Fired for a medication error - Page 3

i was recently fired over a minor documentation error (6 months ago) but got a much better job offer the next day. couldnt believe my luck. I was not given a chance to give my side of the issue.

I worked m/s 2-3 yrs ago in a rural hospital and I 'pushed' phenergan (diluted in 10 cc saline) with no adverse effects many many times - as did all the other rn's. There were a few extreme situations in the literature which is why they started diluting it and piggybacking it and advising against IV push but it used to commonly given via this route.

I admit I have made errors (none fatal thank God) but my question is.....everytime I have to work short staffed should that be considered an 'error' on the part of the nurse mgr?? Some errors are caused because of a faulty system. Unfrtunately, the nurse takes the beating, we are an easy target. Investigating 'why' the error was made might be too much work on part of mgmt and god forbid they need to implement systemic changes so the same error doesnt happen again


Kudos to the OP for hiring a lawyer - this issue does need to be addressed in the nursing profession. You were honest about what happened and u shouldnt be retaiated against.

oh and btw - a few weeks ago I called the facility in which i got fired from - stating I was going to be moving to the area and wondered if they had any openings. "Oh yes yes. Can I send u an application? We have openings on all shifts!" states the receptionist.

25mg of phenergan is the max iv dose and needs to be administered over 10-15 min. dosages should start at 6.25mg iv and increase if necessary. this is a very caustic drug to the veins and despite precautions some facilities have removed it from their formularies.

severe tissue damage can occur regardless of the route of parenteral administration, although intravenous and inadvertent intra-arterial or subcutaneous administration results in more significant complications, including: burning, erythema, pain, swelling, severe spasm of vessels, thrombophlebitis, venous thrombosis, phlebitis, nerve damage, paralysis, abscess, tissue necrosis, and gangrene. sometimes surgical intervention has been required, including fasciotomy, skin graft, and even amputation.
safe practice recommendations: along with the manufacturer recommendations, the following strategies should be considered to prevent or minimize tissue damage when giving iv promethazine.

limit concentration. since 25 mg/ml is the highest concentration of promethazine that can be given iv, stock only this concentration (not the 50 mg/ml concentration).

limit the dose. consider 6.25 to 12.5 mg of promethazine as the starting iv dose, especially for elderly patients. hospitals have reported that these smaller doses have proven quite effective.

dilute the drug. require further dilution of the 25 mg/ml strength to reduce vesicant effects and enable slow administration. for example, dilute the drug in 10 to 20 ml of normal saline if it will be administered via a running iv, or prepare the medication in mini bags containing normal saline if there is time for pharmacy to dispense them as needed for individual patients.

use large patent veins. give the medication only through a large-bore vein (preferably via a central venous access site, but absolutely no hand or wrist veins). check patency of the access site before administration. note: according to the package insert, aspiration of dark blood does not preclude intra-arterial placement of the needle because blood can become discolored upon contact with promethazine. use of syringes with rigid plungers or small bore needles might obscure typical arterial backflow if this is relied upon alone.

inject into the furthest port. administer iv promethazine through a running iv line at the port furthest from the patient’s vein.

administer slowly. consider administering iv promethazine over 10-15 minutes.

create alerts. build an alert to appear on computer-generated medication administration records (mars), electronic mars, and on automated dispensing cabinet screens for nurses to view each time they access and administer a dose of promethazine, reminding them that the drug is a vesicant and should be diluted and administered slowly through a running iv.

treat. the manufacturer notes there is no proven successful management of unintentional intra-arterial injection or perivascular extravasation. however, sympathetic block and heparinization have been employed during acute management of promethazine extravasation.

use alternatives. consider safer alternatives that can be used for the various conditions treated with iv promethazine.

remove from formulary. some hospitals that have continued to experience adverse outcomes despite safety measures have removed promethazine from their formulary or banned its iv use.
promethazine -* intravenous (iv) dilution

OP. YOU made an error....in and of itself is probably not grounds to fire you.....however, most places are "at will" employers and the can fire you for whatever they wish.

