It was a busy shift. One of my colleagues came over to me and asked me to check her dosage calculations for a drug she was about to give a 5 year old girl.
I was doing about a hundred things ( a-hundered-and-five if you count what I was actually doing outside my head) but I said “sure…” and went over to do the quick drug check.
After all, she was an experienced nurse…everything would be good, so this would only take a moment.

One minute later I was back on my own task list, when I realised that I had not really checked her calculations at all. I had stood there and nodded in agreement. I had said “I concur…” But my mind had never accompanied my body over to the desk.
I couldn’t tell you what the calculation was. I had not really looked at the medication expiry date and……crap….I don’t think I even really looked to confirm it was actually the right medication!

I zipped back over to her and re-did the check. Everything was fine. No thanks to me.
My inattention had potentially put the patient and my colleague at risk.
Thankfully all I had actually done was to let them both down.

I have already spoken a little to the topic of nursing mindfulness and using the act of washing your hands to anchor you to this state. STOP washing your hands

Paying attention to what you are doing is such a simple thing. Remembering to do it is deceptively difficult. In fact, most of the time we are not paying attention to just how much we are not paying attention.
And when it comes to the domain of calculating and preparing medications in-attentively …..here there be dragons.

How about another prompt or anchor to trigger some attentiveness during that most important of activities: medication management?
The trigger is the word drug.

  1. Deep breath.
    Simple. Pay attention to yourself as you take one slow breath. This is like logging into the mindfulness/pay-attention network.
  2. Re-focus.
    Bring your full attention to the task at hand. Opening a medication, or drawing up antibiotics, or checking a drug calculation with a colleague. Politely exterminate any interruptions.
  3. Understand.
    This is important. You have cleared you mental desk, you are focused on the task….now you must engage your knowledge and skills that relate to it. Understand what you are doing, what you are about to give and why ( think about your medications rights).
    If you do not understand, do not proceed.
  4. Go.
    Now…go and deliver the medication.

Develop a link between the act of interacting with any drug and using the mnemonic DRUG to cradle your medication activity within a container of mindfulness and attention.

It only takes a few seconds to remind yourself to pay attention and disentangle yourself (even if only for a few moments) from all the interruptions, distractions, and mental wanderings that crowd out your shift and pull you towards error.

Developing a DRUG habit will give you that little mental nudge to manage medications more safely, and more effectively.

4 Responses to “How to develop a DRUG habit.”

  1. Great advice! When I was working in palliative care and oncology, you are dealing with S8 drugs constantly, (and multiple drugs with syringe drivers) and there was a rule we all tried to follow:
    DO NOT DISTURB THE NURSES WHEN THEY ARE COUNTING, CHECKING, DISPENSING OR DRAWING UP MEDICATIONS.
    Having other staff wandering in and out of the meds room is expected, but when questions are being asked to nurses that are concentrating on drawing up (eg) Hydromorphone, it is easy to get distracted. Just looking away from what you are doing, if only for a few seconds can cause major (if not fatal) mistakes.
    This should be followed in all medication rooms/areas.
    Complacency leads to errors and mistakes. It could lead to a patient fatality AND our nursing registration.

  2. Great mnemonic! I’m trying this year to bring more mindfulness to the bedside. It ‘s always OK to ask if you don’t understand why something is being given, especially when drugs we give are used for “off label” uses. The MD’s I work with have always been helpful in explaining why something is being prescribed.

  3. If I have to check a drug calc I always do the calc myself. I get looks sometimes, as if I’m being mistrustful, but if anyone asks I just say, it’s my rego too. Same goes with going to the bedside as a second person with S8s. Especially when you hear stories about nurses leaving the drug on the table for the pt to take and leaving the room and it gets sold to the pt’s friend.

  4. Great stuff :)

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