Archive for the ‘Medication Error’ Category

Adverse Drug Reactions

July 1, 2013

Recently there was a new Canadian study that stated there was a “link between some medications and serious health problems.” (Posted by Tom Lamb at DrugInjuryWatch.com)The study went further to say that 1 out of 9 visits to the ER were medication related. As a nurse working in an acute care setting I often see patients admitted to the hospital who are on multiple medications and they are unfamiliar with the names of their medications let alone why they take them. Taking Dr. Johnson’s nursing pharmacology course has been very eye opening to me to see exactly all of the potential problems between medications and how dangerous different interactions truly can be. Patient safety should always be our first priority in the health care industry. When patients are discharged home it should be our priority to keep our patients safe by teaching them how their medications interact together and could potentially cause adverse effects. By being diligent in our education for our patients on their medications there is the potential to not put individuals in harms way from the medication that is meant to keep them healthy. DrugNews Defective Drugs News and DrugNews Pradaxa Updates are two websites for extra reading.

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Driving under the influence of carisoprodol

February 24, 2013

Many people frequently drive cars, operate heavy machinery, while under the influence of prescription medications, even though it is clearly labeled they must not do so. Depending on the injury being treated, perhaps it would be beneficial to use a natural treatment for muscle relaxation rather than rely on such a potent drug such as carisoprodol.

When there is a desire to use a natural treatment, people still need to consult with their healthcare provider. This includes those treatments taken by mouth and applied to the skin/muscles. For example, the natural herb valerian or valerian root may cause drowsiness. Another example, a hot pack may lead to discomfort while driving or operating heavy machinery.

People also need to read the labels for Over The Counter medicine and therapies. Some of these will tell the consumer not to drive or operate heavy machinery. If the consumer has trouble understanding the labels, the consumer should consult the pharmacist or the professional on staff. Many products list a toll-free number and website that can be contacted. There are also some general public consumer hotlines and websites that can be contacted.

What should be done if there is an automobile accident? Please read “What To Do After A Car Accident.”

Medication Safety, comment

March 8, 2012

I appreciate your article Medication Safety. My work as a forensic nurse I see as helping people. I am not set out to put people in jail or prove them wrong. Our consulting firm is about helping institutions and their employees do their jobs without major errors. I too have witnessed people cry when they realize a lethal mistake they have made. If I can help them prevent future mistake, I am happy. If I can help others avoid mistakes, then we have done our service well.

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Medication Errors

January 22, 2012

Medication errors occur when a patient receives the wrong drug or dose or is given a drug at the wrong time or by the wrong route. If a medication is administered without consideration for possible side effects or drug interactions there may be dangerous results for the patient. Elderly patients are at high risk for medication errors because they frequently take many medications at the same time which can result in drug interactions or dosage mistakes. Problems can also occur if patients do not report all of the over-the-counter drugs or natural products that they may be taking. Even drugs that are “natural” and considered safe may still interact with other prescribed medications and have harmful effects.

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Medication Errors

January 11, 2012

It is impossible to stress the importance of going through all of the rights of drug administration. A nurse must be alert and ready at all times. A good example is epinephrine. Epinephrine is can be administered by several routes: IV, IM, subQ, intracardiac, intraspinal, inhalation, and topical (157). The strength of epinephrine depends on it route of administration. The same concentration would not be administered for IV and IM. IV administration would less concentrated than that of IM and most other routes. Always be careful in looking at the orders and when drawing up the medication make sure it is for the correct route. If one is not careful they could potentially cause a fatal reaction that should have been avoided if only they had used the drug rights of administration. Whether one has been a nurse for 6 months or 16 years, it does not allow leeway for one to skip a step.

