Elena Buglione, RN, Surgical A, won the Great Catch award after demonstrating attention to detail and a questioning attitude in identifying a medication packaging discrepancy. Buglione noticed that a patient who had been prescribed ZenPep-10 had four medication packages. One package was labeled as ZenPep-10 but contained a different medication. Buglione escalated the matter, prompting an immediate review of ZenPep inventory in the main Pharmacy and in Pyxis machines. No additional mislabeled medications were identified, and Buglione prevented a potential medication error.
