Nursing Errors

1. Nursing Errors By: Kristy Clark and Dawn Simon

2. What is a nursing error? • A mistake that is made by a nurse that: • Can affect the outcome of something • Causes an adverse effect • Is a result of poor judgment • Is potentially irreversible Anoosheh, M., Ahmadi, F., Faghihzadeh, S., & Vaismoradi, M. (2008). Causes and management of nursing practice errors: a questionnaire survey of hospital nurses in Iran. International Nursing Review, 55(3), 289.

3. Ohio Law Regarding Nursing Errors • According to the Ohio Board of Nursing, all licensed nurses should report errors. • Unfortunately, Ohio law doesn’t mandate that you report a medical error, therefore many go unreported. • It’s an RN’s ethical obligation to report his/her errors as well as other nurse’s errors that are witnessed. Ohio Board of Nursing (n.d.). Chapter 4723-4 standards of practice relative to registered nurse or licensed practical nurse. Retrieved from http://codes.ohio.gov/oac/4723-4. Karlsen, K., Hendrix, T., & O'Malley, M. (2009). Medical error reporting in America: a changing landscape. Quality Management in Health Care, 18(1), 59-70.

4. Types of Nursing Errors • Medication administration: • Given at wrong time, wrong patient • Lack of documentation of administration and given more than once • Not given at all • Given at incorrect site i.e. IM injection in a subcutaneous site. • Calculation error • Illegible penmanship and failure to obtain clarification Austin, S. (2008). Seven legal tips for safe nursing practice. Nursing 2008, 38(3), 34-39. Bohomol, E., Ramos, L., & D'Innocenzo, M. (2009). Medication errors in an intensive care unit. Journal of Advanced Nursing, 65(6), 1263.

5. Types of Nursing Errors (cont.’d) • Patient neglect • Ignore what the patient is saying • Perform duties beyond an RN’s scope of license • Failure to report and monitor for deterioration • Communicating ineffectively with family and colleagues during transfer of care • Careless documentation- inaccurate, not in a timely manner, and/or failure to document completely Austin, S. (2008 March). Seven legal tips for safe nursing practice. Nursing 2008, 38(3), 34-39.

6. Impact of Nursing Errors on Patients • Patient dies • Patients condition worsens • Patient develops permanent disability • Lawsuit

7. Discipline R/T Nursing Errors • Not all errors lead to punishment • R/T not being reported • No harm to patient • Loss of RN license • Suspension of RN license • Incarceration • Humiliation R/T your name, reason for losing/getting license revoked and reason for the punishment being published on the www.nursing.ohio.gov

8. Causes of Nursing Errors • Personal life interfering with professional life • To stressed to think clearly • Take on to large of an assignment • Show up to work impaired R/T alcohol or drug use • Understaffed units • Under qualified nurses • Long shift hours • Inadequate time available for proper nursing care • Failure to follow requirements for continuing education

9. How Errors are Corrected • Tell the patient about the error if coherent • Notify patients family if patient is incoherent • Report and properly document error in a timely manner • Do everything possible to prevent adverse effects of error on patient

10. How to Report an Error That You Witness • Complete a complaint form located on www.nursing.ohio.gov under the forms tab • Send completed form to the Ohio Board of Nursing via website listed • Report to nursing supervisor • If it was you that made an error, fill out an incident report via hospital protocol

11. Nurses at risk • New RN’s with limited experience • RN’s who cannot say no • RN’s who work on a unit that’s understaffed

12. Are Medical Errors an Issue? • It’s suggested that the leading cause of death in the U.S. is preventable adverse events in the hospitals. • The most common medical errors are medication errors • Affect at least 1.5 million people each year • Cost the health care system between $77 and $177 billion annually • More than 42% participants in a study said they or someone that they knew had experienced a medical error. • Out of all healthcare professionals, RN’s have been responsible for the most medical error related patient deaths. • Due to nurses spending the most time with patients Anoosheh, M., Ahmadi, F., Faghihzadeh, S., & Vaismoradi, M. (2008). Causes and management of nursing practice errors: a questionnaire survey of hospital nurses in Iran. International Nursing Review, 55(3), 288-295. Reinburg, Steven. (2009, April 27). Medication errors could be cut: experts. US News and World Report. Retrieved from http://www.usnews.com/health/managing-your-healthcare/healthcare/articles/2009/04/27/medication-errors-could-be-cut-experts.html

13. Ways to Prevent Nursing Errors • Ask another RN to double check your medication calculations • Call physicians for order clarifications • Double check pharmacy • Only do what you can handle • Ask questions when necessary, use available references • Ask for clarification with orders that are not legible

14. Ways to Prevent Nursing Errors (Cont.’d) • Use “five rights” of medication administration • Right patient • Right medication • Right dose • Right time • Right route Austin, S. (2008). Seven legal tips for safe nursing practice. Nursing 2008, 38(3), 34-39.

