Have you ever made a med error? - page 7

i'm a senior rn student & i made my first med error last week. the nursing director said if i make another med error i'm out of the program. Has anyone done a med error as a student? i know i'm... Read More

  1. by   soon2bim
    I, personally, would document the conversation in your personal information/records. This way you will have a record of exactly what was said, by both sides. I just like to think CYA. You have sort of done that here on this site though. It is just a thought.
  2. by   askaham
    This whole discussion saddens me on so many levels. First, that so many of you have only owned up to one or two errors. Having been a nsg instructor and a clinical supervisor, I have caught so many med errors that had continued on, some for years. For instance, while giving meds with a student, I noted that the pt had an order on the MAR to give lubricating eyedrops to both eyes every 4 hrs. My student gave one drop to each eye and when we returned to the medcart, I noted that the MAR stated to give 20 drops OU. This order had been transcribed onto a computerized MAR for over 1.5 yrs and no one had ever caught it. We got the order clarified to read 2 drops but can you see how errors happen without you even being aware of the error. This same facility was notorious for documenting that they were administering meds by mouth when the majority of their pts were receiving their meds via GT. Many of these meds were ones that were not to be crushed or opened but they did it on a routine basis. Remember that there are now considered to be 6-7 rights of medication administration (right pt, right drug & right dose for right reason, right time/frequency, right route, and right documentation). I think it is terrible that a student should be dismissed immediately for one mistake. I would never fire a licensed nurse for a first med error. Med errors are usually system-errors not the error of one person. How can we grow as "practicing" professionals if we never get the opportunity to learn from our mistakes?
  3. by   pagandeva2000
    Quote from askaham
    This whole discussion saddens me on so many levels. First, that so many of you have only owned up to one or two errors. Having been a nsg instructor and a clinical supervisor, I have caught so many med errors that had continued on, some for years. For instance, while giving meds with a student, I noted that the pt had an order on the MAR to give lubricating eyedrops to both eyes every 4 hrs. My student gave one drop to each eye and when we returned to the medcart, I noted that the MAR stated to give 20 drops OU. This order had been transcribed onto a computerized MAR for over 1.5 yrs and no one had ever caught it. We got the order clarified to read 2 drops but can you see how errors happen without you even being aware of the error. This same facility was notorious for documenting that they were administering meds by mouth when the majority of their pts were receiving their meds via GT. Many of these meds were ones that were not to be crushed or opened but they did it on a routine basis. Remember that there are now considered to be 6-7 rights of medication administration (right pt, right drug & right dose for right reason, right time/frequency, right route, and right documentation). I think it is terrible that a student should be dismissed immediately for one mistake. I would never fire a licensed nurse for a first med error. Med errors are usually system-errors not the error of one person. How can we grow as "practicing" professionals if we never get the opportunity to learn from our mistakes?
    Wow...I have only been an LPN for 4 months, and this is the first time I am hearing that some of these mistakes can actually go on for this long. Something to ponder...
  4. by   stefannie
    Not only going slow but also ask questions if you are unsure and look up any medication you do not know the reason for giving, the side effects and contraindications. These are habits that will benefit you your whole nursing career. Your teacher may seem tough but medical errors can end your career if they cause harm to a patient. If its too busy on the unit to give medication safely then the administrators need to make changes to protect the nurses and the patients by making the working and care environment safer.
  5. by   pagandeva2000
    Quote from stefannie
    Not only going slow but also ask questions if you are unsure and look up any medication you do not know the reason for giving, the side effects and contraindications. These are habits that will benefit you your whole nursing career. Your teacher may seem tough but medical errors can end your career if they cause harm to a patient. If its too busy on the unit to give medication safely then the administrators need to make changes to protect the nurses and the patients by making the working and care environment safer.
    Unfortunately, in some facilities (such as mine), administration turns a blind eye to adjusting policies that support nurses in this. It is a ongoing arguement that has not had solutions, yet.
  6. by   RN1263
    Quote from stefannie
    Not only going slow but also ask questions if you are unsure and look up any medication you do not know the reason for giving, the side effects and contraindications. These are habits that will benefit you your whole nursing career. Your teacher may seem tough but medical errors can end your career if they cause harm to a patient. If its too busy on the unit to give medication safely then the administrators need to make changes to protect the nurses and the patients by making the working and care environment safer.

