Improper Medication Administration


Recently at the hospital where I work and this apparently is in all hospitals it is required to check insulins before administering the insulin to the patient. We have always used the multiple use vials drawing up the amount of units required and then having another RN check the dose and the correct insulin. Approxmmately 2 weeks ago, we went to the insulin pens. I, like a lot of my co-workers are not to fond of the pens however not many like change. Recently on one of my shifts the pens came up from the pharmacy, patients drawers are changed every 24 hours. When getting ready to administer insulin on my morning med pass I was getting ready to set the pens when I noticed the Lantus label was on the humolog pen and the Humolog label was on the lantus pen. It was definetly a good catch as the patient could have gotten a large dose of Lantus when the Humolog was indicated. The pens went back to the pharmacy and were sent back properly labeled. I have always made it good practice not to assume medications should be what they should be. I have also always had another RN co-sign with me when hanging an IV medication even before it was required. When ever I have to calculate something ,i.e. IV Synthroid, I always have another RN do the calculation to be sure my calculation was and is correct. I have never opened meds at the med care, I always check them 3 times before I administer them and check the patients name band and account number to the MAR. I have on many occasions come accross account numbers for patients that do not match and before administering the medication calling admitting to be sure the account is for the right patient, there could always be another patient in the hospital with the same name but the accounts are obviously going to be different therefore I want to be sure that the patient I have has the correct MARS. You can never be too safe when passing medications.

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