NSO 2007 Webflash
Advances in information technology can change both your nursing responsibilities and your professional liability risk, as described in the 2007 NSO Risk Advisor. But to provide optimum care for patients and avoid errors that could lead to a lawsuit or invite professional discipline, you must also understand the uses and limitations of medical technology. That means keeping current with changing technology and staying alert for malfunctions that could threaten a patient's safety.
Some of the problems associated with two common types of medical equipment you may use regularly can serve as examples of potential difficulties.
Bar coding pitfalls
Study after study has demonstrated that using bar codes when dispensing medications can drastically reduce medication errors. But, no bar coding system, no matter how sophisticated, is perfect. Sometimes bar codes don't scan properly or the system loses connectivity. Other less obvious types of equipment flaws and limitations also can cause problems.
Say you can't give a patient her medication exactly when it's due because she is in another unit having tests done. Does the bar code system your facility uses make allowances for long delays' Bar Code Medication Administration (BCMA) software initially developed by the Veterans Health Administration automatically removed some medications from the list a few hours after the prescribed administration time.1 If nurses didn't pay attention or relied solely on the system, their patients could have missed critical medication doses.
Because bar code systems track when you administer doses, they may subtly encourage you to make prompt medication delivery your top priority. That's not necessarily appropriate, though, if the patient has other more pressing needs. Medical equipment is no substitute for your own observational skills and professional judgment. Letting equipment dictate what you do or don't do can lead to patient care errors.
On the other hand, so can overriding the system inappropriately. Say you try scanning the bar code on the patient's wristband, but it doesn't work because the wristband is damaged. Instead of waiting for a new wristband to arrive, you decide to save time by typing either the patient's name or the numbers from his wristband into the computer on the medication cart. By entering data manually, you sidestep the safety features designed to make sure the right meds go to the right patient. In this situation, you should try to get a new wristband before dispensing the medication. If no other equipment is available and you must dispense manually, have another nurse confirm that you're giving the right patient the proper medication in the correct dosage at the appropriate time and in the right form. In other words, whenever the system is malfunctioning and can't be fixed immediately, find another way to replicate the system's safety features. Also be sure to use the system properly, even when that's inconvenient. If a patient is sleeping, for example, and you can't access his wristband, wake him; don't skip the scanning step.
Faulty infusion pumps
Operator mistakes can cause many medication-related errors involving infusion pumps. A decimal point is missed, an extra zero is added, or maybe micrograms per kilogram per minute gets punched in rather than micrograms per kilogram. Sometimes, though, equipment failure, not human error, causes the problem.
An example: One major brand of infusion pump was recently recalled for a defect called key bounce--a number pressed once registered twice. The fault could cause infusion rates at least 10 times too high, a potentially lethal dosage depending on the medication being dispensed. Another brand of pump also was recalled earlier this year. The problems included underinfusion, undercharged batteries, and false alarms resulting in inappropriate equipment shutdowns.2
Even though sophisticated infusion pumps have software that watches for and aims to prevent such errors, you can't always assume that's working properly, either. With one of the recalls described above, the programming verification processes didn't catch the problem.
You may not always be able to detect such errors, and it may not be your fault when they occur. But, it is your responsibility as a nurse to check on patients regularly rather than relying on technology to do it for you. You must also stay informed about the equipment you're using and exercise your judgment when it doesn't work properly.
Pay particular attention any time your facility introduces a new piece of medical equipment, which increases the likelihood of errors. And, whenever you become aware of a problem, notify your supervisor and your facility's risk manager in writing as soon as possible so the problem can be properly addressed.
REFERENCES
- Patterson E S, Cook R I, Render M L. Improving patient safety by identifying side effects from introducing bar coding in medication administration. J Am Med Inform Assoc. 2002; 9: 540-553.
- Institute for Safe Medication Practices. FDA safety alerts for drugs and medication-related medical devices. http://www.ismp.org/Tools/FDASafetyAlerts.asp.