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Insomnia and the elderly

October 17, 2011

Not only is insomnia an issue for the healthy older adult, it can be even worse for the older adult with dementia as they frequently get their sleep/wake cycles confused. Families often call or present at the office requesting sleeping aids. These sleeping aids for healthy elders pose their own risks, but for a dementia patient these risks are increased. Sleep aids often cause confusion, which can lead to increased wander. With increased wandering, there is an increased potential for falls, especially if there are stairs in the home. The likelihood of a patient actually leaving the safety of the home is increased, with the very real possibility of becoming lost. Another issue associated with increased nighttime confusion is often frantic phone calls, most often to adult children/siblings, which can disrupt other households. These phone calls also are known to go to emergency response personnel requiring them to respond to the home for a non-emergency situation. For all these reasons, the use of sedative/hypnotics as sleep aids in the elderly, especially those with dementia, should usually be avoided at all costs. Other pharmacologic interventions, which have been found to be useful with fewer side effects, are trazadone or melatonin. These medications usually work, but the patient can develop a tolerance, requiring higher doses. These medications are not addictive, but higher doses increase side effects. Non- pharmacologic interventions include herbal teas or gentle massage, much as you would do to an infant’s back. The overall goal, of course is return the patient to the appropriate sleep/wake cycle. No one intervention is always effective, and several mat need to be tried. The use of sedative/hypnotics should always be used as an absolute last resort and only for very short periods of time.

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200,000 Americans Killed Each Year in Hospitals by Medical Error (comment)

July 26, 2010

Errors in medication administration can be fatal to patients. It is extremely important for nursing staff to have the training and experience to administer medication but they also need to pay attention to detail. Not just using the 5 rights when administering medication but using them accurately and correctly. A nurse can go through the motions of the 5 rights but if they are not vigilant in their medication administration they are likely to make an error. Of course an error in medication administration is not the only error that can be made within the hospital that can be harmful to patients.
Another error that is possible to be harmful to patients is negligence. If a nursing assessment is not performed as it should be then a change in patient’s condition could be easily overlooked. Or the onset of something like a bed sore could go unnoticed and undocumented casing harm to the patient because it wasn’t caught early enough. Or the signs of a DVT could be overlooked and the DVT could be come fatal all because the assessment was lacking in care and awareness.
Hospitals are not the only place where an error could bring harm to patients. For example pharmacies are a place that can make easy careless mistakes that lead to harm patients. Working as an RN in family physicians office I have had patients call and say their pharmacy gave them the wrong medication or the wrong dosage. As an RN in a doctors office I must be vigilant in my duties as much as if I worked in a hospital, if I don’t pay attention to detail an error I made could have the potential to be life threatening to a patient I am caring for.
It may lie within the duty of the forensic nurse to participate in the legal side of medication error after it has happened. A forensic nurse may need to testify on what happened leading up to the error or even to what may have cause it. A forensic nurse or any other line of nursing it is imperative to be very oriented to every detail in caring for patients.

Original Post
July 7, 2010
Title: 200,000 Americans Killed Each Year in Hospitals by Medical Error, comment
The advent of medication distribution machines may give health care providers a false sense of security when administering medications to patients. As health care providers, we need to recognize that human error is still a potential part of this new medication administration process. The orders are entered by a human, then checked by a human. As nurses we need to review the 5 rights each and every time we administer a medication to a patient. If we become relaxed because the information is coming from a computer, or the medication pops out of a machine, then we are opening ourselves up to “high-risk” nursing practice. Each and every medication you administer to a patient needs to be considered independently. Medication errors should be reviewed monthly by nursing staff in a “morbidity and mortality conference” type of review meeting in order to educate ourselves and learn from others mistakes rather than shame ourselves with a discreet incident report. This may further bring to light the fact that we are human and we make errors, but accountability is key for us to reduce the numbers and make it a safer environment for providers as well as patients. Using machines and computers as tools, not as a replacement of our own cognitive skills, is the balance we need to embrace to reduce medication 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.

Forensic Healthcare Medication Error Attorney Lawyer

Effective Measures Toward Pain Management, comment

July 15, 2010

Nurses as caregivers in primary, secondary and tertiary roles play an important part in caring for patients experiencing pain. While assessing pain as nurses, we need to collect a substantial amount of subjective data in order to properly address a patients level of discomfort.  Because pain is influenced by a variety of factors such as culture, chronic verses acute pain, sleep deprivation, individual thresholds and other sensory stimuli, one of the best measures of pain is to pain is what the!?? patient tells you it is.  Visual cues as well as vital signs should be gathered in the assessment to support the patients complaint of pain.  Patients will often compare their pain to other pain they have experienced before, for example.  Documenting the description of pain and initiating a scale by which to continue to assess the relief of pain through medication and other means of providing comfort is the most effective way to ensure relief.  Patients may respond to certain interventions better than others.  If a medication is ineffective in relieving pain, the physician should be notified and the patient should be assessed for another type of analgesic.  The nurses role as an advocate to the patient should always be at the forefront when addressing a patients need for relief from varying degrees of discomfort.  By knowing your patients individual pain thoroughly from assessment nurses are in a position to help decrease and or alleviate suffering early on in intervention.

