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Nursing Made Incredibly Easy!:
doi: 10.1097/01.NME.0000426302.88109.4e
Department: On the Horizon

How to avoid the top seven nursing errors

Delamont, Ann MSN, RN, VHA-CM

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Nurse Manager • VA Medical Center • Nashville, Tenn.

The author has disclosed that she has no financial relationships related to this article.

Nurse B is a busy nurse on a medical-surgical unit. He has been out of school for almost a year and still hesitates at times with quick decisions. He sometimes fears that he'll make a mistake when caring for his patients.

According to one study, 42% of healthcare-related life-threatening events and 28% of medication adverse reactions are preventable. Developing a culture in which nurses can ask questions and function in a professional working environment without anxiety can reduce these alarming statistics. Nurses play a vital role in preventing events that may negatively impact patient health.

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The big seven

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Nursing errors commonly revolve around patient falls, infections, medication errors, documenting errors, and equipment injuries. These include failure to:

* collaborate with other healthcare team members

* clarify interdisciplinary orders

* ask for and offer assistance

* utilize evidence-based performance guidelines or bundles

* communicate information to patients and families

* limit overtime

* adequately staff patient care units with enough nurses to allow them to safely provide care.

Let's examine what you can do to prevent these types of errors.

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Prevent patient falls

The CDC estimates that one out of three adults age 65 and older falls each year. There are physiologic effects that can contribute to these falls, such as vertigo (common with hypoglycemia), the flu, Meniere disease, multiple sclerosis, and anesthetic medications commonly used during inpatient and outpatient procedures. This is important for Nurse B to keep in mind when he's caring for his patients.

As a nurse, there are several simple preventive measures he can take to protect his patients from falls.

* Encourage patients to ask for help when they get out of bed, and make sure there are no obstacles to the restroom or around the bed. Many patients believe that they don't require assistance or can become tangled in equipment, causing them to fall.

* Verify activity orders. These can vary during the hospital stay and after changes in condition or medical-surgical interventions. Continuously assess and compare the patient's ability with the written activity orders.

* Assess the patient's gait when out of bed and offer assistance.

* Perform hourly rounding. Studies have directly correlated rounding with decreased falls in the hospital. Basic needs can be taken care of at this time, such as toileting, moving objects within reach, offering food, and asking about pain.

* Be aware of any medications that may cause drowsiness, dizziness, or impaired judgment. You should also discuss this with the healthcare provider.

* Use protective measures, such as nonslip socks and bed alarms, to decrease the risk of falls.

* Make sure nurse managers are monitoring for safe nurse-patient ratios.

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Keep away infections

Basic hand hygiene can go a long way to prevent infections. Patients have become increasingly involved in their care, and they often monitor their providers for hand washing.

Other measures that are effective in the prevention of infection include:

* using chlorhexidine for skin preparation, practicing sterile technique, and following guidelines for central line use and removal to prevent bloodstream infections.

* appropriately cleaning urinary catheters, removing them in a timely manner, and avoiding long-term use unless medically necessary to prevent catheter-related infections.

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No more medication errors

When administering medications, Nurse B should ensure that he has minimal distractions because being distracted is a primary cause of errors. In the United States, medication errors kill one person every day, according to the National Medication Errors Reporting Program. Extra caution should always be taken to avoid a potentially devastating result.

Nurse B can take numerous preventive actions to reduce the likelihood of a medication error.

* Utilize a bar coding medication scanning system. This allows nurses to verify the six medication rights (correct medication, patient, route, dose, time, and documentation) more accurately.

* Take an active role in consulting with the interdisciplinary team, including the pharmacy, to ensure all look-alike or sound-alike medications aren't stored near each other.

* Double check all high-alert medications with another nurse. This can prevent errors such as neonates being administered an adult dose of heparin.

* Understand and know the medications that are being administered, along with adverse reactions. Tell each patient what he or she is receiving and the reason for each medication.

