I screwed up

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    Busy night in the ED, down two RNs, and I screwed up and hung my abx before blood cultures were drawn. I know in the big scheme of things there are a lot worse mistakes that could have been made but I feel like an idiot and had a knot in my stomach the rest of the night.
    There is no excuse other than I just didn't check with our lab person first. I've only been in the ED 3 months (Trauma ICU before that) so still learning, but feel like such a dope! Had to get that out!
  2. 17 Comments so far...

  3. 4
    In patients were are very concerned about being severely septic we will occasionally start the antibiotics immediately on obtaining a line regardless of whether cultures were obtained or not. Everything I've read on septic management puts a big emphasis on how quickly antibiotics are administered- having cultures on hand can help in later management but early antibiotics improves survival. So really, your mistake was a "check list" mistake. You didn't check box A off before checking box B off, which will be an issue with The Joint Commission if it happens at your hospital frequently but in the end, won't harm the patient.
    flyingchange, poppycat, SionainnRN, and 1 other like this.
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    Thank you. I felt horrible cause it caused us to "fall out" which costs the hospital money, and I know it didn't impact the pts health (hopefully), but it was just one of those days when you're trying to "move the meat" and get stuff done. Sigh. I know I'll never make the same mistake again, but just felt horrible for making it in the first place.
    hiddencatRN likes this.
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    I've been in the ED for a little over 3 months now. I had the same thing happen to me, when I hanged the ABx before culturing the pt. It was when I was in orientation for less than a month, and like you, I felt my heart plumet. I felt so bad!!!

    I have to agree with what's already been told here - it's not the end of the world. what's most important is that you treated the pt, right?!

    And I totally agree with you - after something like this happens once, you're conditioned for life... This will not happen again.

    little mistakes will happen, and there's nothing you can do about it. We're all human, and we're working under crazy conditions. All we can do is try our best.

    Don't worry about it!
    SionainnRN likes this.
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    Oops! it happens and I bet you will be more careful next time so lesson learned. If the patient already had a very clear cut source of infection you did not lose out on too much information. If they did not then you did lose valuable information. You only get that one chance to get that culture that reveals a pathogen that prompts the ID to look for an alternate source. Some of the tricky ones can endocarditis,osteomyelitis,and various abscesses.

    The good part is that the patient got their antibiotics and they will continue to monitor them for response to treatment and adjust as needed. If it happeend to you as a nurse it can easily happen to another nurse so what I would do is to figure out a system to solve the problem so it does not happen again. I would present the ideas to management. I cannot tell you how many times a "miss" or near miss has prompted me to solve a problem.
    SionainnRN and Susie2310 like this.
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    Is it okay to hang your abx after one set of blood cultures is drawn or should you wait until both sets are drawn?
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    Quote from whichone'spink
    Is it okay to hang your abx after one set of blood cultures is drawn or should you wait until both sets are drawn?
    Just the first set usually. Second set isn't drawn for a bit after.

    Luckily we knew where the infection was coming from. Poor pt is failure to thrive, dementia, and has aspirated pneumonia. Thank you guys for the reassurances. And it was all my fault, no policy problems, I was hurrying and missed an important detail.
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    Quote from whichone'spink
    Is it okay to hang your abx after one set of blood cultures is drawn or should you wait until both sets are drawn?
    Draw both sets before antibiotic admin. 2 sets are drawn from 2 different sites to minimize contamination.

    I guess there is a national back order on culture bottles? We haven't had red tops in a week, and we have been drawing 1 green top per set, lab says they can run aerobic and anaerobic cultures off of one culture bottle.

    Cultures are not truly important in pneumonia treatment, and they rarely alter the course of treatment. The practice is continued mostly due to CMS reimbursement. Darn government. http://intranet.emergency.med.ufl.ed..._Pneumonia.pdf
    txrn13 and SionainnRN like this.
  10. 1
    I know that feeling all too well.. Throat swells up, abd cramping, face flushes.

    I took over for a nurse last week who told me in report pt was getting ready to transfer to floor, had pne. IV atb running well.. Then says 'Oh she needs 2 sets of blood cultures drawn'... Atb had been running 30 mins already. I didn't draw cultures. I wasn't going to lie, back time them before the atb was hung and send. I felt that feeling in my body cuz a mistake was made. When chart gets audited soon, I'm sure I will be approached and spoken to because I was the last nurse on the case at time of transfer.

    Mistakes are going to happen, we're gonna feel that feeling, in the great scheme of things, It makes me feel better to know Pts were not hurt in the process. I don't want to feel THAT feeling
    SionainnRN likes this.
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    Quote from Sassy5d
    I know that feeling all too well.. Throat swells up, abd cramping, face flushes.

    I took over for a nurse last week who told me in report pt was getting ready to transfer to floor, had pne. IV atb running well.. Then says 'Oh she needs 2 sets of blood cultures drawn'... Atb had been running 30 mins already. I didn't draw cultures. I wasn't going to lie, back time them before the atb was hung and send. I felt that feeling in my body cuz a mistake was made. When chart gets audited soon, I'm sure I will be approached and spoken to because I was the last nurse on the case at time of transfer.

    Mistakes are going to happen, we're gonna feel that feeling, in the great scheme of things, It makes me feel better to know Pts were not hurt in the process. I don't want to feel THAT feeling
    Did you mention to the nurse you got report from that the cultures should have been drawn before the abx were hung? Yeah when I told the doc I felt like a complete idiot, luckily he didn't dwell on it for the rest of the shift. And yes, thank God, it wasn't something that harmed the pt, but still sucks!


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