New nurse, Second Medication error, Scared

[Kaysonrose]

Hi I'm a new RN and I was recently hired at an acute setting in October 2010. In the past three months, I have made two medication errors and my DON told me the third one will be up for termination? After hearing this, I've been absolutely scared. I mean this is my first RN job and already I'm making medication errors.

First Drug Error: I didn't see the order for potassium and so the night nurse ended up giving it to the patient (4 hours late) but of course I was written up for that.

Second Drug Error: I forgot to give coumadin 2mg for maintenance (written by the pharmacy per protocol) and again I was written up for it.

I admit that I made the mistakes. I was just crushed because just when I thought I had been thorough with my work that day, I get a call from my DON telling me about the error. I'm feeling so frustrated with myself.

I don't want to lose my job. I'm new and I'm learning. I don't even know if they'll put me on probation or not or if there is such thing with medication errors. Will they terminate me if I somehow make another error after a year?

I don't know if I should start looking for another job. But lesson learned, I am NOT leaving that hospital without looking at the MAR and the Chart thoroughly from now on. I'm just feeling so traumatized because I now know I can't afford to make another mistake and so I have this pressure on my shoulders. Now I'm thinking, are they going to automatically terminate me if I make another error? Any advice to ease my stress?

[NocturneNrse]

Ok, you missed the order for the K. Can you think of a reason that new order was missed? Are there "alerts" in place so the nurses can clearly SEE that a new order has been written? Perhaps there needs to be some changes to the "new order" protocol to prevent other nurses from missing them as well. You made a mistake - you're NEW, perhaps it's JUST NOT YOUR FAULT - the system may be faulty as well... glad you owned up to it though, because that shows integrtiy.

You also missed the 2mg of Coumadin per Pharmacy Protocol.... OK, is that protocol CLEARLY displayed for the nurse to see? Where I used to work, there were loads of protocols.. but many were in such area's that noone would ever find them, or would even suspect they exist!!! Perhaps - you could take some time and look over all of the protocols for your hospital - just skim over them to see they exist, so you will get that "OH YEAH" in your brain when your patient is on that medication, etc etc... Also - your integrity shines through loud and clear with your willingness and accepting of your mistake.

My advice.. When getting report, ask "I'm new, is there anything that I should know about this patient? Any new orders, protocols that I might not see?" Hopefully you'll have a helpful nurse handing off to you. Also, SLOW DOWN.. I know you're probably crazy busy, and want to show that you can hustle like the rest of them.. but it does take time. And always bring that MAR with you when giving a med - that is how I made my med error.

And finally.... :hug: hugs to you.. it's hard, and we support you!!

[April, RN, BSN, RN]

I just don't really like the fact that the unit secretary can take my MAR at any time and write down an order without telling me. Of course it's not an excuse for making mistakes but maybe there's a better system to reduce med errors.

Just an idea.... can your unit secretary stick one of those fluorescent sticky note things to the MAR so it's sticking out of the top to alert nurses that there is a new order? Does your hospital have any plans for electronic MAR? I've found that it's near impossible to miss a med using the EMAR. The doctors enter all orders into the computer, then the orders pop up as one color in the 2 hour window that they are due (1 hr before, 1 hr after), and then pop up red when they are overdue.

[bullygirlie]

HI, I am a new night nurse of 2 months. Though I don't have all the details about what went wrong, but I supposedly did my 24 hour chart check and didn't catch a certain drug that pharmacy accidentally posted on the mar. The drug then was given to the patient for 3 days before another nurse realized the medication was not actually ordered by the M.D.. When the M.D. found out, he went to the director and demanded something to be done immediately to rectify the situation. The drug was solu-medrol. I take responsibility for this, not sure how it happened, but it happened. The Good, the bad and the ugly....what are everyone's opinions on this? I meet Monday to find out if I still have a job.

[FancypantsRN]

bullygirlie - so all the nurses that gave that med are in jeopardy of losing their jobs? really?

[FancypantsRN]

med errors happen. i have made a couple myself. i have almost made many (especially when i worked at places with the paper MARs).

i just try to question why the patient is on the meds. if i can't figure out why i am pulling the med, i try and find it in the chart. this has saved me from a couple of med errors. it's hard to do when you are super busy and i haven't done that every time, so perhaps i have made more errors than i know.

it's even harder to catch when the doc puts the order in the wrong chart (happens), the us enters it wrong, the pharmacy verifies it incorrectly, or even verifies the wrong med on the wrong patient.

it's tough sometimes to catch a break. we do the best we can with the systems we have. we just make note to self, and try not to make the same error in the future. just like our priorities and to do list is ever changing, so is the way we look at our own processes for doing things.

