Sigh. Messed up, not sure how big of a deal it is...

wensday, MSN, RN, APN, NP · Dec 7, 2004

I've done it before. Unfortunatly that's one of the things about our job, time x workload does NOT = easy job.....if the doc didn't look that bothered, it's not a problem. What i do at the start of each shift is take a peice of A4, draw a table with the hours of the shift along the top and your patients along the left. Write in all thier drugs at the relevent times, along with any important stuff eg tests etc and stick it somewhere you will see frequently. i have mine at the nurses work area where we prep drugs etc....otherwise in your pocket would do! Hope this helps with our time management problems. Makes things so much easier. You can see when your free(er) times are so you can take your breaks then.

Tweety, BSN, RN · Dec 7, 2004

I just called a nurse the other day at home questioning if she gave a med or not. She didn't. I've done it too. Be gentle and forgiving and chalk it up as lesson learned. See what you can do in the future to prevent it from happening again.

Mandylpn · Dec 30, 2004

Jen42: at least you owned up to the mistake and reported it as we are supposed to do. At my school they taught us to always admit a med error, and I would rather admit it than being caught trying to cover it up or harming a patient. On my last day of my internship, I missed a sliding scale insulin dose in the am pass. I admitted my error to the nurse training me, even though I knew she would be p---ed. Thankfully nothing adverse happened to the patient. Be gentle with yourself!

webblarsk · Dec 30, 2004

Its a mistake! Everyone makes them! If they say they don't they are lying. I learn alot from my mistakes and it makes me that more aware!

URO-RN · Dec 30, 2004

Dear all:
I posted a few months back because I was having crazy problems keeping up on my unit. Anyway, our nurses take 2 or 3 patients (it's bone marrow transplant, so they're pretty intensive), and now, after being on the unit for 5 months, they bumped me up from 2 to 3, a full patient load, for the last two days.
Anyway, I never got to sit down, never got to eat lunch, etc. One patient was completely bedbound and running a high fever, one needed assistance getting out of bed at all and is one of those patients who call for EVERYTHING, even just to share thoughts, and one COULD get out of bed but refused to and couldn't speak English. So. The first day was a weekend, I ran around like nuts but got done in time. The second day (yesterday) was a wreck. Giving blood, sending people for tests, trying desperately to get everything done on time. I had a bunch of RNs pitching in and helping me, but the floor was nuts, a patient coded, our call light system was broken... it was one of those days.
So at the end of my shift (with an hour and a half to go before I left) I'm finally charting the meds I gave and realized I missed an important one at 2:30. It's 7. (This is after I accidentally gave a med early, but the doctor for that pt said it was not a time-sensitive med). Burst into tears, told the doc, they rescheduled his doses and it looks like it's not a big deal for the patient. The doc wasn't pleased, but not too freaked out. I also missed a couple of orders because the patient service representatives didn't put the copies in my box. They weren't emergent ones. Filled out an incident report, spent an hour catching up on chart, emailed an assistant manager asking to meet with her to figure out how to better organize my time, crying all the while, escaped home and cried some more.
So I guess my (long-winded) question is, well, how common is it to miss a med? I know it's not excusable, but I'm worried. A few months ago my manager called me in after a month of working on the unit and said she was worried because I'd missed a few things and wasn't nursing like I should be. She mentioned moving me to an easier unit, but we decided to try some more because I like where I am. The past few months have been hard, but fine. I'm worried that I'm going to be moved to another unit, which would be difficult but not catastrophic. But moreover, I'm worried that missing this med is so unacceptable that I'll be fired, or put on probation, etc. I'm having all sorts of morbid daydreams and I'm not sure how realistic they are. I haven't nursed long enough to be able to put things in any sort of perspective. So.... can anyone else?

Wow! I am reading your post and I am amazed at how well you can multi-task!. So you missed a med, no harm done to the pt and doc didn't throw a fit. Everyone makes mistakes. Don't be too hard on yourself. Seems that you are doing pretty darn good!. You should be proud of all that you accomplish in the unit.

