Question

A nurse gives an incorrect medication to a patient without doing all of the mandatory checks, but the patient has no ill effects from the medication. What actions should the nurse take after reassessing the patient? (Select all that apply.)

a. Notify the health care provider of the situation.
b. Document in the patient's medical record that an occurrence report was filed.
c. Document in the patient's medical record why the omission occurred.
d. Discuss what happened with all of the other nurses and staff on the unit.
e. Continue to monitor the patient for any untoward effects from the medication.
f. Send an occurrence report to risk management after completing it.

Answer 1

After administering the incorrect medication, a nurse should notify the healthcare provider, send an occurrence report to risk management, and continue monitoring the patient. It is important to document the incident in the medical record, but not to discuss it informally with staff or document that an occurrence report was filed.

Step-by-step explanation:

When a nurse administers an incorrect medication to a patient without performing mandatory checks and the patient experiences no immediate ill effects, there are still important steps to be taken to ensure patient safety and compliance with healthcare policies.

• Notify the healthcare provider of the incident to review the situation and determine if any immediate medical intervention is necessary.
• Complete and send an occurrence report to risk management. This documentation is critical for institutional learning and process improvement.
• Continue to monitor the patient for any untoward effects from the medication. Ongoing vigilance is essential for patient safety and for catching delayed reactions.

Furthermore, the nurse should document the event in the patient's medical record, including the medication error and the actions taken thereafter. However, it is not standard practice to document that an occurrence report was filed in the patient's medical record as it is part of the institution's internal review and safety system rather than the patient's personal medical history. The nurse should not discuss the incident with all other nurses and staff on the unit informally, as it may violate the patient's privacy and is not a constructive approach to addressing the error. Instead, the nurse should participate in any official review or debrief as directed by their institution.