Original Post

July 12, 2010

Title: Effective Measures Toward Pain Management, comment

Nursing assessment plays a significant role in the management of pain in caring for a patient.  Pain being a very subjective area to measure you can not only take the subjective level of pain you must also take into account the objective level of pain observed.  The level of pain is a grey area; it is not as simple as being in pain or not being in pain.  There are different levels to the pain and this varies from patient to patient.  Each patient has their own level of pain tolerance.  For example; in the practice I work in now we use a NIBP to measure the patients’ blood pressure in which most patients are not affected by this instrument.  However there are some patients that cannot tolerate the NIBP, it is too painful for them to use to measure their blood pressure; these patients have a lower threshold for pain.  They experience pain in a different way, however their pain is real.  As a nurse you need to be alert and conscious of each patient’s pain threshold.

An accurate pain assessment holds such an imperative function of a nurses advanced health assessment when caring for their patients.  When a nurse is functioning in the role of some area of forensic nursing their experience and knowledge of pain assessment may be called upon to use in their responsibility as a forensic nurse.  For example; if a forensic nurse is being called upon in the court of law to provide testimony in a legal matter they may have to incorporate this experience and knowledge of assessing pain to give an honest and accurate testimony.  Another example of pain assessment being incorporated into forensic nursing would be when a forensic nurse is assessing a possible victim of abuse; the victim may downplay their pain.  As a victim they may try to hide their pain and the forensic nurse will be required to be able to observe accurately any objective signs of pain to give the victim the care they need.

Original Post

September 2, 2009

Title: Effective Measures Toward Pain Management

Pain is an alteration in ones comfort level, which can significantly impact the physical, emotional, and psychological well-being. Pain is a subjective experience that can only be explained by the patient. Cultural and ethnicity are a few factors that influences patients response to pain, to improve outcomes nurses must be able to understand pain from a cultural perceptive. People respond to and view pain differently. Among various groups for various reasons emotions may or may not accompany pain it is viewed by some as an act of punishment or as a spiritual test. Having knowledge of patient’s views and how they define pain is very valuable in that it can assist the nurse in achieving positive outcomes by incorporating this information in the plan of care. Nurses who ignore or refuse to develop cultural sensitivity not only do they violate patients’ rights but also a chance of having a trustful relationship and without this you can expect poor outcomes. Pain is often poorly assessed and poorly managed due to reasons like misconceptions and nurses lack knowledge. This usually leads to under medications and poor outcomes, such as the post-op abdominal surgery patient that develop pneumonia because is unable to perform cough and deep breath exercises every 2hrs secondary to pain because of the nurses’ misconceptions about administering pain medication to a patient with history substance abuse. To achieve goals of effective pain management nurses must first be aware of their values and personal beliefs concerning pain and the behaviors associated with it, this will assist in developing an awareness and sensitivity to the patient’s need. Nurses must be knowledgeable and skilled in collection of both subjective and objective data (by accepting the patients’ assessment of pain by using pain assessment tools and observation of emotional behaviors such as crying or moaning), which will assist in identifying the intensity of patients’ pain and promote better outcomes. Misconceptions must be explored and addressed because these also impact outcomes, such as administering pain med on regular basis will lead to addiction or those who abuse drugs usually over exaggerate their pain, by acknowledging these misconceptions nurses will be able address patients’ pain related issues more professionally and improve steps toward effective pain management.

