Posts Tagged ‘Medical Errors’

Medical Errors

April 24, 2008

I like one author have worked with many male nurses. I agree that all male nurses are not nurturing, but neither are all female nurses. In some instances I would prefer a male nurse to a female one. They usually are computer literate, able to problem solve computer issues, and willing to help when needed. (Their lifting strength is an asset to have). I see more women in nursing “just for the paycheck”. When either a male or female nurse doesn’t have a caring attitude toward their patients or job, that is where mistakes happen.
Perhaps as more individuals start looking into natural medicine and organic food and natural foods, people will be able to build up their immune system, and therefore be able to fight off some of the disease processes they are coming in the hospital for.

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Nurse To Patient Ratios, comment

April 10, 2008

It is true that the nurse to patient ratio is not fare to nurses or patients. But how about the fact that nurses are called off when the census goes down and there is not enough patient per nurse? The same nurse has to take off when census is down and use her/his PDO, which was earned over a period with hard work.

My question is why not let the same nurse work with less pt that day or that night and give the nurse a chance to catch her breath for those busy time that she even did not have time to take a lunch break or go to the bathroom in 8 or 12 hrs shifts? Why don’t make them educate the nursing assistants that they are there to help and make them CNA (certified nursing assistance)? Why the same nurse who had 8 to 10 patient can not work on the days the census is down? Why should the ratio be 2:1 in ICU which was the case in two local hospitals I have worked, but in step-down the ratio is 1 nurse to 5 pts. In step down unit if the censes goes down and ratio become 2 to 3 patient a nurse will be cancel and are called extra nurses. In my humble opinion as an experienced nurse, it is not important how much less patients you have it is the acuity that is important. Nurses are dealing with the person’s life. Patients and nurses are humans they not object. Hospitals and care organizations are 24/7 they are not a department store that open and closes in certain hours, they can not tell the patient sorry we are going to close in ½ hr you should not have chest pain now, you have to wait, nursing is a matter of life and death and they should be treated as partners in this endeavor.

This practice causes nurses to move around for more equitable pay, and leaving their own place where the patients need them, which has given rise to nursing shortage, but with more traveling and agency nursing for temporary assignments. Another drawback to this is that local nurses who take care of patients with the same standard are unhappy because they are working under the same condition with the same patient ratio and getting paid less. There seems to be no justification to make nurses satisfied as far as these issues are not solved. May be some of the hospitals should reduce the
manager to nurse ratio and not waist nursing staff to management so much. Let nurses do nursing job and take care of patients not spend long hours in meetings and unnecessary paper work. Of course patients deserve best and safe care no matter where they are with justified and fair patient to nurse
ratio.

Original Post:
September 19, 2007
There are 2 distinct sides to one of the most controversial dilemmas facing nurses today. First, the patients deserve to have better care from their nurses who don’t already have 9 other patients to take care of. If a nurse is responsible for 8-10 patients on a typical med-surg floor how can they be expected to provide the best possible care, or even just the standard of care? The more you spread a nurse out the less attention one single patient is going to receive. This puts them at greater risk for nosocomial infections, medication errors, incorrect or omitted assessments, the list could goes on. Even if a super nurse is able to accomplish this inhuman standard in their occupation what harm will be done to the nurse? A nurse, the backbone of the medical industry, does not deserve to be worked like a dog, to put these kinds of physical and mental demands that ultimately will harm their ability to take care of themselves and their patients. A standard in setting how many patients a nurse can be assigned to is a top priority for are already overworked nurse workforce.
Of course, you have valid arguments provided by hospital administrators and government agencies, but they are not strong enough arguments to persuade this nurse to think any different. The costs are too high, there aren’t enough nurses to staff this way. This is the mentality the non-nurses elect to have. If there are not enough nurses to staff a set ratio then it just supports the fact that nurses should be respected and not overworked to the point where they have to quit nursing. When aspiring nurses see how very little the hospital administrators actually care for their then the smart ones will choose another field and only add to the nursing shortage. The costs are high now because of law suits and problems that arise from not having a healthy ratio standard in place. By reducing errors caused now by not staffing patients well should reduce the unexpected costs that hospitals have to eat on a regular basis.
Really when it comes right down to it the golden rule should be considered by all. Would you want to be just another vulnerable patient that is one of 10 total care patients that the same nurse has to juggle?

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Documentation errors

October 11, 2007

One of the things I have found with the electronic documentation that my hospital is doing is the proclivity for ongoing documentation errors. Most of the daily or BID assessments are simply template forward with a check box placed by the assessing nurse. I have found errors as simple as documentation of the wrong extremity for IV placement that went on for several shifts before it was caught. With paper documentation each area had to be filled out originally and required thought, I can foresee legal issues for the nurse and hospital with this system. I know all systems have liabilities but in the quest to make it user friendly, I think it has left us vulnerable.

