to try and keep up with the two halls of patients she was assigned to treat that day because the facility was under staffed. She was rushed and pressed for time so rather than wait for me to finish getting the medications I needed, she started to pull them right beside me. Thankfully we were able to identify the error before it harmed our patient. In that moment I realized just how easy it is to make a medication error.…
Medication errors compromise patient safety. Factors that relate specifically to nursing medication errors include acuity of patients and workload of nurses, distractions, and interruptions that can occur during medication administration. Medication errors underlying causes are inadequate staffing, time restraints, unit atmosphere, and exhaustion. Administering medications is one of numerous responsibilities of a registered nurse and is regularly fraught with disruptions. It was reported that every medication pass was disturbed because of other staff members, absent medications, and further patient care requirements.…
According to (Parker, 2014) “failure to identify and intervene in a timely manner on behalf of patients who are deteriorating physiologically has been correlated with an increase risk of death.” He goes further to say, “a nurses main role in patient safety is to function as “an around the clock surveillance system in hospitals for early detection and prompt intervention when patients conditions deteriorate.” (p.159) Nurses do not need a physician’s order to increase assessment frequency or monitoring, we must make a clinical judgement to do these things if we feel our patients’ assessment warrants it. Just as in the example above, the nurse should have followed up with Mrs. W’s complaint by assessing her again after the Tylenol was given, and then monitor her more closely thereafter. Nurses are the eyes and ears of the physician, so when we notice a patient making a turn in the wrong direction it is imperative that the nurse identify, gather data needed and communicate to the physician in a timely manner.…
The healthcare administrator’s first priority is to report the error according to the organization’s policy and in compliance with the ACHE Code of Ethics, which states that administrators must disclose mistakes (ACHE Code of Ethics, 2016). Although the patient did not receive the incorrect medication, a medical error did occur when the nurse failed to give the medicine ordered by the doctor. The next step would be for the administrative to investigate the cause of the mistake. In addition to disclosing errors, administrative must also effectively address the issue.…
Administering medications to patients is a daily task performed by almost all nurses. In the Bachelor of Nursing curriculum, the 7 rights and 3 checks of medication administration is taught, practiced and performed by all nursing students to ensure proper habits are developed. The problem occurs when health care providers are no longer under supervision of an instructor, and short cuts are acquired. These short cuts, although time saving, ultimately cause more complications for the patient and the health care system. As a group, we have found that CARNA’s Medication Administration Guideline (2016) is not being implemented or enforced as it should to prevent medication errors.…
In providing healthcare, there is a thin line between making an innocent mistake and changing a life forever. Regardless of the amount of experience a provider has, even the slightest oversight could potentially result in a deadly consequence. For most healthcare providers, the mere thought of an unintentional medical mistake resulting in a medical malpractice litigation triggers a state of anxiety. In the article, A Mistake or Medical Malpractice?, Ms. Latner highlights this concern by describing an actual occurrence involving a medical mistake, the response to the mistake, and the resulting outcome (Latner, 2014). As healthcare professionals, we have an ethical and professional duty to uphold with all members of society.…
Medication error can be defined as an unintended action that results in a harmful undesired outcome (Karen, 2011, p. 1). According to Choo (2013) medication error is described as a preventable action that causes harm and does not achieve the desired medication administration outcome (p. 245). Both definitions identify the intention of medication error to be an action that is done unconsciously, as a result the action has a negative aftereffect. Medication errors can occur at any stage from prescribing of medication to administering the medication (Choo, 2013, p. 245). Not only may the medication error generate an unintended result, it can also lead to death of the patient and other further life changing complications.…
These medication errors are unintended but very much a factor within the profession of anesthesia providers. Medication errors are a concern not only to anesthesia providers but also nurses, doctors, and pharmacists. As a group they try to improve patient safety and reduce medication administration…
The clinical nursing phenomenon in the case study is the failure of Justin, the charge nurse to communicate with Cindy when she was clearly not meeting the job expectations. Health care workers plays an important role in patients’ safety as reported by the Institute of Medicine (IOM). With the guidance and recommendations by IOM to improve nurses’ work environment, it is the nurse leader responsibility to act upon those recommendations. The charge nurse or manager duty is to provide consistent day to day feedback and counselling about job performance to staff members to improve the quality of work and to avoid problems that might affect high quality patient care. This is evaluating employee performance which is a part of controlling, the fifth…
Medication error is defined by many different things, whether it is administering medication to the wrong patient or giving a patient too much of the medication ordered (Xu, C., 2014, p. 286). All medication errors should be held as an emergency and should always be reported. The use of technology is starting to be used to help minimize the amount of medication errors, but the nurse should not assume that the technology will not make mistakes (Xu, C., 2014, p. 286). The registered nurse should always double check the medication being dispensed is the medication on the written…
Patient Safety in Medication Error “Five Rights” Patient safety is what the health care system needs to uphold at all times. This is especially important when it comes to administering medication. Medication error is a very serious mistake that a nurse can commit and effect consequently the patient's stability. It is a nurse's duty to follow protocols and be responsible for what they're doing each step of their clinical care.…
Reporting of errors relies on voluntary reporting. Traditionally, the nursing profession has operated based on a culture of fear and blame that focuses on individual culpability rather than looking at problems from a system-wide perspective. There can also be some ambiguity with regards to what actually constitutes a medication error (e.g., is late delivery of a dose a medication error?) and there is often reluctance to report errors that do not result in patient harm. Often nurses feel that reporting medication errors will be personally and professional damaging and are also reluctant to report errors made by others such as physicians, pharmacists and other…
Be mindful of look-a-like or sound-a-like drugs. Hospitals should use commercially available products to decrease the need for iv compounding medications and iv mixing. For a nurse who makes a medication error, consequences may include disciplinary action by the state board of nursing, job dismissal , mental anguish, and possible civil or criminal charges. To safeguard against medication errors, be conscientious about performing the six rights of medication…