    also, to any administrators out there what's up w/ the pixus being placed in the middle of the nursing station where everybody and their brother is trying to get by & bump into you??? why isn't there a med "room"???
  7. by   kit3375
    Well today was it... I made my first TRUE medication error. Knew it would happen just didn't think so soon. I have only been out of school since May, and I've already made a mistake. Anyways... I gave Dilaudid 2mg instead of Morphine 2mg. I was trying to do everything the safe way by checking respirations, blood pressure, and giving the lowest ordered dose first. That didn't help. The Dilaudid is in the cabinet beside the Morphine, which I think is crazy. I guess I just focused on the Morphone in hydroMOROHONE instead of looking for Morphine. Don't really know what happened I was just devastated. I cried and felt like I couldn't breathe. No one acted like it was a big deal at all. The Dr. actually laughed at how upset I was. I already feel so insecure and I know that this is going to make it so much worse. Don't know if I'll ever be able to get this off of my mind!
  8. by   i_am_evergreen
    Quote from kit3375
    Well today was it... I made my first TRUE medication error. Knew it would happen just didn't think so soon. I have only been out of school since May, and I've already made a mistake. Anyways... I gave Dilaudid 2mg instead of Morphine 2mg. I was trying to do everything the safe way by checking respirations, blood pressure, and giving the lowest ordered dose first. That didn't help. The Dilaudid is in the cabinet beside the Morphine, which I think is crazy. I guess I just focused on the Morphone in hydroMOROHONE instead of looking for Morphine. Don't really know what happened I was just devastated. I cried and felt like I couldn't breathe. No one acted like it was a big deal at all. The Dr. actually laughed at how upset I was. I already feel so insecure and I know that this is going to make it so much worse. Don't know if I'll ever be able to get this off of my mind!
    Hi Kit. Sorry about what happened, I know the feeling. Just try not to beat yourself up over this. Wish you the best.
  9. by   askaham
    Quote from kit3375
    Well today was it... I made my first TRUE medication error. Knew it would happen just didn't think so soon. I have only been out of school since May, and I've already made a mistake. Anyways... I gave Dilaudid 2mg instead of Morphine 2mg. I was trying to do everything the safe way by checking respirations, blood pressure, and giving the lowest ordered dose first. That didn't help. The Dilaudid is in the cabinet beside the Morphine, which I think is crazy. I guess I just focused on the Morphone in hydroMOROHONE instead of looking for Morphine. Don't really know what happened I was just devastated. I cried and felt like I couldn't breathe. No one acted like it was a big deal at all. The Dr. actually laughed at how upset I was. I already feel so insecure and I know that this is going to make it so much worse. Don't know if I'll ever be able to get this off of my mind!
    Narcotics and other high-risk meds (ie. anticoagulants, electrolytes, etc) should always be double-checked independently by another licensed nurse.
  10. by   manettohillnurse
    to kit3375. you will get over this. don't let this spoil the rest of your career. this will make you all the more careful. it will always remain in the back of your mind, which is where it should rest. i'm sure that you'll go on to be a great nurse because you had the integrity to own up to your mistake !!!!!!!!!! i'm sure that the doctor who laughed at how upset you were didn't help too much. anyhow, good luck you'll be fine.
    [color=#00bfff]sylvia
  11. by   RN1263
    Quote from kit3375
    Well today was it... I made my first TRUE medication error. Knew it would happen just didn't think so soon. I have only been out of school since May, and I've already made a mistake. Anyways... I gave Dilaudid 2mg instead of Morphine 2mg. I was trying to do everything the safe way by checking respirations, blood pressure, and giving the lowest ordered dose first. That didn't help. The Dilaudid is in the cabinet beside the Morphine, which I think is crazy. I guess I just focused on the Morphone in hydroMOROHONE instead of looking for Morphine. Don't really know what happened I was just devastated. I cried and felt like I couldn't breathe. No one acted like it was a big deal at all. The Dr. actually laughed at how upset I was. I already feel so insecure and I know that this is going to make it so much worse. Don't know if I'll ever be able to get this off of my mind!
    i'm the OP, and i can tell you that the devastation does wear off a bit....it's been about 2 weeks since my med error & although i'll be extra careful from now on, i'm not going to beat myself up about it anymore.
    the first 2-3 days i was sooooo depressed literally i would just go back to bed every few hours during the day, but soon realized i had to get over it or i was going to make myself sick!

    ....so learn all you can from it (what you can change in the future), know that most nurses have made an error, & move on!....also, don't let any nurse w/ a "high and mighty" attitude about the subject get you down, they apparently don't understand you're already beating yourself up enough and don't need them getting their jabs in also!

    ...... this too shall pass!!!!:kiss
  12. by   kukukajoo
    Just wanted to say that this thread helped me pass my med admin lab with flying colors! Thanks to all who shared their stories and let me learn from you, it is greatly appreciated!
  13. by   Teachingnurrse
    Imagine this: You are working in long term care. Your patient load is 40 They all take from 5-15 meds apiece. You have one hour before and one hour after to pass from 200-600 pills before it officially becomes a med error. I personally can't imagine NOT making some sort of med error when your patient load is that heavy. 40 patients seems the norm here in the state of Colorado.

    The first thing to do when you KNOW you've made a med error, be accountable. But what happens when you've passed meds to 40 or so people, done treatments, answered the phone, charted, supervised CNA's, among many many other things and you've made a med error and you don't even realize it.

    Part of stopping med errors, especially in long term care is for nurses to refuse to accept assignments with such large patient loads. I've worked for a nusing agency for years.....large patient loads are the norm, not the exception. I don't accept more than 20 patients anymore.

    I've made a few med errors myself during the years, but I've owned up to all of them. Then after all was said and done, I wanted to quit nursing.

    Judy

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