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Nurse To Patient Ratios

September 19, 2007

There are 2 distinct sides to one of the most controversial dilemmas facing nurses today. First, the patients deserve to have better care from their nurses who don’t already have 9 other patients to take care of. If a nurse is responsible for 8-10 patients on a typical med-surg floor how can they be expected to provide the best possible care, or even just the standard of care? The more you spread a nurse out the less attention one single patient is going to receive. This puts them at greater risk for nosocomial infections, medication errors, incorrect or omitted assessments, the list could goes on. Even if a super nurse is able to accomplish this inhuman standard in their occupation what harm will be done to the nurse? A nurse, the backbone of the medical industry, does not deserve to be worked like a dog, to put these kinds of physical and mental demands that ultimately will harm their ability to take care of themselves and their patients. A standard in setting how many patients a nurse can be assigned to is a top priority for are already overworked nurse workforce.
Of course, you have valid arguments provided by hospital administrators and government agencies, but they are not strong enough arguments to persuade this nurse to think any different. The costs are too high, there aren’t enough nurses to staff this way. This is the mentality the non-nurses elect to have. If there are not enough nurses to staff a set ratio then it just supports the fact that nurses should be respected and not overworked to the point where they have to quit nursing. When aspiring nurses see how very little the hospital administrators actually care for their then the smart ones will choose another field and only add to the nursing shortage. The costs are high now because of law suits and problems that arise from not having a healthy ratio standard in place. By reducing errors caused now by not staffing patients well should reduce the unexpected costs that hospitals have to eat on a regular basis.
Really when it comes right down to it the golden rule should be considered by all. Would you want to be just another vulnerable patient that is one of 10 total care patients that the same nurse has to juggle?

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No Harm No Foul: If Nobody Gets Hurt, Is it an Incident?

September 11, 2007

In the book HEALTH PROMOTION THROUGHOUT THE LIFE SPAN, by Carole Edelman and Carol Mandle. Mosby, Inc. Chapter 3 discusses medical errors and refers to the 1999 Institute of Medicine (IOM) research study, To Err is Human: Building a Safer Health System. I had also read an article in OUTCOMES MANAGEMENT titled An Innovative Method of Collecting Adverse Event Data and was very intrigued by both of the articles. So, I conducted my own study at the small, rural community hospital that I am employed. I had noticed that only a small percentage of medical errors were being filed as incident reports and I wanted to know WHY. I made up an Anonymous Adverse Event Survey Questionnaire. For 10 days, one was given to every nurse at the beginning of each shift and to be returned in a plain brown envelope at the end of each shift to keep it anonymous. Over the years, I had heard a lot of grumbling that “Management doesn’t do anything with the incident reports anyway” so I had included that in the 11 reasons for not filing an incident report. The results were amazing. Of the 281 surveys handed out 209 were returned (74%). Of the 209 returned, 130 (62%) reported no adverse events and 79 (38%) reported adverse events. However, of 79 that reported adverse events, only 17 (22%) filed incident reports. That leaves 62 (78%) that did not file incident reports. The most commonly reported reason 21, answered no harm sustained (34%). Nurses that did not think it was an incident 14 (23%). Seven nurses (11%) thought an incident report was not necessary because they informed the nurse involved. Six (10%) did not think that the incident report is used by management as a tool for improvement. Four, (6%) did not want to take the time to file an incident report. Four, (6%) believed it was a waste of time because nothing is done with the reports. Three (5%) answered none of the above and wrote an explanation. Two (3%) feared retaliation from the nurse involved. One (2%) did not know how to use the computer incident form. Zero (0%) feared getting too many incident reports in their file. I added the first 2 reasons together, no harm sustained and did not think it was an incident to equal (57%). That is (57%) did not think they were incidents to be reported, yet according to the returned surveys 14 were medication errors and 4 were patient falls. So, the major barrier to make our healthcare system safer continues to be the question of what constitutes an error, adverse event and incident. (The complete survey report available upon request.)

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Forensic Nursing And Charting

August 22, 2007

Documentation in the nurse’s notes is essential in evaluating patient care and outcomes. It is a legal document and will be used in a court of law if a lawsuit is initiated by a patient or family member.