At-will employment is a doctrine of American law that defines an employment relationship in which either party can break the relationship with no liability, provided there was no express contract for a definite term governing the employment relationship and that the employer does not belong to a collective bargaining group (i.e., has not recognized a union). Under this legal doctrine: any hiring is presumed to be "at will"; that is, the employer is free to discharge individuals "for good cause, or bad cause, or no cause at all," and the employee is equally free to quit, strike, or otherwise cease work.
http://www.bls.gov/opub/mlr/2001/01/art1full.pdf

An at-will employee can be fired at any time, for any reason (except for a few illegal reasons, spelled out below). If the employer decides to let you go, that's the end of your job--and you have very limited legal rights to fight your termination.If you are employed at will, your employer does not need good cause to fire you. In every state but Montana (which protects employees who have completed an initial "probationary period" from being fired without cause), employers are free to adopt at-will employment policies, and many of them have. In fact, unless your employer gives some clear indication that it will only fire employees for good cause, the law presumes that you are employed at will.What was wrongful? You made a mistake, you were fired.

Your employer is subject to federal and state laws prohibiting job discrimination (as all but the smallest employers are), you cannot be fired because of certain characteristics, such as your race, religion, or gender. (For more information on discrimination, see Nolo's articles on Your Rights Against Discrimination and Harassment.) Similarly, you cannot be fired because you have complained about illegal activity, about discrimination or harassment, or about health and safety violations in the workplace (see Nolo's article Assert Your Safety Rights Without Fear of Retaliation). And you cannot be fired for exercising a variety of legal rights, including the right to take family and medical leave, to take leave to serve in the military, or to take time off work to vote or serve on a jury.

Employment At Will: What Does It Mean? | Nolo.com

But laws vary somewhat state to state. Did you have a contract? Most disciplinary policies at hospitals state "subject to disciplinary action up to and including termination". You can hire a lawyer....they are expensive and they do not usually do pro-bono or consignment agreements. From what you have posted I do not see what was wrongful and they don't need to consult "risk management" in order to fire you. Even if you have never made a mistake before and are the epitomy of a stellar employee.....you made a mistake and they feel it was severe enough to terminate your employment, unfortunately it's their choice. I am curious as to what they felt was disorderly conduct.

I am sorry you are going through this and I wish you luck. And if you hired a lawyer....I'd stop posting on public boards.

In L&D we used IV phenergan all the time, good patent vein, highest port over 2 min.

In Kaiser it would take a whole lot more than a documented, reported, followed up medication error. We can't even be written up for med errors unless it is obvious neglect or intent. A reporting form is done that does not have your name on it and you may be given a QA questionairre to fill out (why did it happen, how could you prevent it in the future, etc.) They did this to get nurse to admit the mistake so we could fix it.

If you are so worried about getting fired then no one would admit the mistake. The OP didn't have to tell anyone about the mistake. Think about it, IV vs IM? With no witnesses? She didn't have to admit it, but she thought the process would protect her and it didn't. Shame on them.

I agree that it is total bull manure to fire a nurse over a 'simple' med error where no pt harm occured. However, it sounds as if the facility was within their rights to let the OP go. Perhaps since she new in the job, the NM saw this as an attempt to demonstrate her authority to the rest of the staff.

I almost hate to bring this up...what was the 'disorderly conduct' mentioned in the first post? Just wondering if this had something to with the NM's decision.

Exactly.A few years back hospitals began to take a less punative approach to med errors and to encourage voluntary disclosure in order to discover where and how in the process errors occur and educate staff to prevent them from recurring. Let's face it; if staff members see that the consequence for voluntary disclosure of a med error is threatened loss of livlihood, you do the math. Not to take med errors lightly but this has got to be a step backwards!

​i've been wondering about that, too. i wish the op would explain what is meant by "disorderly conduct".

Just culture will only work if we support its virtues. I don't think you should have been fired because it sounds like you followed up with appropriate actions. Why so harsh, other posters? Have you all never make an error?

yes, i've made errors. med errors, even. one of them was quite serious. anyone who tells you they've never made an error is either lying or too stupid to realize they've made one. the issue that i have -- and perhaps others will agree -- is that the op seems to take an attitude of "no harm, no foul" rather than being miserable about the possibility that he may have harmed a patient. if his manager saw him as being caviler about the med error, that may have been the reason for the termination.

the "disorderly conduct" concerns me, too.

Huh. Well, I admit I'm kinda surprised in that I really didn't think any facility was still using this med IV, considering the insane adverse effects. Even before the hospital I worked for at the time banned it from IV use, *I* got each and every order that I came across changed from IV to IM. I didn't want it on my plate if someone got seriously injured from it---and I'm happy to report the three or four times this came up (before the ban), every doctor changed that order once I told him/her why I wanted it changed. Just made good sense.