Following Procedure Protects the Patient, the Facility and You


Following Procedure Protects the Patient, the Facility and You

Skipping that extra step is when errors happen

By Carol Peracchio, RN
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During my hospital nursing career, the word "procedure" brings to mind a huge, dusty three-ring binder on a high shelf in the nurses’ station. I would haul it down when a physician requested an unusual treatment that no one had done for a year or two. But if we think about it, nurses follow procedure all day long.

Take the “five rights of medication administration.” As students we all meticulously followed the procedure, often repeating to ourselves, “Right patient, right medication, right dosage, right time, right route.” As the years go by, however, the five rights become so routine that only when we have a near miss of a medication error do we stop and reconsider how important it is to follow them.     

I recently read of an uproar in England over the decision by a hospital to give their nurses smocks emblazoned with the phrase Do Not Disturb to wear during medication administration. The hospital blamed medication errors on interruptions by patients and families, and hoped that by placing signs on the nurses that the error rate would decrease.

Although I agree that interruptions can be an opportunity for error, it’s been my experience that most mistakes happen when nurses simply aren’t concentrating on the task at hand. It might seem silly to check the name band of a patient you’ve cared for the past two days. But following the procedure, every time, will protect everybody, even with the occasional interruption.

Pre-operative checklists can often be a hit-or-miss procedure. There have been a few times I’ve gotten called up to the OR to retrieve a patient’s dentures or jewelry, simply because I hadn’t followed procedure by completely filling out the checklist.

The Close Call

Patients can be very irritated when the same questions are asked over and over: “Have you eaten anything today? Did you take your medicines this morning?” But how many of us have experienced that close call where you ask (for what seems like the umpteenth time) if the patient has eaten anything, and he innocently asks, “You don’t mean that little cup of coffee, right?”

I remember one time where following procedure actually saved a patient (and nurse) from disaster. In the ICU where I worked we had a rule that all insulin was to be double-checked with another nurse. As busy as we all were, it could be tempting “just this once” to skip the extra step. But we all followed the procedure, rolling our eyes as we dashed around finding an RN to check the dosage.

One night a co-worker stopped me as I was heading into my patient’s room.

“Hey, Carol,” she called out, holding up an insulin syringe. Per procedure, she stated how much insulin was ordered. “Five units, right?” I was startled. In the syringe was 50 units of insulin. “Are you kidding?” I asked. “There’s 50 units in here!”

My co-worker paled as she realized how close to catastrophe she had come. Tired and busy, she’d read the markings completely wrong. Believe me; I’d always known her to be a very good nurse. Unfortunately, her mind at that moment wasn’t totally focused on what she was doing. But following the procedure saved the day.

So get back in the habit of mentally pulling that three-ring binder off the shelf and taking all the right steps. There may come a day when you’ll be glad you did.   

Carol Peracchio graduated from nursing school in 1978. She has worked in ICU, ER, PACU and Utilization Review. Currently she is employed as a medical records reviewer.


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