Is this a med error?

[nessa77]

I am two weeks out of orientation. I've felt pretty good being on my own(typical stress of a new grad) but I'm always so nervous during my shift. I work on a typical medical unit, and this past friday I'm afraid I may have made a med error, and didn't realize it until yesterday when I was trying rethink my day through. It was a very hectic day. One of my pt's was to have dobutamine stress echo. She was NPO for the procedure, she had several BP meds that morning, along with paxil. So, I held her 0800 meds, and she went on her way. In the mean time, I had a discharge and a new admission on the way,along with my other pt's, and I was so focused on getting all the admission assessment stuff done, and the discharge paperwork ready to go. I finished my up my shift feeling very uneasy...I'm always so paranoid that I will forget to chart something, or that I will just forget something major. Well yesterday as I was reliving my shift in my head, I realized that I forgot to give the pt who was NPO her 0800 meds when she got back.

I suddenly got this quesy feeling in my stomach and thought oh, no, I think I just made my first med error. Of course being a new grad, and already feeling not too confident I started to question whether or not I'm really cut out to do this. There is such an unbelievable amount of charting, along with a million other things to do, I'm wondering how others don't forget things. I mean honestly I'm wondering how I will remember everything all the time. Any suggestions, maybe I'm just not organized enough?? I keep the pt's report sheet with me that goes from shift to shift, along with my own sheet of meds, VS, assessment, I&O, diet, code and allergy info, etc.

I'm wondering also what others do to keep things straight on a really hectic day??? I love nursing, but feel so worried that next time I will forget something even bigger.....

This turned out to big a longer post then usual....guess I needed to vent more then I realized. Thanks for any suggestions/support!

[babynurselsa, RN]

First, take a deep breath. Now another.

How did the order read, besides being NPO?

What time did your patient return?

We have al felt about being in over our heads as new nurses just off of orientation. As your confidence grows these feelings will lessen.

Good luck

[nessa77]

When I got on the floor at 0730...the dept that handles echos called to make sure the pt had been NPO for the procedure. In the chart the order read something like: pt to be NPO after midnight for dobutamine stress echo. I should have asked the charge nurse if I should have given the pt her meds when she got back to our unit. I was so busy, that it didn't even cross my mind:idea: How does one remember everything???? Yikes...I just don't know:(

[hikernurse]

Stuff like that, I write on my paper "brain" and highlight. Otherwise, I forget entirely--there's way too much to remember.

That reliving your shift I hate--I think it's very useful, but, I always think of something I should have done differently. But sometimes I think it's kind of like being a mom, as long as everyone's safe and alive and tucked into bed at the end of the day, then some days that's as good as it's going to get.

[nessa77]

Thanks for the replies...just knowing there are others who have been there, can relate, understand the stress...so on and so forth. I have a great family who is willing to listen to my venting, but until you've been there, I think it's hard for others to understand. Thanks again!

[GardenDove]

It should have been caught by the next shift, and they should have called you up at home. It's a very understandable omission on a busy day. I've made the opposite mistake, given a PO med when the pt was supposed to be NPO for a procedure. I was told by my charge nurse at the time that it wasn't the end of the world.

This is how you learn in nursing, btw.

[classicdame, MSN, EdD]

I create a grid with hours across the top and room numbers down the side. Then I make notes in the grid, such as RX when meds are due. I cross them out when given. That way I know. If I give some, but not all, I make one half of an "X" then add the other half when all meds are given. I find the grid helps me keep up with procedures, MD visits, all sorts of stuff. I am careful to make notes in my own shorthand and NEVER leave the grid where anyone else has access to it. At the end of the shift it gets shredded.

[NotReady4PrimeTime, RN]

We frequently have patients NPO for whatever reason, and they are often receiving PO sedation such as Chloral, or a diuretic like Aldactazide, or someo other med that probably wouldn't be disastrous to miss, but... I will ask if they want me to give the meds anyway. We usually have a small bowel feeding tube we use for feeds and can get away with giving enteral meds that route without worrying about aspiration. Sometimes the answer is yes, sometimes it's no. I chart that I asked and what reply I got, then do accordingly. Once they're done with whatever they've been NPO for, I'll ask again what they want me to do about the PO meds. Usually we'll give it as soon as possible then adjust the remaining doses just enough to get us back on schedule.

[andre]

I realize this doesn't directly address your situation, but on our floor we give po meds in the am before a dobutamine stress...with the exception, of course, of beta blockers. Yes they are otherwise NPO at least three hours prior, but so many of our cardiac patients need their meds! We don't hold them unless there are parameters that apply, or with a specific md order to hold them am of procedure.

Now, depending on what time she came back, and whether any of those am meds were qday only or had other doses due, would definitely make a difference on whether or not I felt I needed to give them after the dobutamine stress. For example, if she had BID Lasix and she came back at noon, I'd probably non-administer the am dose and just give the pm dose. Does that make sense?

Nonetheless, if you feel it was a med error you should document it as such, per your facility's policy. It happens. Take a deep breath. If that's the worst med error you ever make you're in good shape :)

[nessa77]

Thanks for the replies! When I spoke to the charge nurse about NPO status, I mentioned to her that I was going to hold her BP meds, but give her the paxil (this is after I got off the phone with dept handling echos). The charge nurse at that point told me to hold the paxil as well. I know the paxil was a once a day med, which means the dose I forgot to give her was a missed dose for the whole day.

I think I will talk to the charge the next shift I work, explain the situation, and see how to handle it (if I need to do the paperwork for a med error) Once again, thanks for the feedback!

[AdelaideChic]

How did it go Nessa?