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Tips to Avoid Med Errors

nursing pharmacology tips

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Medication math requires great attention to detail, and the math can be challenging.  Pharmacology is already very difficult to master with interesting medication names and lists of side effects and contraindications.  But, we are here to help with some tips that will help you avoid any med math errors.  

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Podcast Transcription

What’s up guys. My name is Jon Haws, RN CCRN within our sng.com where our goal is to give you the tools and the confidence that you need to succeed in nursing school on the in clicks and in your life as a nurse to help you succeed on this journey. We’ve created weekly cheat sheets that we send to you every single Friday to sign up at over to nrsng.com/freebies that’s interesting. [inaudible] dot com slash freebies and every single Friday we’ll send you a cheat sheet on pediatrics, OB, med surge, mental health, ICU, critical care, every single aspect of nursing care to help you succeed. That’s nrsng.com/freebies all right, now let’s roll into the show. What’s up guys? This is [inaudible]. This is 

Katie Kleber here with the episode of the NRSNG podcast and today I want to talk about a really important topic. This isn’t a, this is a topic that will affect every single one of you no matter what aspect of nursing you work in, and this is medication errors. So I think in school you get this impression that you don’t, when you become a nurse, somehow you’re perfect and infallible and you’ll never mess up. And the only people that do mess up are terrible nurses. Well, I’m here to dispel that, that a thought process. We are human, we are fallible and we will make mistakes. We will be exhausted, we will be distracted or we will. Some people will be careless. I pray that is not the reason behind a medic mistake, but that is the reality of the world that we live in. And if we pretend that we can’t and won’t make mistakes and it’s a lot harder to prevent them. 

So let’s talk about ways to avoid them. And I know you get in the in school and people tell you, well, don’t never get distracted and never interrupt, but it’s let’s be real. You’re given meds and seven people walk in the room or you, you’re scanning your meds and four people peek their head in, Hey, your new admissions here. Hey, the doctor’s on the phone. Hey, if family members on the phone, that’s the reality of what we work in. So I’m going to give you some tips to empower you as a nurse, um, and as a student nurse, um, to be the best you can when you’re given meds. And sometimes, sometimes we just honestly, we need permission. I feel like our need to be empowered to say to people, um, to say, Hey, this is the priority right now. Um, I’ll get to that in a minute and focus on what we’re doing. 

So I’m going to give you some, some very practical tips on ways to avoid med errors as an IX, as not only as an experienced nurse, but as a nurse that has had many errors before. I have another podcast where I talk about what to do and one occurs, but let’s talk about how to avoid them in the first place. Aside from that very fluffy of don’t be distracted. Let’s talk real specific. So when you’re giving meds, a lot of patients and a lot of honestly, people don’t like silence. They feel awkward and they feel like they need to talk. And I’ve noticed that with so many patients that I have to truly say something. Or, Hey, you know, I’m going to right now, I’m going to be looking at your medications. I just need a couple minutes to make sure I’m focused and I have everything situated. 

So if you hang on a second, um, and then we’ll, we’ll chat a little bit more. Um, don’t start conversation or simultaneously do two things while you’re, um, giving meds. You know, the way to survive as a nurse is to be a multitasker, but this is the, the one task where you cannot multitask, if that makes sense. So it’s okay to say to a patient, hold on a second, let me just focus real quick. Many times I’ve said that many times and a lot of times the patient’s like, Oh, you’re right, I’m sorry. You know, they realize, Oh, you do need to focus when, and I didn’t even realize I was talking while you’re doing this because you’re doing it so seamlessly. So do not be afraid to say something to a patient. And another tip too is patients for some reason, um, don’t equate setting up an IV pump or dealing with Ivy stuff as meds. 

For some reason, I don’t think I get a lot of patients and family members trying to talk to me while I’m programming and Ivy pump. And, um, that I honestly, I feel like more patients and families understand to hush hush when I’m looking at the computer or dealing with like oral meds. But when I walk over to that Ivy pump, it’s like, okay, let’s talk. And it’s like, ah, I need to focus cause that is just as important if not more important to focus while programming your pump. So don’t be afraid to say it in a very nice, um, polite way that Hey, I’m just going to focus real quick. I really want to hear what you have to say. But hold on, let me just, um, I, I am the tiger for a little bit here and make it into a little joke and then that’ll lighten the mood. 