[bullygirlie]

HI, thanks for replying. It's all 100 percent my fault for the patient getting the drug???? I failed to realize there was no M.D. order for it and Pharmacy posted it onto the wrong MAR. I should have caught it and the other nurses just gave it, relying on my 24 hour chart check. I am going to ask to see the chart tomorrow in my conference as I don't know what the specific details are. I walked into a bunch of rumors and found out my boss is going to talk to me about it second hand. That sucks!!!! I must have not crossed it off the Mar during my 24 hour chart check and the day nurses gave it for 3 days afterward. Then the last nurse caught it and notified my boss. The M.D. was furious. I guess it is 100 percent my fault alone. What do you think? I feel terrible and I am very meticulous when it comes to my meds. I fear med errors the most. I also told my work I was swamped and sinking with all the admissions and discharges they give to me every shift. I am brand new and the season nurses don't get half the admissions I do. I do take responsibility for my actions and inactions and I will own up to my errors. The pharmacy should have some accountability as well though. I think I am getting fired.

[FancypantsRN]

well i think getting fired would be kind of harsh. i am not sure of the details - but if they call you in, i would just explain to them that you take responsibility for the mistake and you have learned a valuable lesson from it. you would think with all they put into you being a nurse on their floor that they would not can you for this. i would just not given them excuses, if it were me, about the admissions and dc's. that will even out in time - really it will. a lot of charge nurses think that new people on the floor should pay their dues (as wrong as that is to a new nurse). when i was new, i got all the heavy patients. i was promised a "slow easy group" until i got adjusted. ha! no way, all confused, combative and high acuity for me : )

yes, pharmacy does share in the error. med errors are not usually just one persons fault, sometimes it is a system error and they don't get corrected unless risk management gets involved and so on.

[April, RN, BSN, RN]

You are not solely responsible for this error. It's a systems error. It was initially pharmacy's error. The med was given for 3 days. That means it got missed on three 24 hour chart checks, right? Were you responsible for all three of those checks? No nurses on other shifts that gave the med questioned the order? Don't let management put this all on you.

[rkitty198, BSN, RN]

I know you made two drug errors, and so have the rest of us. I wonder why your management sucks so bad that they would not have a system that isn't punitive- so that you can learn from your mistakes.

[carolmaccas66, BSN, RN]

Get into the habit of following your medication checks, and also checking your medication charts B4 u leave to go home. Get into a routine with doing meds, one at a time, don't mix meds up (ie: don't get two out at once to 'save time'), don't get out or give two meds at the same time, don't let people interrupt you (ie say: I am doing meds right now, I will get back to you). If you get interrupted (and you will), start the checking process from the beginning for that particular med again. Also check med charts (or whatever u have there) BEFORE going into the patient's room, as the patient will start talking and interrupt you. Always check with other nurses if unsure of anything.

We all miss things, and having you written up has made you more nervous.

did you make the potassium mistake cos the orderr was hard to find? If so tell your NM about it.

Also why is pharmacy writing up coumadin? Is that a US thing? Just curious.

[carolmaccas66, BSN, RN]

Wow thanks guys for all the support! I'm new to this site and you guys make me feel like I'm not alone in this situation. I will defintely be more thorough with my medications. I just don't really like the fact that the unit secretary can take my MAR at any time and write down an order without telling me. Of course it's not an excuse for making mistakes but maybe there's a better system to reduce med errors.

I will definitely check the chart with the MAR every chance I get in between the chaos that goes on at work. Again thanks for all the advice and support!

Kaysonrose

Whoa! Now I'm more confused and curious!

The Unit Secretary can take your med chart and write down an order? What does THAT mean? And why is she doing that?

This does not sound like a good system. If people are adding stuff onto charts all the time, they should at least be TELLING YOU, ie: putting it down on the handover tape, or telling you face to face. No wonder you are missing things! You need to have a meeting with your NM I think - this does not sound like a safe system to me.

Also I meant to say, get a cheat sheet (or make one up) with the patient's names & room number down one side and times (each hour of work) up the top and list all your meds at those times, procedures to be done, etc. I highlight meds in red then cross them off after I'm done - that can help you as well.

[lvnnars1]

if you give less than the prescribed does, is that also considered a medication error?