fellow nurse, small error...what to do?

Nurses Safety

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Today at work, i was assessing a pt's skin and noticed an approx 3-4cm bruise with raised, palpable hematoma at her deltoid. I asked, "what happened here?" and she said, "the other nurse gave me that really painful shot for my diarrhea right there." This pt is on SQ, SUBQ!!! sandostatitin for a high-output fistula q8h. From what I inferred, the "other nurse" had given this med IM. It is very clearly, and has always been, ordered as a subq medication (and is never given IM, as far as I know). If I assume correctly, and I recognize that assuming is a bad thing, this is a med error--WRONG ROUTE.

My dilemma is this: Should I address this with my fellow RN directly, or write up a med error report that will involve the DON and powers-that-be and become part of the pt's medical record? I am sure this caused minimal harm to the pt and hopefully the hematoma will resolve without complication. The pt also, technically, received this medication, although the absorption may be different... arghhh. The nurse is very sweet and I don't doubt her safety, in general. I also don't want to bring it up to other nurses on the floor for fear of being gossippy or undermining...

Any suggestions would be appreciated.

Specializes in ER.

Granted the deltoid area is a not the first choice or a place I think of for a SQ, I always go to the underside of the upper arm with a SQ, unless it's ordered abdominal, etc. If the patient is large or has fleshy arms it's very possible to give a SQ injection in the deltoid area. What injection would be for diarrhea? That's a new one on me.

I would ask the nurse who gave the injection if she had seen the area it left and let her take it from there. If she does absolutely nothing then tell the nurse manager. You do have to CYA when all is said and done.

Specializes in LTC Pharmacy.

Why not go to the nurse first, give her the opportunity to tell her side of the story, then go from there? It's entirely possible she doesn't realize she did something wrong, and you could use this opportunity for a little education among peers.

Going to her also gives her the opportunity to do the right thing. While you're talking to her, you could stress that in situations where a med error is made, you write a report and document document document to cover your ass and the facility as well.

This could be a valuable learning experience for all concerned.

Specializes in CTICU.

I might play dumb, and ask for her advice in giving the med to see what she says. If she says IM, I'd taken it further.

Document the presence of the bruise in your assessment. You didn't see how the injury happened and you didn't cause it so what is there to report? The documentation acts as a flag for the provider to reassess the area. There are enough questions here that I would not feel comfortable making an allegation or a report as you did not see the mechanism of injury. Documentation covers you because you have noted what happened. Tweety is right to make sure that you have covered your butt.

Specializes in MSP, Informatics.
Deltoid isn't the usual site for a SQ injection. I think the med WAS probably given IM.

but it can be a site for a SQ injection, and a SQ can leave a mark. If this is someone you have to work with, don't jump to conclusions.

Area the Deltoid or Upper Outer aspect of the Arm : Have the person's elbow flexed and the forearm supported. Locate the lower edge of the acromium process. Estimate a point opposite the axilla. Visualize an inverted triangle with the base at the acromium process and the apex just below the axilla. This defines the deltoid muscle. The area over the deltoid or the upper outer aspect of the arm may be used for subcutaneous injection.

rightinjectarm.jpg

Specializes in Family Nurse Practitioner.
Today at work, i was assessing a pt's skin and noticed an approx 3-4cm bruise with raised, palpable hematoma at her deltoid. I asked, "what happened here?" and she said, "the other nurse gave me that really painful shot for my diarrhea right there." This pt is on SQ, SUBQ!!! sandostatitin for a high-output fistula q8h. From what I inferred, the "other nurse" had given this med IM. It is very clearly, and has always been, ordered as a subq medication (and is never given IM, as far as I know). If I assume correctly, and I recognize that assuming is a bad thing, this is a med error--WRONG ROUTE.

My dilemma is this: Should I address this with my fellow RN directly, or write up a med error report that will involve the DON and powers-that-be and become part of the pt's medical record? I am sure this caused minimal harm to the pt and hopefully the hematoma will resolve without complication. The pt also, technically, received this medication, although the absorption may be different... arghhh. The nurse is very sweet and I don't doubt her safety, in general. I also don't want to bring it up to other nurses on the floor for fear of being gossippy or undermining...

Any suggestions would be appreciated.

Wow, Arghh... hadnt heard that since popeye.

How often do you write something up without having

any information about things. I am curious ?

How often have you "assumed"

Sometimes it is bad to ass U me when you obviously

admit to not having all the information.

Why would you even bring it up with other nurses ?

Are you that cutthrought of a person ? The mere fact that your posting

in here about this indicates otherwise

Yea go ahead and tell your supervisor

see how long your job lasts, it is a fairly

trivial point.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Yea go ahead and tell your supervisor

see how long your job lasts, it is a fairly

trivial point.

Giving a medication the wrong route is someone missing one of the five (or is it now 8??) rights and not necessarily trivial.

I agree however like most people are saying it's important to ask the person exactly what happened. One can probably keep it between the nurses and away from management. But one shouldn't ignore it either.

Specializes in Telemetry & Obs.

I give myself SQ injections all the time (insulin dependent diabetic) and sometimes those suckers leave huge bruises. I've also given SQ injections in the fatty tissue over the deltoid which is an acceptable location.

I would document the bruise which is all the "proof" you have without an admission from the administering nurse that she indeed gave the med IM.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

I actually have gotten a bruise from the subdermal tb shot.

Specializes in ER.
I actually have gotten a bruise from the subdermal tb shot.

Me too! But you do mean a subdermal TB skin test?

Most bruises I have seen from injections were subqs. Not too many hematomas from IMs.

Specializes in Corrections Health Care, OB-Gyn, Psych,.

good grief...i'm sure glad i don't work with nurses that report every little thing to the nurse managers. we have lots of agency nurses with different skill levels working with us. as an older, more experienced nurse, i would talk to the nurse who gave the questionable injection and teach the proper method and area for the sub-q to be given. without condemnation or condenscension, i would ensure that if the injection were improperly given, the error wouldn't be repeated. i would then keep the issue between myself and the other nurse. too often, we work with emotionally needy individuals who thrive on tattling and creating workplace stress in an already stressful occupation. of course, there are always situations that demand attention from managers to prevent recurrence or patient harm. use some mature problem solving skills and become a mentor rather than a tormentor. if you're a less experienced nurse and feel you might be challenging an older nurse's practice, tell him or her that you aren't sure where or how this injection should be given. allow them to explain to you how they give this injection then initiate a discussion about best practices. this is less threatening and leads to better relationships with your peers then, in turn, leads to more open communication among team members. it doesn't take long for someone to be tagged as a "tattler" which then leads to isolation and even possibly retaliation. (remember, you aren't perfect either so imagine having your every little oversight addressed in a verbal reprimand by your nurse manager) of course, it should go without saying that if careless or unsafe practice continues beyond one incident, it becomes a nurse manager's issue.

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