Um, and so this applies when you are scanning in the meds. When your, um, using equipment that has to do with medications and this kinda goes into my next one. So like, especially too, when you’re working with like an arterial line at blood pressure, um, and you’re looking at that to dictate maybe medication that you’re going to give. You know, a lot of us, um, have patients that’ll have, um, PRN blood pressure meds to give. So if the blood pressure, the systolic blood pressure is greater than one 60, I want you to give, you know, 10 milligrams of hydraulic Zane. If it’s greater than one 70, I want 20 milligrams, you know, you, so it’s important to double check those vitals before treating them, you know? Um, so if I have like when I would work on the floor and my CNS would get vital signs and then I’d have one, Hey, I’m bed 72, his blood pressure was one 70. 

Okay. Thank you for letting me know. I’d grabbed the med. Uh, um, if, if it was on my way and then I’d go in the room and I would double check the blood pressure or the, the CNA was going back in there. I would say, um, to double check it. Although the CNS on that unit got very used to double checking when they had a higher number just to verify that yes, this is indeed the correct blood pressure. You never know, especially in like ICU when we have leave the blood pressure cuffs on the patients, sometimes they slip down and the blood pressure reading is not accurate so we have to go back and double check before we treat. That can help you prevent a med error by giving a med when it really wasn’t indicated because you’re not, you’re treating a false number or I guess an inaccurate number. 

Excuse me. So the number one focus, and it’s okay to tell the patient to be quiet in a very, or that you need that you need to focus, especially when you’re working with equipment and drawing up medications. The second one, double check your vitals before treating them. My third one is to label your tubing and Tracy are tubing on your IV pumps. I know this sounds simple and basic, but when, if you can quickly look at pumps, especially if you have two or three medications infusing via IV or six, seven, eight, nine, 10, you know, if you’re working in an ICU or CVOR are you or something, um, you may have a ton of medications going through and that’s a ton of lines and a ton of, um, opportunity for air really like are with all of those ports. So, um, something I like to do, if I, if I had more than two things running and if I had an IV pump that didn’t, um, flash the name of the medication that was, that’s been given, cause some pumps don’t do that or sometimes they do, but it’s not readily, like you can’t see it real easily. 

I would write it on a piece of tape and put it on the IV pump so that when I looked at that, glanced at that tower of, of um, T, uh, not tubing. When I glanced at that tower of Ivy pumps, I knew, Hey, morphine’s on top the salient carriers below verse heads below. Um, then I’ve got my, um, Liva fed, you know, so I could easily see where they were and then, um, I would label them not only close to the patient, so at the port closest to the patient nearby, I would also label it behind the pumps. So that means between the bag of Ivy fluid or whatever it is, and a lot of times a pump, I would label it there as well so that I could easily see up at the top where what each was and make sure when you’re connecting and disconnecting that you’re double checking by tracing the tubing. 

And if you have them labeled it is a lot quicker and easier to see what’s what because you, you can tell very quickly, especially a lot of tubing labels are brightly colored, which is wonderful. Um, kind of helps you differentiate a little faster. Um, that way, you know, if you trace before you connect and double check, you know, you trace and double check, you pop whatever it is on or take it off. And then before you leave, you check, you know, or before you let go, you double check again to make sure, yes, I’m disconnecting or connecting this to the correct one. And then you make sure if you’re starting in an IV antibiotic, you’re starting anything that you see that it drips before you leave out of the room. Some, uh, actually many. So a pumps, um, when you’re administering secondary something via secondary tubing, like most frequently an antibiotic, um, if you don’t have it to the appropriate height, it may pull from the wrong bag. 

So you have to make sure that, um, the actual antibiotic is infusing instead of like this saline carrier that it’s connected to. So, um, make sure that that is dripping before you leave the room because that’s something that is not going to alarm and tell you, Hey, I’m giving them saline instead of antibiotic cause it’s coming from the same line the pump thinks I’ve given, you know, 250 CCS of vancomycin. So you’ve got gotta make sure that that’s dripping before you leave. So Ivy tubing and Ivy pumps, making sure they’re programmed appropriately. You’re focusing when you’re programming them, you’re tracing your tubing, you’re labeling your tubing, and you’re making your pumps organize. That’s really important. Here’s another great tip, not for Ivy meds. Well for maybe Ivy push meds. So let’s say your skin and your nine o’clock meds and you’ve got 10 pills, um, and two IVs stuff, you know, you’re scanning it. 

And usually whenever a partial dose is necessary, or maybe two tabs, three tabs, you’ll scan the one bar code and then it’ll say, you know, partial dose or it’ll give you that little warning to remind you to cut the pill or do whatever. So I encourage you to, cause the tendency is to let me just scan everything real quick and then I’ll go back and cut it. But the more time between all the scanning and then going back and cutting the more room for error, because Hey, when I’m scanning the other ones, that gives, you know, maybe someone’s gonna pop in and say something and then I’m gonna forget to cut the pill, or I’m gonna forget to go grab another one, or I’m gonna forget, um, to do the partial dose. So as that warning flashes up, go ahead and stop scanning, put the scanner down and cut the, cut the pill and make sure your um, your dosage correct, your dosage is correct. 

