help!

[sweetieann]

Please bear with me....I'm really upset. So I basically just realized this, and it happened 2 days ago. Long story short, I had a new patient (new admit) and they were to get a controlled substance (which I didn't realize was a cojntrolled substance bc even though I looked it up, it's a newer drug) due at 10 o'clock, along with some other meds. I kept calling to pharmacy to see when the meds would be coming up since 10 was nearing. They said they would be on their way. Waited and waited.....charted and took care of some other things. So I then realize that the one med I had been waiting for was in the pyxis machine the entire time! (live and learn). Well, I did have to wait for pharmacy to put it in so it could be accessed thru the pyxis, and I didn't see it when I scanned to see if her other pyxis meds were in there yet earlier. Shortly after, the other meds came up also (which were in the bins but NOT the pyxis). I pulled them out of the bin, got the one out of the pyxis and gave them. HOWEVER, and here is what I'm now really worried about: a few days later when I went into work we did a narc count. Everything came out fine but as we were doing it, I realized you could pull up staion events by user, med, etc. I decided to just look at the different functions and I pulled up my name and scanned it. That's when it hit me: I had taken the med that was due at 10am out of the pyxis at 11:40! I kept looking at the screen thinking WHAT? It just didn't make sense. I go into the break room (where I had been charting the day before) and looked at the clock and realized it was an hour or so slow.....someone then pointed out it had been for days. This is when I realized that I must have been so caught up i ncharting, calling for meds, and attending to other things that I thought the time was closer to 11 when I pulled them (which would be on time). But instead, it was really 11:40! I also charted these meds as being given at 11 (which is in the one-hour window). But now, in reality, I see I gave the med 40 minutes "late." I was with the patient the rest of the shift and they did fine (in real life, how many people take their meds EXACTLY on time every day?) So I'm nto worried about the patient's well-being at all but now I am worried that pharmacy will see I pulled the med late....and then if they look to see when I charted, that won't be in sync with the pyxis pull time. I'm so upset by this! I've only been a nurse a few months and alot was going on this shift with rushing around...I know that's no excuse, but I'm still learning and aghhh I just don't know. I'm so nervous. I always try to do everything perfectly and I can't believe this happened. I keep telling myself at least it wasn't a mistake that would harm a patient (which would just kill me!) but I am worried about getting in trouble for this. I love my job, I try to do my best, my patients like me....I know I'm human and things happen, but I'm terrified for the reprecussions. And since I didn't realize this till late and since the story is so hard to put into writing, can't really go and write up an incident report now (those have to be done within 24 hours).

What's everyones take on this? How likely is it that pharmacy will approach me on this? I haven't been off any other times, I always pull my narcs/ controlled substances out when the pt is in front me (so never way early and never late). Could I lose my job over something like this? I feel like I've learned to be even more diligant and check the pyxis but what good is learning if you get canned over a mistake?

[widi96]

This seems like a completely honest mistake. I would just let your manager know of the situation and see what can be done to correct the chart - addendum or whatever to denote the correct time the med was given and that it was a late entry with the time and date that it was entered. This does not seem like something to get too worked up over. We have to adjust med times all the time to accomodate for a number of things (pts being NPO, gone for tests, etc.). The only thing that could reflect poorly would be the inconsistancy in the charting vs when the meds were pulled, but if you are proactive to get that corrected, then there should be no problem whatsoever.

[oncnursemsn]

Please don't worry! Documentation that's 40 minutes off isn't going to be that scrutinized. If you signed our multiple narcs, etc on your patients, it would create a warning depending on your pharmacy system. I've been a nurse over 25 years and teach nursing students- you will learn which mistakes are "serious" and which are not. As far as I'm concerned, this isn't serious. You could even go back and do a "late entry" in the nursing progress notes to document the late giving of this med. I tell my students that there are "soft" medications and "hard" medications. If you're ordered to give 20mg of Lasix, you give 20, not 22 or 18. If you are giving nystatin swish and spit, a few more or less cc's won't make a difference. I feel the same way about times of medications. I work in oncology, and we have a few chemo drugs and pre-meds which the timing is critical. Be patient with yourself and just know that with time, you'll get the hang of this. I wish you good luck and relax and take a breath. All you other experienced nurses, what do you think?

[Natkat, BSN, MSN, RN]

I doubt that anything will come of it.If you're worried you might approach your manager and explain your side of things first in case something does happen later. If the clock was wrong and everyone knows it, I think they'll understand.Relax, sweetie. You're just learning. You'll be okay.