Making an error

[AusSRN]

Hi everyone,

I am a student RN, a final year on my final placement. I am on my 2nd day at a big teaching hospital and I felt confident all day.

My buddy RN left 2 hours earlier than I was due to finish and therefore I assisted other nurses and answered buzzers to help out.

A patient asked me if I could heat up a heat pack she had to help with pain she had in her knee post TKR + infection = VACC dressing.

Without hesitation I pottered off and heating it slightly for her and said I wished her to feel better soon.

Half an hour later I saw nurses rushing in an out of her room, then a clode blue..

It turned out that there was a bleed (for the 3rd time in 3 days) in the wound on her knee... this lead to hypotension and a code.

I was approached by a senior nurse who informed me that it is hospital policy we do heat up heat packs for patients and because I had done this, this patient placing it near her wound caused vasodilation and the bleed.

I was nearly in tears at the thought that my good intention caused her to code.

I spoke to this patients nurse who explained she probably had already had another bleed but the heat caused it to bleed more, and quicker.

Not only did it cause this outcome, there was the potential to cause a burn to the patient.

This is so obvious to me now, but the only thing I considered was if she had a pain patch such as fentanyl as I am aware that heat to these can cause high dose of medication being administered?

But I cannot shake the self blame or guilt. I know I will learn from this but I can't help but feel so defeated and incompetent... I don't know how I'm going to go back without being anxious about everything I do now. I've never been a cocky or arrogant student nurse but I do like to be independent as possible. Now I feel I will be fearful to do ANYTHING.

Have you made a big error and how do you get over that guilt?

[Castiela]

Every nurse has made errors, some serious to result in senteniel events. I know personally, I get that same sinking pit in the stomach feeling when I discover any mistakes. You aren't incompetent. You are learning, which means you will make mistakes.

As for getting over the guilt, I acknowledge what I did wrong, figure out what I learned from the error, deep a deep breath and continue working. i personally just to ignore that feeling and get on with my day/ go for a walk/ be active. Some times I have journaled out the error and that helps sometimes, but I find ruminating on it makes me more depressed and anxious and takes my focus away from my patients.

I'm personally a bit surprised after 3 bleeds in so many days that they didn't reassess the use of vac therapy for a different method, unless they were minor bleeds.

[Here.I.Stand, BSN, RN]

If she was bleeding enough to code, I'm guessing there was more going on than a heat pack.

[AusSRN]

Thanks a lot for your advice. :) I am finding that I'm dwelling on it too much and need to move on. I may try journaling. I'm not on placement today so I can't even be reassured that this patient is fine. But thank you again for your response.

[AusSRN]

This is what I thought also, as I gave the heat pack and just as soon as I got back to the nurses station she buzzed again to notify of the bleed.

I feel as though it just bought her attention to the bleed. But I was made to feel as though I contributed to it.

[RotorRunner]

I seriously doubt that your heat pack caused the patient to go into hypovolemic shock and cardiac arrest half an hour later.

[Nurse SMS, MSN, RN]

Pretty much zero chance your heat pack caused the bleed. That nurse was wrong to say that to you, especially at such a time. If so, why did that patient have a heat pack in the first place??

HOWEVER...never, ever, EVER reheat a heat pack and never, ever, ever use something other than the hospital purchased heating packs to provide to the patients. I have seen patients develop terrible blistering burns from heating packs that have been reheated as well as towels heated in the microwave.

Let this one go. You did not cause that code.

[Wuzzie]

I'm sorry but there is no way you caused her to code. That's complete rubbish.

[kcochrane]

Let this one go. You did not cause that code.

This.

[PixieRN1]

No how, no way did you cause this code. Yes, the heat could have sped things up. But truly, the pain could have been a symptom of bleeding, but no way that you caused that code.

Moving forward, don't reheat packs, don't initiate heat therapy for pain, and if your patient complains of pain, let your nurse know immediately, every time. Then it becomes her responsibility to assess the patient, not yours.

You have to lose a lot of blood to go into a significant enough hypovokemic shock to code. Not knowing all the details, it's hard to say if something should have been caught and how much sooner. But having been in ICUs most of my career, I've never heard of a heat pack singularly causing a fatal bleed.

Deep breaths and best of luck to you.

[3ringnursing, BSN]

You are not incompetent. Nursing is harder then most "outsiders" think (I am counting you, as a nursing student, an insider).

Nursing is not merely a glorified waitress/waiter, stationary flight attendant [stewardess], handmaiden to doctors, or servant/maid - it's a serious job with many responsibilities necessitating critical thinking and problem solving skills, and has real repercussions for errors. Even at the best of times it can go sideways - and damn fast too.

That being said, I've yet to meet even one nurse that has never made an error in the course of their nursing career while on the job, so you are in good company my friend.

There are so many facets to nursing that if we were to stay in nursing school until we knew it all then no one would ever graduate {even then we would likely: 1) retire before ever working as a nurse, or 2) die from old age and STILL not learn it all}. It's just not possible.

Keeping this in mind, that means we are naturally bound to make errors.

Errors aren't technically always bad - and thankfully in this case the patient didn't die. You also learned something from it - a BIG something.

Errors really only end up in the "bad" category if you walk away without having learned from the mistake, which then makes you vulnerable to repeat the same error again and again until you do. Most people won't hold a mistake against you - unless this is the 5th time you've repeated it (then people tend to get pretty ticked off).

All nursing students and new grads feel frustrated because they want to have 30 years of experience and solid nursing skills under their belt from day #1 (me included) but it just can't work like that. Experience and skills only come from one source: working as a nurse.

On a side note, if it helps make you feel any better ... this patient brought her home microwaveable heat pack in with her to the hospital with the intent to use it - and she was going to use it no matter who heated it up. If it hadn't been you then someone else would have accommodated her request. I say this because when I had a hysterectomy I too brought in my microwavable heat pack made by Origins (which not only smells amazing, but really relieves pain). I was up walking the halls most of the night miserable, and I nuked that sucker up multiple times throughout the night.

Something else that may make you feel somewhat better: the nursing protocol I use on the job recommends to use heat 48 hr's after an "injury" (surgery included) for increased blood flow to the wound for faster healing (it recommends cold for the first 48 hr's to decrease inflammation, swelling and pain). You never mentioned how many days post-op this patient was, but if it was 48 hr's or more you followed nursing protocol (oddly, my GYN surgeon ordered a heating blanket for my lap hysterectomy wounds as soon as I got to the unit from PACU).

Anyway, take a deep breath, dust yourself off and finish your clinical rotation. You'll be amazing once you get some work experience under your belt. Just be thankful you didn't give an NPO patient whom was also constipated a plastic spoon.