Have you ever headed somewhere and took a shortcut only to wind up taking more time than had you taken the original route?

Well, the same is true in nursing. Some nurses take shortcuts to expedite their work load. Shortcuts can include pre-documenting, medication administration, setting up medications early or even ordering items well before the physician arrives because you are sure the doctor will order it.

All of these are very dangerous practices. I have represented nurses who asked nursing students to administer medications. There have been nurses working the emergency room who start an IV, order blood work and x-rays for patients if the physician is too busy. And I’ve had nurses who pre-chart their medication administrations leading to the wrong medications being given to the patient.

All of these are very dangerous practices. Although you may not have an issue now but believe me, it will eventually catch up to you. The reason why these standards are practiced is to prevent problems and to protect patients. If you have the nurse aide administer medications that end up going to the wrong patient, then you have a problem. If the doctor did not want the IV, labs and x-rays ordered, that’s your problem! And if you pre-chart and the patient gets transferred, then that too is a problem for you.

Even though you may think shortcuts like these will save you time, just like taking a shortcut on the roadway, you can actually cause yourself more problems than if you would have gone the routine way in the first place.

If you are busy and don’t feel like you can complete your work in a timely manner, ask for help. It is much safer for you and definitely much safer for the patient.

Are you taking shortcuts in your practice? If you are, commit yourself NOW to practice the proper way so that your job and license will not be put in jeopardy.

Is a med error considered malpractice?

“Malpractice” is a fancy word for negligence, but involves a professional. There are 4 elements of malpractice:

1. Duty (the standard of care)
2. Breach (you didn’t do what you were supposed to do or did something that you should not have done);
3. Causation; and
4. Harm.

So, let’s put it in layman’s terms. You have a duty to come to a halt at a stop sign, you don’t stop at the sign and you hit another car and cause injury. That is negligence because all 4 elements are present.

If you fail to come to a stop BUT you don’t hit anyone or cause damage or injury, that is a violation of the law but it is not negligence. You must have all 4 elements for it to be negligence.

Now, let’s take this concept into a professional context. Healthcare providers have a duty to give the right medication. If there is an order for Aminophylline and the patient is given Ampicllin and is fine, then there is no causation and no harm. As I say, “no harm, no foul.”

Yes, you did violate the rule by giving a medication that was not ordered but it is not malpractice. However, it can be grounds for discipline before the licensing board. The board is charged with the obligation to protect the public. If there is any concern for public safety, the licensing board can take action against your license. Even a simple med error can be grounds for actions against your license.

Health care providers are encouraged to report medication errors. This sounds counterintuitive now knowing that you could be reported to the licensing board. However, in the interest of patient safety, ideally reporting of these medication errors are designed to improve patient care. For example, the labeling of Heparin for the adult dose and for the pediatric dose is very similar. In one instance, a pharmacy incorrectly filled the Pyxis in an infant area with the adult strength Heparin which was not checked by the nursing staff and subsequently given to a number of babies. While the consequences that resulted to the babies were sad, in the long run, it’s helping in forcing the company to change its labeling and improve patient safety.

Honesty is the best policy! It would seem easy to “sweep it under the rug” but it is better to be honest if the matter is identified through an audit or some other means.

How can you improve patient safety and reduce med errors where you work? Do you think honest reporting of a med error should be a violation of the Nurse Practice Act? Leave your comment below.