The Forensic Nurse uses nurse’s notes as a means to obtaining evidence in court pertaining to the patient involved. As I read through the “Basic Pharmacology for Nurses” textbook, it is evident in each chapter that charting is documented proof of patient care. Evidence of patient care and treatments, outcome of treatment, health teaching and effectiveness of teaching needs to be documented. We learn this all in nursing school.

Marianne DeMilliano BSN, JN describes “Eight Common Mistakes to Avoid when Charting” which is available at http://www.nso.com/newsletters/features/common.php

These mistakes can be avoided and definitely will help a nurse if she ever winds up in court.

With regards to Pharmacology and Nurses, the sixth right of medication preparation and administration is “Documentation”. As discussed in one of my previous posts called “Medication Errors”, documentation of date, time, drug name, dose, site and route of administration is important. Further documentation is required in the nurse’s notes to indicate a patient’s response from the medication. Was the drug effective? Did the patient exhibit any adverse effects (psychologically or physiologically) from the drug? Was there any reaction to the site where the drug was administered? Is the patient’s level of pain pre and post medication documented as per a pain level scale? Was the physician notified of the patient’s response to the medication? Did the physician assess the patient and change the medication order? When a new medication was administered, what was the effect of the medication?

Failing to record nursing actions and failure to record reactions or changes in the patient’s condition is just one of many mistakes Marianne DeMilliano discusses in her article. Other mistakes she notes is failing to record pertinent health or drug information, failing to record that meds have been given, recording on the wrong chart, failing to document a discontinued medication and transcribing illegible or incomplete orders.

Nurse’s notes will aid the Forensic Nurse in obtaining specific content relevant to evidence required for investigational purposes and for use in a court of law.

Forgetting to document patient information means “If you didn’t chart it, it didn’t happen”.

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Response to the listing “Medical Errors”

July 26, 2007

This is in response to the listing “Medical Errors”

I would like to respond to this response from the Quality Director. She was talking about how she is responsible for investigating all medication errors in her facility and finding a solution. I was at a conference for Nurse Educators this past week. One of the statements made was how medication errors by nurses are responsible for a large majority of lawsuits.

I took this information back to my students and we talked about how this can happen. We discussed that in order to administer medications, a nurse must have a current license and a medication order signed by a practitioner licensed with prescription privileges. We discussed that the nurse must understand the client’s diagnosis and symptoms as they pertain to the medications they are getting. It is the nurse’s responsibility to know why a medication is ordered, actions, dosing, route, side effects, adverse reactions, contraindications, and drug compatibility. The nurse must also take an active role in the education of the client and family. This information the nurse needs to safely administer medications follows the nursing process. Assessment is an ongoing process. Nursing diagnosis helps to identify problems. Planning helps one to be ready to recognize therapeutic, side effects, and adverse reactions. Nursing interventions allow the nurse to perform baseline assessments and additional assessments to establish goals. Evaluation is an ongoing process as well. The nurse must assess, collect data and evaluate her client on an ongoing basis to be certain that the therapeutic effects and adverse effects of a medication regime are noted. I pointed out to my students that being “unfamiliar” with a medication is considered negligence.

We teach students the proper way to identify a client. They must have two patient identifiers. Examples of these would be validation of patient name, medical record number, or date of birth. These can be found on the arm band and patient worksheet. They are responsible for asking drug allergies at the bedside prior to medication administration. We teach them to do three checks on their medication. The three checks include; first to check the original doctor’s order with their worksheet, second to check their medication against the worksheet when pulling it from the pyxis machine, and third at the bedside in front of the patient. We also teach the five rights of medication administration: right drug, right dose, right route, right time, and right patient. One of the ways our hospital facility has tried to decrease medication errors is to have a mat placed on the floor in front of the pyxis machine that says “quiet zone”. When someone is on the mat, no one is to talk to them. There are also signs posted in the medication room warning of SALAD; sound alike, look alike drugs. Our facility has identified a list
of “unsafe” abbreviations. The doctors may no longer use certain abbreviations when writing orders. A few examples related to medications are: must write out units not U, magnesium sulfate not MgSO4, morphine sulfate not MSO4, and daily instead Q.D.

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Response to the listing “Medical Errors”

March 28, 2007

This is in response to the listing “Medical Errors”

Currently working as a Quality Director at facility that has been functioning less than a year, believe me I understand the all the issues regarding medication errors. I am responsible for researching each and every medication error and finding a solution to the problem. I know that a large percentage of the time it is a systems problem. A ‘systems problem” leaves numerous opportunities for failure. I know that the medical profession in general no matter what the mistake was, would like to find one person to take the blame. I am in a position where I can follow the bread crumbs look into the “systems problems.” I am not sure of what the answer is at the moment. But, when I reach it I will let you know.

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