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Effective Measures Toward Pain Management, comment

July 12, 2010

Nursing assessment plays a significant role in the management of pain in caring for a patient.  Pain being a very subjective area to measure you can not only take the subjective level of pain you must also take into account the objective level of pain observed.  The level of pain is a grey area; it is not as simple as being in pain or not being in pain.  There are different levels to the pain and this varies from patient to patient.  Each patient has their own level of pain tolerance.  For example; in the practice I work in now we use a NIBP to measure the patients’ blood pressure in which most patients are not affected by this instrument.  However there are some patients that cannot tolerate the NIBP, it is too painful for them to use to measure their blood pressure; these patients have a lower threshold for pain.  They experience pain in a different way, however their pain is real.  As a nurse you need to be alert and conscious of each patient’s pain threshold.

An accurate pain assessment holds such an imperative function of a nurses advanced health assessment when caring for their patients.  When a nurse is functioning in the role of some area of forensic nursing their experience and knowledge of pain assessment may be called upon to use in their responsibility as a forensic nurse.  For example; if a forensic nurse is being called upon in the court of law to provide testimony in a legal matter they may have to incorporate this experience and knowledge of assessing pain to give an honest and accurate testimony.  Another example of pain assessment being incorporated into forensic nursing would be when a forensic nurse is assessing a possible victim of abuse; the victim may downplay their pain.  As a victim they may try to hide their pain and the forensic nurse will be required to be able to observe accurately any objective signs of pain to give the victim the care they need.

Original Post

September 2, 2009

Title: Effective Measures Toward Pain Management

Pain is an alteration in ones comfort level, which can significantly impact the physical, emotional, and psychological well-being. Pain is a subjective experience that can only be explained by the patient. Cultural and ethnicity are a few factors that influences patients response to pain, to improve outcomes nurses must be able to understand pain from a cultural perceptive. People respond to and view pain differently. Among various groups for various reasons emotions may or may not accompany pain it is viewed by some as an act of punishment or as a spiritual test. Having knowledge of patient’s views and how they define pain is very valuable in that it can assist the nurse in achieving positive outcomes by incorporating this information in the plan of care. Nurses who ignore or refuse to develop cultural sensitivity not only do they violate patients’ rights but also a chance of having a trustful relationship and without this you can expect poor outcomes. Pain is often poorly assessed and poorly managed due to reasons like misconceptions and nurses lack knowledge. This usually leads to under medications and poor outcomes, such as the post-op abdominal surgery patient that develop pneumonia because is unable to perform cough and deep breath exercises every 2hrs secondary to pain because of the nurses’ misconceptions about administering pain medication to a patient with history substance abuse. To achieve goals of effective pain management nurses must first be aware of their values and personal beliefs concerning pain and the behaviors associated with it, this will assist in developing an awareness and sensitivity to the patient’s need. Nurses must be knowledgeable and skilled in collection of both subjective and objective data (by accepting the patients’ assessment of pain by using pain assessment tools and observation of emotional behaviors such as crying or moaning), which will assist in identifying the intensity of patients’ pain and promote better outcomes. Misconceptions must be explored and addressed because these also impact outcomes, such as administering pain med on regular basis will lead to addiction or those who abuse drugs usually over exaggerate their pain, by acknowledging these misconceptions nurses will be able address patients’ pain related issues more professionally and improve steps toward effective pain management.

Online Forensic Nursing introduction course
Online Forensic Nursing certificate program
Online Nursing Assessment undergraduate education
Online Nursing Assessment graduate class

200,000 Americans Killed Each Year in Hospitals by Medical Error, comment

July 7, 2010

The advent of medication distribution machines may give health care providers a false sense of security when administering medications to patients.  As health care providers, we need to recognize that human error is still a potential part of this new medication administration process.  The orders are entered by a human, then checked by a human.  As nurses we need to review the 5 rights each and every time we administer a medication to a patient.  If we become relaxed because the information is coming from a computer, or the medication pops out of a machine, then we are opening ourselves up to “high-risk” nursing practice.   Each and every medication you administer to a patient needs to be considered independently.  Medication errors should be reviewed monthly by nursing staff in a “morbidity and mortality conference” type of review meeting in order to educate ourselves and learn from others mistakes rather than shame ourselves with a discreet incident report.  This may further bring to light the fact that we are human and we make errors, but accountability is key for us to reduce the numbers and make it a safer environment for providers as well as patients. Using machines and computers as tools, not as a replacement of our own cognitive skills, is the balance we need to embrace to reduce medication 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.

Forensic Healthcare Medication Error Attorney Lawyer


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