That feeling you never want to experience – heart racing, dry mouth, tunnel vision as you look again at the vial in your hand and realisation kicks in – you’ve just pushed 5mg of Midazolam IV instead of Metoclopromide.
Human error in any industry is unfortunately a fact of life.
In the nursing profession these errors can be simple in nature and easy to fix, or they can be catastrophic and life threatening.
Recent times have seen a bit of a shift in health care trends, with most employers encouraging reporting of events in order to analyse how and why the error occurred, and to minimise the chances of it happening again.
With regards to medication safety, there are multiple check processes in effect to minimise the probability of a catastrophic medication error occuring.
When administering medications, nurses are responsible for ensuring that the medication given and nursing actions will not harm the client, and accepts this responsibility as a condition of their registration.
This means that you can not assume that the medication ordered (eg the dose or route) is correct for the patient – nurses should be familiar with usual doses of drugs, routes, therapeutic and side effects and correlation with blood results (eg, you wouldn’t expect to be giving adenosine to a patient who needs atropine – the doctor may have written the wrong drug order).
Consequences and disciplinary action against Nurses
It has been suggested that if too harsh a decision is taken in cases of simple medication errors, other nurses will not report drug errors in future, leading to a situation where error reporting is almost non-existent in a world of cover-ups.
If you find yourself in a situation where a medication error has occurred, the best course of action really is to take ownership of the mistake & make sure that no cover-ups occur, despite that initial moment of realisation/panic.
There have been documented cases of cover-ups leading to further disciplinary action, for instance a doctor was banned from practising for 2 years when he falsified patient notes prior to a coronial enquiry in order to cover up negligence.
Initial course of action following a nursing medication error should include:
- Reporting the medication error to the treating doctor
- Reporting the error to the patient (this may be done by treating doctor)
- Reporting the error to your supervisor or unit manager
- Documenting the error in the patient notes
- In-house notification of the medication error per your hospital guidelines (e.g. via online reporting or incident form)
Disciplinary action or consequences to the nurse really depend on the type of error and the ramifications to the patient. Also taken into account is whether or not the nurse followed protocol after the mistake was discovered.
What happens next is difficult to say, as there is a whole spectrum of ways to manage errors of varying severity or outcomes.
It could be as simple as an acknowledgement from the unit manager that the medication error had been followed up correctly and no further action is warranted, or it may involve retraining or a period of supervised practise, right through to a full blown investigation involving the Office of Health Ombudsman (formerly HQCC) or the Nursing and Midwifery Board of Australia.
Referral to your registration board could produce findings that no further action needs to be taken, or they may impose conditions on your registration, and in ‘worst case’ scenarios a tribunal or panel can suspend or revoke your nursing registration.
I should note however, that investigations take into account the fact that errors can and do happen, and it really is in your best interest to take ownership of any error that may have happened, and show good faith that you tried your best to acknowledge and rectify the situation based on your workplace guidelines.
For further reading:
- Reducing Medical Errors, one patient at a time
- Court and Tribunal Decisions in Australia
- AHPRA Panel Decisions on Registered Practitioners
- Medication errors: Don’t let them happen to you
- Legal and Ethical Issues in Nursing