Medication Errors...and how they effect you as a provider

[MP-EMT22]

Overdosing or committing a harmful dosing error is probably the #1 nightmare I have as a paramedic. I was looking online for something completely separate when I came across a news story about a seasoned nurse who had accidently administered 10 times the appropriate amount of medication and it was devistating for the patient, as well as the nurse.

http://www.nbcnews.com/id/43529641/ns/health-health_care/t/nurses-suicide-highlights-twin-tragedies-medical-errors/

What safeguards do you have at your service to prevent med errors? How does your service handle reported medication errors? What do you wish EMS would do differently to make events like this less common?

[scubanurse]

I've had a med error while a nurse, never in EMS though. I gave Fioricet instead of Fiorinal (GASP!) the patient was fine, the provider wasn't upset but I have seen some tragic medication errors. One nurse gave 160mg of Oxycodone to a patient and it had the potential to be tragic. I also know of a nurse who didn't call in a PT/INR and the patient died of DIC.. pretty extreme.

Most hospitals I know have a non-punitive response to med errors to encourage their reporting and monitoring. There have been several safeguards that I'm not sure would work in EMS. After my medication error, I slowed my med passing down a bunch, took time to double check the med I was pulling against the MAR and review the 5 rights.

[mikeymedic1984]

It is pretty hard to overdose a patient in the EMS field, unless you leave the Dopamine or Lidocaine drip running wide open. With that being said, it is still possible to have dosing errors, or wrong medication errors due to packaging being similar.

For years in the hospital world, there was Heparin overdoses because all heparin was in the same colored/sized/shaped/labeled vial, regardless of concentration. They finally changed that. In the ems field it is good to someway deliniate or move "like colored" vials and boxes away from each other --- Albuterol and Atrovent for instance. Does your Benadryl vials look like your Vasopresin vials --- but as always, if you do the 5 "R's", you should not have these problems.

P.S. if you do have two vials of medicine that are very similar in appearance or color of packaging -- switch to another manufacturer for one, or change what you order (if in a vial, can you get it in an ampule or bristojet) ? Can you package it in another package of your own (fishing tackle or pill bottle container) to separate it from it's similar friend ?

The most dangerous error is probably going to be drips, due to the lack of IVpumps on the truck. If your service is too poor to buy pumps, at least purchase dial-a-flow tubing so that you can be somewhat accurate in your dosing. Think about it, if your 14 month old child was being placed on a Dopamine drip, and the nurse just wanted to eyeball the drip rate and not use a pump, would you be cool with that ??????

Edited July 22, 2014 by mikeymedic1984

[paramedicmike]

Medication errors affect everyone differently. The effects of medications can vary widely.

Establish a double check system. One place I worked encouraged two people checking meds when possible. Were one person to give a medication it would be verbalized and visually identified by both providers (assuming dual medic coverage). If the other provider drew up the medication both the syringe and the medication vial were handed to the person administering the medication to verify.

Working as a single medic I just got in the habit of saying everything out loud like I was explaining things to the patient. For example, as I was drawing up medication I would say, "Ok, I'm going to give you medication X. You're going to get Y amount of it which works out to be <volume>. This will help with <complaint>." Sometimes they care. Sometimes they don't. It can be a good habit to get in to.

At least, it works for me, anyway.

Reported medication errors are usually handled as part of the QA/QI process. Sometimes, depending on the situation it can be as simple as a "...pay more attention...". Other times, if an education or knowledge deficiency is determined (e.g. new medication or not one commonly used), more educational follow up can be mandated.

How common are med errors in EMS? I don't know. Do you have any resources on the subject?

[Just Plain Ruff]

I have one medication error in my history.

Gave 5mg morphine to a pregnant patient seizing instead of giving 5 of valium. Same exact type of syringe, both syringes in the same box, I got in too much of a hurry, looked in the box, saw the valium, reached in and apparantly grabbed the morphine rather than the valium. They looked exactly the same. I looked at the syringe, and my head said valium but the syringe said morphine.

so I gave it.

The seizure soon stopped. I thought all was well.

I delivered the patient to the ED with no seizure activity.

Returned to my rig, my partner asked "Why did you give morphine to a seizure patient" and my heart dropped. I just sat down and shook all over.

I immediately went into the ER, told the doctor what I did, he said "well no wonder why she has pinpoint pupils" he then told me no harm to the patient. He even went so far to talk to my risk manager after I was done reporting it, telling the Risk manager that he was impressed with the honesty I had for telling him and risking ridicule and reprimand. He said the patient suffered no ill effects, they administered narcan and patient was doing fine and the baby was doing very well also.

He recommended that we change suppliers of at least one of the drugs because he took a look at how we had our drugs stored and said that he understood how this error occurred and because of his suggestion, we changed the way things were done.

I could have been fired but thanks to this doc's good word I was not. I did get a day of remediation with risk management to go over the drug box and to revamp the setups but I did get paid to do that. It was a definate scary scary thing, I thought I had hurt the patient. Had I have hurt her or the baby, I am not sure how I would have reacted.

A positive learning experience.

You learn from these types of things. If you do not, then you don't need to be in EMS.