Forensic Nursing Chronicles

Pain management and overdose is an interesting topic. I notice that some providers provide a patient with unlimited amounts of medication and others put their foot down and say they will limit the amount. Often in the Emergency Department, there are some people who have a nickname of “seekers”. This refers to them as patients who come to the ED and all they want is pain medication. They refuse and get angry if labwork or radiology reports are ordered, they state ” just give me a pain shot so I can go home”, are comfortable and then become Al Pacino when you walk in the room and are rolling around on the floor in pain (Literally) and then watch TV calmly when you leave the room. No one takes the time find out what is at the root of the problem, refer them to pain management or have empathy. Can we help these patients? So, you give a patient a narcotic and then they have respiratory arrest. What are we doing? We are not treating the problem. We need more education as nurses and need to learn about how to teach those patients with pain how to treat it properly. There is no absolute answer to resolve this very complicated issue. More research needs to be done on this topic.

Original Post

May 3, 2010

Title: Medication safety

It is completely devastating to make any type of medication error, even if there is no negative outcome to the patient. Although there are guidelines in place to check and recheck before giving medications, we are human and can easily overlook some steps. I agree that newborns are at risk and that there should be additional steps in place to even triple check medications given to them. Of course textbooks can tell us to check the patients name, dose, route, and allergies, but can they be missed. Yes! They can easily be missed. Often, many of the stories I have read about involve new graduate nurses still in training and student nurses. Although they are not the only ones, many nurses and varying degrees of experience can make errors. I myself made an error when I was still in training as a new nurse that completely turned my life around. There was no negative outcome, but I sure did learn the biggest lesson I could imagine. Why was the error made? I was in a hurry, didn’t follow all the steps to verify the correct medication and patient. I read the patients name on the medication and quickly hung the IV piggy back. Something popped in my head just moments later to check everything the pharmacist had typed on the bag. Quickly I turned off IV pump just in time. The medication was 4 times the needed dose for an infant! The pharmacist had made an error in the weight of the patient and gave me medication that was way more than what was needed. Thankfully this ended well. Never again am I in too much of a hurry to look at every detail of a medication.

Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Medication Error

Recently we have acquired a vending machine to give us our medications… Well it is an electronic way of typing in what you need and a little drawer opens. This does not help much in reducing errors. I was beginning to think that someone in our hospital owns stock in the company that provides the machines. The doctor can order the wrong med/dose, the nurse can type in the wrong med/dose, the pharmacy can place the wrong med/dose in the drawers, nurses can misread the order on the computer if it sounds like another med. If there were some magical way to reduce errors and administer medications without killing patients and saving thousands of lives, it would be great. Actually, we as nurses are paid pretty well in order to provide the best care and to use our brains to avoid errors. Yes, we are only human, but we are humans that live in the United States where there are courts and families who want to sue. It is ultimately up to everyone in the process to evaluate orders and reduce errors.

Original Post

March 31, 2010

Title: 200,000 Americans killed each year in hospitals by medical errors, comment

I definitely think this is a drastic number and being on the front lines, I can see how this happens. Especially in today’s ever changing healthcare field. First, you have EMR which has completely changed our world. There have been so many changes recently that it is very hard to keep up with it all. Not only they way we chart things, but how we administer medications. Caremobile, the pt scanning device, is supposed to help catch errors. But with the Electronic charting, the charts and orders are not getting checked like they were because it is too difficult to do and navigate around. Not to mention that there are alot of issues with connectivity, timeliness of entering meds by pharmacy, etc. That by the time the med could be given, alot of unnecessary time has passed, so you may just do a work around to get the task accomplished which defeats the purpose of using Caremobile to begin with! Throw long hours, after hours “catch-up”, high acuity, understaffing, and a whole slew of other issues that are dealt with daily, it is easy to see how these unfortunate things could take place. I definitely think that issues that are causing unnecessary deaths should take precedence over anything else. And fix what is the current problem before you add something else into the mix.

Original Post
March 29, 2010
Title: 200,000 Americans killed each year in hospitals by medical errors, comment
There is no simple answer to why medication errors occur. People die every year from preventable medical errors; wrong limbs are amputated, wrong organs removed, people receive the wrong medications, orders are incorrectly transcribed, medication reconciliation is often flawed, the list could go on forever. Errors are a result of human nature. While every effort is made to minimize and prevent errors, they still occur. Nursing education, annual and ongoing review of the Joint Commission National Patient Safety Goals, time outs prior to surgical procedures, are all great ways to work to prevent errors from occurring. Responses to errors should not be punitive; they are situations from which we learn. Errors result because processes fail.

Original Post
March 4, 2010
Title: “200,000 Americans Killed Each Year in Hospitals by Medical Error”
Listed in the above are common causes of medication errors: lack of sleep in caregivers, poor communication, illegible handwriting, poor staffing. These problems are encountered in all areas of patient care. There are never enough nurses, nurses have too many patients, work too many hours, and in reality are often rushed . Home medications are often not reported accurately and many physicians (who are also often rushed) write poorly. Several of the 2010 National Patient Safety Goals focus on medication administration as a result of reported medication errors. How do we change this? Change begins with education. Nurses must continue to learn about new medications and review old ones, never hesitating to consult resources if unsure about any aspect of a medication. As the last line of defense between the patient and a medication error, nurses must be dedicated to practicing the 5 Rights and the nursing process as it relates to medication administration, providing thorough assessments and evaluations even when rushed. Patients must be educated as well, and taught to ask and know about their medications, to report untoward effects and to learn about lifestyle changes which could reduce or eliminate the need for some medications. As nurses, we must continue to promote better nurse to patient ratio in all areas of care. We must exhibit professional and safe medication administration in our own practice and in mentoring new nurses just beginning their profession. The amount of reported medication errors is a sobering fact which should incite a call to all nurses and facilities to performance improvement in this area.

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Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Medication Errors, Forensic Healthcare Medication Error Attorney Lawyer, Forensic Medical Nursing Medication Error Attorney Lawyer

It is completely devastating to make any type of medication error, even if there is no negative outcome to the patient. Although there are guidelines in place to check and recheck before giving medications, we are human and can easily overlook some steps. I agree that newborns are at risk and that there should be additional steps in place to even triple check medications given to them. Of course textbooks can tell us to check the patients name, dose, route, and allergies, but can they be missed. Yes! They can easily be missed. Often, many of the stories I have read about involve new graduate nurses still in training and student nurses. Although they are not the only ones, many nurses and varying degrees of experience can make errors. I myself made an error when I was still in training as a new nurse that completely turned my life around. There was no negative outcome, but I sure did learn the biggest lesson I could imagine. Why was the error made? I was in a hurry, didn’t follow all the steps to verify the correct medication and patient. I read the patients name on the medication and quickly hung the IV piggy back. Something popped in my head just moments later to check everything the pharmacist had typed on the bag. Quickly I turned off IV pump just in time. The medication was 4 times the needed dose for an infant! The pharmacist had made an error in the weight of the patient and gave me medication that was way more than what was needed. Thankfully this ended well. Never again am I in too much of a hurry to look at every detail of a medication.

Tags: Forensic Nursing, Forensic Nursing Chronicles, Forensic Nursing Theories, Forensic Nursing Medication Error