Nurse Chronicles: Medication Error - What to do?

A few years ago, I worked in a Long Term Sub-Acute care facility. I worked the morning shift that day. I needed to give a patient Humalog insulin. Instead, I drew up the correct dose, but the wrong insulin was given to the patient. I gave the patient Novolog insulin. Shortly after I gave the insulin, I realized what I had done. I felt it within me that I had given the wrong insulin. I proceeded to inform my charge nurse and then my supervisor.   

My supervisor expressed gratitude toward my honesty and boldness in letting her know of my error. One of the other nurses called the doctor to make him aware. The physician stated it was okay. Thankfully the patient was stable. The supervisor then provided some coaching and counseling to me regarding attentiveness in administering medications. From then on, I became very much alert when I administer insulin and other medications. I eventually resigned from that facility but since then medication safety became a very important aspect of my patient care.   

I now work for an organization that requires another nurse to confirm a patient’s name, date of birth, type of insulin and dosage and signs off the medication before it is given. I really appreciate this policy because it improves patient safety.

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There many reasons that contribute to medication errors performed by nurses. Some of these reasons are nurses' workload, fatigue, familiarity, carelessness, and lack of facility establishment of safety measures for medication administration such as a barcoding system. Patient safety involves ensuring the right patient and administering medications and treatments as per facility protocol. Patient safety also involves reviewing physicians' orders and communicating with the physician concerning unclear orders. Even though a physician may order a certain medication for a patient, it is nurses' responsibility to be sure it is the right dosage, time, frequency and medication for the patient.

Tips for avoiding medication errors:

For nurses before administering medications please confirm and perform the following:

Right client: ask the patient's full name and date of birth. If your facility has a barcoding system, utilize it all times to ensure the right patient.

Right route: certain medications can be administered either intravenously or intramuscular. Be sure to utilize the right route.

Right drug: be sure you have the correct medication for the right patient at all times. 

Right dose: if you are to administer half of a dose, ensure you do so. 

Right time: administering medications in a timely manner can often be a challenge for nurses, but endeavor to administer medicines timely especially such medicines as blood pressure medicines, antibiotics and insulins.  

-Check doctor's orders: oftentimes doctors' orders may be unclear - communicate with the doctor about the unclear order. 

-Communicate with pharmacy about drug interactions: I had a patient who had had a baby recently. The patient was concerned about breastfeeding her baby while on IV antibiotics. I informed the patient that I will contact the pharmacy and let her know my findings of her request. I contacted pharmacy who provided resourceful information. Although nurses receive education about drug interactions, we may not remember it all, pharmacists are very useful in this area as it is their specialty - so don't be afraid to consult pharmacy!

-When in doubt, ask another nurse: this has been such a great help to me. It really helps to have another set of eyes to confirm anything regarding patient care. Some weeks back, one of my patients had a colonoscopy scheduled the next day. The doctor ordered 14 packets of Miralax to be given at one time. Miralax is a laxative that enables ease of bowel movements. Due to the scheduled procedure, the patient's bowel needed to be free of all bowel content. The amount of Miralax to be given was unfamiliar to me, so I asked another nurse. She wasn't too sure and so I spoke to my charge nurse who stated that the order was in fact okay. The physician also called and confirmed the order.

-Don't be afraid to ask questions - it is better to administer a medicine a few minutes late due to a collaborative confirmation of a medication dosage than to administer the wrong dosage and drug in a timely manner without confirming.

-Read all medications to the patient and briefly explain what the medicines are for: this requires a nurses personal knowledge of medications. Furthermore, this is a good practice because some medicines may be unfamiliar to patients and it is a way to reconfirm whether you're giving the right medication. If all the medicines are to be administered to the patient, educate the patient.

When you do make a medication an error, don't panic. The popular adage says, "to err is human." Don't hide your error. Inform your charge nurse and or supervisor. Your integrity in practice is key and will be appreciated! Your error is a learning experience not only for you but for other nurses to glean lessons from. 

I hope this is a helpful read! If you are a nurse reading this, I hope that this post challenges you to practice safe nursing regarding medication administration! What are some ways that you avoid making a medication error as a nurse? Do you have any experiences of a medication error?

In the business of practicing and prioritizing patient safety,

-Charity Boadi, BS, RN