Um, and then my last one is, and I want to empower you guys with never interrupt a med pass for anything. Um, I am a people pleaser. Hi. It is really challenging for me to um, tell people no or to kind of push back a little about what I need. But it’s important to do that when you’re giving medication. So that means I’m in here, I’m giving my patient medications and someone pops in and says the doctor’s on the phone. Okay, that’s great. Even if it’s a doctor that I’ve been trying to get ahold of, um, you know, I’ll say, can you let them know I’m in the middle of given meds. It’ll be a couple of minutes or I can call if they want to give me a number to call them in five, 10 minutes, I am not going to leave that med pass to go talk to the physician or a family member or anyone. 

I am in the middle of a med pass. Those typically don’t take too long. But if I stop what I’m doing, leave the room and then come back. I mean that’s definitely huge. Huge room for error. So truly, unless there is an urgent emergent situation going on, um, make sure that you are focusing and finishing what you’re doing and it is okay to tell people to wait. Um, you know, when you’re a nurse, a lot of everyone has to kind of come to you for the patient because you’re home base. But EV, but what happens is everybody thinks that whatever’s going on with them is the priority. And when I say them, I mean members of the healthcare team. Um, so you have to take, you have to understand what is the most important looking at everybody’s requests. Like I know I’ve had times where I had the physical therapist wanted to work with him, the doctor was rounding, um, the case worker wanted to do this, they wanted me to do this and this person. 

And then there was a family member on the phone and then it’s like, wait a second, this patient is hypertensive right now and I need to give them blood pressure medicine. So all five of you have to wait because I need to give this patient blood pressure medication. And I’ve had people get frustrated and get mad that I couldn’t attend to their need immediately. But that the end of the day I’m in the middle of a med pass. I’m in the middle of doing what I need to do for the patient and I am the one that can, has the view of everybody really. I have the view of what all needs to be done for this person right now. So I unfortunately sometimes have the not so awesome job of telling people that their need is not the priority right now. Hey, I will get to, I will get to you in a moment or the patient will be ready for physical therapy in about 20 minutes. 

I know you came up now, but Hey, they’re in the bathroom. The maybe the physician’s talking to them or whatever, you know. So that kind of falls into the role of the nurse. And you know, it was, it was really tough at me. Tough for me at the beginning cause I really wanted to um, make everybody happy and do everything, you know. So it was like everyone was happy, but at the end of the day and many days that is not possible. And I had to be okay with disappointing some people for the greater good of the patient. So those are my tips. Remember, focus when you’re giving them given meds, double check your vitals before treating them. Label and trace your tubing and making sure it’s dripping. The correct ones are dripping before you leave the room every single time. When you’re scanning those medications, make sure that as you get the warning to cut or do a partial dose or to do whatever you do it when the warning pops up and don’t finish scanning and going back and never interrupt a med pass for anything unless someone is legit, urgent, emergent situation. 

So those are my tips. I hope this is helpful to you. Um, you know, and you will do all that. We can to prevent a med error, but sometimes they happen, sometimes it’s are us being, um, too rushed. Maybe we’re not, uh, practicing the way we should be, or maybe there’s a flaw in the system. So if we pretend like we didn’t have a med error, we don’t report it appropriately or we don’t, um, participate in the solution that we’re, um, enabling and potentially others to fall down that same path. So it’s important to address these med errors as they occur and making sure that we’re, um, taking accountability if we have committed one and making sure, um, that we’re doing all we can every day to prevent them. And if it does happen, we learn from it, we move on and, um, um, do what we can. So thank you guys so much for listening today. I hope, I hope this helps and encourages you. 

All right. All right. All right. I hope that was helpful today guys. I hope that gave you some motivation, some inspiration to go out and to be your best self, to go out and to become the nurse that you want to be, to make a difference. And to do the best work that you can. Listen, we’re here to help you along your way at interest’s in ge.com our goal is to give you tools, incompetence to help you in nursing school on the end, clicks and in life. One of those tools we created is our Friday freebies, these weekly PDF cheat sheets that you can refer to on the clinical floor in the classroom, and just throughout your entire career as a nurse. To get these cheat sheets, head over to nrsng.com/freebies that’s nrsng.com/freebies you guys, if you need anything, we’re here for you. You can reach out to us on social media or via email, at [email protected] we want you to succeed. We want to help you along the way. We’re here to hold your hand. We’re here to give you the tools, the competence that you need to achieve success in this journey, to nurse our eyes. So you guys know what time it is now. It’s time to go out and be your best self today. Happy nursing. [inaudible].

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