I am getting so fed up with the poorly trained staff at nursing homes and the similar types that corps hire as pharmacy techs.
I see a order for Clonidine 0.1mg and to DECREASE the dose to 0.5 mg .. this is what came from the nursing home and the tech typed in “TAKE FIVE TABLETS DAILY”… This has nothing to do with the drug .. it is all about MATH and reading/thinking/typing AT THE SAME TIME. I know that some of us are better at multi-tasking than others…but …
Yesterday it was a order that seemingly had a stray small vertical line on the order – like the number ONE… it was for Levothyroxine and could have been for 125 mcgs or 25 mcg… I had triage call for a clarification.. nurse confirmed 125mcg. I was still not comfortable… I looked back at the pt’s profile.. in Oct pt was on 100mcg… in Nov the pt was on 75 mcg… in Dec the pt was on 50mcg… sure looked like a GDR… of course it was after hrs and the doctor on call was not the doctor who gave the verbal order to the nursing staff.
Then there was the order for Lyrica 500 mg BID.. when 600mg is max per day in divided doses.. I had tried to teach these techs time and time again.. when you get a order for more than the maximum single dose (tab/cap) available … probably needs to be clarified.. not this time… two orders entered Lyrica 300 mg and Lyrica 200mg each BID. HELLO ?
Everyone believes that Electronic Medical Records will help prevent errors.. except when nursing staff can type in (make up) whatever drug they want.. how about the order for HCD/APAP liquid 5mg/500mg/10ml… with a dose of 10ml q4hr prn. What did they want? they don’t make it commercially. The commercial product is HCD/APAP 2.5mg/167mg/5ml.
Then there was the order for change of po Risperdal from 1mg bid to 25mg qAM and 0.5 mg at HS… the tech read it as 2.5 mg.. of course there was no preceding ZERO in from of the decimal… no one bothered to look/see that the patient – for the first time – 3-4 days earlier had received their first shot of Risperal Consta. Who would have thought that after a shot – good for two weeks – would a patient need an INCREASE in their PO meds?
These are just the more serious mistakes that I can remember from the last 2-3 days of work.. no wonder 1.5 million people get harmed by medication mistakes.. particularly in the LTC environment.. those upstream from the RPH checking orders.. at least from my experience .. seems to lack a certain quality.. of understanding what the consequences of their actions – or lack of actions – can mean to a patient’s quality of life.
Filed under: General dumb-ass problems
The Lyrica got more interesting… this whole thing started on a Monday. I made the phone call, put the order in a RPH clinical hold que.. I was off two days.. back on Thursday.. nothing resolved.. Come to find out this pt had come from home to hospital to LTCF and her “new ” doc had no background on him/her. I started making more calls.. the ARNP.. agreed this was the right dose…I’m not convinced… I requested from the pt’s nurse that I need to know where the pt had gotten Rxs filled prior to being in hospital.. she would ask patient/spouse and get back with me…
Now it is Friday… still in the RPH clinical hold que.. I call the DON… explain the situation.. I was getting concerned that I was walking on a thin razor edge.. was I denying pt their needed meds and possible throwing into withdrawal/pain or was I preventing a overdose.. I figured that I was going to “catch-it” no matter what… Finally the DON.. got someone attention..the patient’s appropriate dose was 150 mg BID..
Advice to RPH’s reading this.. when your “little voice” and professional judgement says “I don’t think so” it is wise to follow it… all too many of our fellow healthcare professionals are too busy to THINK and go against what they believe is correct.. it is called confirmation bias.. Maybe that is why we kill 100,000 with medical mistakes and harm 1.5 million with medication errors.