* Consult with other healthcare team members, such as senior nurses, for their insight and advice.

* If you have questions about a drug, ask. There are several resources that are available from the pharmacy to drug guides.

* Keep in mind that even if the healthcare provider orders the wrong medication, wrong route, wrong dose, or wrong frequency, the nurse still retains culpability.

* Trust your instincts!

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Steer clear of documenting errors

You should accurately document all major events and changes in patient condition in a timely manner. This is a common pitfall for nursing staff because it often seems as if there isn't enough time to do it all. Keep in mind, if a patient sustains an injury, it could be determined that there was neglect based on a lack of documentation.

Nurse B was taught documenting in nursing school, but what things are important to include?

* Monitor patients regularly and document interventions performed.

* Report adverse events immediately to the nurse manager or supervisor.

* Check the healthcare provider's orders for monitoring and notification intervals, such as BP parameters, fever, heart rate, and abnormal heart rhythms.

* Document as patient condition warrants. For example, if the patient is declining, document every intervention and notification you perform.

* Address all signs and symptoms of distress.

* Document the time and content of all healthcare provider notifications.

* Ensure all documentation is on the correct patient.

* Document patient education and patient and caregiver comprehension of the information.

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Evade equipment injury

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Equipment continually changes in the patient care environment. Nurses have a responsibility to stay abreast of these changes and be competent in the use of necessary equipment. Nurse educators play an important role in ensuring all nursing personnel are trained and competency is documented.

Some key actions to prevent injuries include:

* requesting training on equipment you aren't sure how to use

* examining all equipment and removing it if damaged

* reporting any incidents or defects to the risk management department, patient safety department, or your supervisor

* thoroughly documenting any injury related to the equipment

* using the equipment only as recommended

* routinely validating your clinical competence to operate your facility's equipment to reduce the likelihood of injury to patients, staff, and yourself.

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This way for positive patient outcomes

Nursing administrators play an important role in preventing nursing errors. They're able to create changes to the environment that encourage nurses to control their own practice. Staffing shortages need to be addressed because this is directly related to errors. There should be a staffing mix that's conducive to learning. Ideally, experienced nurses will outnumber novice nurses on each shift to provide a supportive environment. Working with nurse educators and embracing a nurse residency program can foster learning for new nurses like Nurse B.

But what should you do if you make a mistake? The medical profession advocates disclosing errors. The Patient Safety and Quality Improvement Act of 2005 encourages voluntary and confidential reporting of any event that may adversely affect patients. Speak to your facility's risk management department about disclosure; they specialize in the process, have knowledge of your facility's policies, and can assist you with the most appropriate way to handle the situation.

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Error proof

Keeping the seven common nursing errors in mind, Nurse B can incorporate preventive measures into his practice to protect his patients and ease any anxiety he may experience during a hectic shift.

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did you know?

The Institute of Medicine lists six aims for positive patient outcomes that provide a framework for improving care:

* safety—avoiding injuries

* effective—using scientific knowledge to provide services that are beneficial

* patient-centered—being respectful and responsive to patient preferences, values, and needs

* timely—reducing waiting and delays that may be harmful

* efficient—avoiding waste

* equitable—providing care for everyone.

Source: Institute of Medicine. Crossing The Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.

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Learn more about it

Agency for Healthcare Research and Quality. Part IV. Selecting quality and research use measures. http://www.ahrq.gov/qual/perfmeasguide/perfmeaspt4.htm.

Agency for Healthcare Research and Quality. The Patient Safety and Quality Improvement Act of 2005. http://www.ahrq.gov/qual/psoact.htm.


CDC. Falls among older adults: an overview. http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html/.

Institute of Medicine. Crossing The Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.

Nientimp D, Peterson E. Hourly rounds and patient falls. http://nursing.advanceweb.com/Features/Articles/Hourly-Rounds-Patient-Falls.aspx.

© 2013 Lippincott Williams & Wilkins, Inc.

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