Keep up the good work! :)

Jo-

peaceful · Dec 30, 2004

Please do not be so hard on yourself. You are doing the best you can, continue to learn from mistakes, talk with experienced nurses for advice, have faith in yourself. You sound like you are doing an awesome job. Take some time for soul searching and see if this is the area you REALLY want to be. If not, nurses change all the time, no big deal! If you want to stay, keep taking steps forward, all will be okay.

nekhismom · Dec 30, 2004

It happens. It didn't harm the pt, and you reported your error.

Let me just say that even in NICU, with only 2 pts normally, I sometimes miss meds. We give a LOT of stuff, and when things go bad, they go really really bad. On nights with 3 patients, forget it! I'm crazy busy, and errors are more likely to occur.

You work on BMT,right? I work with a nurse who came from BMT and she said they NEVER took more than 2 pts because the pts were "sick as snot" and it was unsafe. She has told us some of her stories, and I can't believe that nurses actually WORK in those conditions!!!! My hat is off to you, because I don't think I could EVER do it. I'm sure you are doing well just keeping up and keeping things in line. Give yourself gentle hugs, ok??

BeenThereDoneThat74, MSN, RN · Jan 3, 2005

I work in BMT too. What was the med (the suspense is killing me). I say this because i think it does make a difference (depending on the med, and the circumstances surrounding the ommission). Also if it's something that can be corrected (like the other one you stated, that wasn't time sensitive), then it's not a big deal.

A parent almost reamed me a new ---hole recently. The MAR, to me, was not clear, and I overlooked a dose of an antiemetic. This was part of a chemo protocol. It bothered me that i missed it, but I managed to justify it. If I were the nurse transcribing the order, I would have made it much clearer. One of my pet peeves about chemo orders- no matterhow hard everyone tries, they are often still ambiguous (---> errors!!!). Of course, I couldn't tell her that, as I'm looking at the MAR and she's saying "you know, there's no excuse for that". It bothered me more that I missed it, not that the mom went nuts on me. Bottom line is the drug was written as once a day, so technically, I didn't make an error (would have if she didn't catch it though :uhoh21: ). She got it about 28 hrs after the previous dose. BTW she wasn't even nauseated that day (thank God).

As for you moving to an 'easier' unit, I've seen it happen. But I've seen new nurses do fine in that environment. Honestly, though, most that I work with have had some experience prior to this. It is a very intense experience. Honestly, I couldn't have done that right out of school. It also depends on the support of your co-workers, precpetors, educator and manager. Are you off orientation? How long is (or was) your orientation? Also, is your unit strictly BMT or are there regular onc. pts too?

I wouldn't give up just yet. We've all made med errors, even nurses with many years of experience have done that too.

meownsmile, BSN, RN · Jan 7, 2005

I wont even look at it as a mistake. It was an oversight and could still be given and rescheduled. It isnt like it was doubled or given way to early. We dont even really write those types of things up. As long as it can be given and subsequent doses rescheduled thats what we do. It happens.

neonursey · Jan 9, 2005

OMG you sound so much like me!!! I went through the exact same thing!! (stupid incident reports scare the drap outta me). I graduated last december and work in the NICU, so we only get like 2-3 patient load due to how intensive it is.

I totally agree with wensday, a schedule really helps things out. Say you have two patients, you take 2 sheets of paper. write the hours down and all the meds/interventions per patient. then put them up next to the patients bed. (maybe the med room will be easier for you, all our patients are in the same room) I forget to check my pockets often, so i dont stick my papers in there. At one point i was so unorganized, that when my co-workers would go on break i couldnt even remember to do what they asked, so then i would get in trouble for that as well, lol, so now I also have a tendency to write a mark on my hand to remind myself of something i think i will forget. "3" for 3 am feed, etc.

SO, now with this new schedule posted next to the beds, i organize my day, my breaks and charting time. (also, rest assured, when you are scared so bad from one mistake, you are a lot less likely to repeat it)

I really hope things work out, and i'm thinking of you. It happens to all of us!! (you learn from mistakes, remember???) Now that i've been there a year, things are running alot smoother, so things will look up, you'll see

GOOD LUCK!!!

Thunderwolf, MSN, RN · Jan 9, 2005

Things happen and sometimes fail to happen when days become hectic. Like thirdshiftguy, I have had to call nurses at home regarding a missed med. Usually not a problem. There are days like that.