15. Ways to Prevent Nursing Errors (Cont.’d) • When transferring care of patient or report patient’s condition use SBAR • Situation • Background • Assessment • Recommendation Austin, S. (2008). Seven legal tips for safe nursing practice. Nursing 2008, 38(3), 34-39.

16. Nursing Process • “Most legal actions brought against nurses arise because a patient or a patient advocate claims that the nurse breached a standard of care and that the breach resulted in harm to the patient” (Austin, S. 2008). • Nursing assessment • Nursing diagnosis • Planning • Implementation • Evaluation Austin, S. (2008 March). Seven legal tips for safe nursing practice. Nursing 2008, 38(3), 34-39.

17. Conclusion • Nursing errors can be prevented, which is why we chose this topic to present to you today • Just one error could lead to permanent loss of a nursing license making all the late nighters, stress, and four years or more of nursing school completely pointless

18. References • Anoosheh, M., Ahmadi, F., Faghihzadeh, S., & Vaismoradi, M. (2008). Causes and management of nursing practice errors: a questionnaire survey of hospital nurses in Iran. International Nursing Review, 55(3), 288-295. • Austin, S. (2008). Seven legal tips for safe nursing practice. Nursing 2008, 38(3), 34-39. • Bohomol, E., Ramos, L., & D'Innocenzo, M. (2009). Medication errors in an intensive care unit. Journal of Advanced Nursing, 65(6), 1259-1267.

19. References (cont.’d) • Karlsen, K., Hendrix, T., & O'Malley, M. (2009). Medical error reporting in America: a changing landscape. Quality Management in Health Care, 18(1), 59-70. • Ohio Board of Nursing (n.d.). Chapter 4723-4 standards of practice relative to registered nurse or licensed practical nurse. Retrieved from http://codes.ohio.gov/oac/4723-4. • Reinburg, Steven. (2009, April 27). Medication errors could be cut: experts. US News and World Report. Retrieved from http://www.usnews.com/ health/managing-your healthcare/healthcare /articles/2009/04/27/medication-errors-could-be-cut-experts.html.

20. Jeoparady

21. 1.) What is a nursing error?

22. 2.) Give four examples of nursing errors.

23. 3.) Jessica has been an RN at a local hospital for 1 week and she takes on an assignment that is to much for her to handle. Who should she talk to about this?

24. 4.) What is the website that displays the names of the nurses who’ve lost his/her license or had the license suspended?

25. 5.) Name two ways to prevent a nursing error.

26. 6.) Why are RN’s considered the most responsible out of all healthcare professionals for medical error related deaths?

27. 7.) How does a nursing error affect a patient?

28. 8.) Are RN’s required by Ohio law to document a nursing error?

29. 9.) Describe a situation where a nurse would be at risk for making an error.

30. 10.) Name three ways a nurse can do a nursing error involving medication administration.

31. 11.) Patients that are difficult are one of the causes of nursing errors. True or False

32. 12.) Are all nursing errors punishable?

33. 13.) Not listening to a patient does not mean you are committing an medical error. After all, nurses are busy and don’t always have time to listen to every complaint. True or False

34. 14.) What is the nursing process?

35. 15.) What is two disciplinary actions that could result from a nursing error?

36. 16.) What does SBAR stand for?

37. 17.) Why is SBAR important?

38. 18.) What is the most common medical error?

39. 19.) You should not admit to a patient when you make a mistake. If you do, they may lose trust in you. True or False

40. 20.) If a nurse forgets to document a blood pressure from the 11:00 vital check, it is okay because vitals are checked again at 3:00 so it’s just one time that day you forgot. True or False

41. 21.) How much are medication errors costing the healthcare system annually?

42. 22.) Name the “five rights” of medication administration.

43. 23.) Most legal actions brought against a nurse arise due to medication errors. True or False

44. 24.) When is SBAR used?

45. 25.) If a nurse receives an order from a doctor and doesn’t understand one or two words, should the nurse still do what she does understand of the order?

46. 26.) Why should nurses report an error?

47. 27.) How do you report an error that you witness?

48. 28.) A nursing error can cause patient death or absolutely nothing. True or False

49. 29.) Why is it important to prevent a nursing error?