HELP med error on my first day as a solo RN

[cardiobaby]

Yesterday was my first day out of orientation at my first RN job. I graduated 7 months ago and had trouble finding a job untill i was offered this position as a casual nurse at a resthome. I was employed and given 4 days orientation with a buddy nurse. yesterday was my first day managing a wing of 24 residents on my own.....

the morning went pretty well and I felt on top of the work. I began my lunch time meds round. When I got to my 4th patient I noticed her blister pack for monday 12pm was not there.... there was one pill DILTIAZEM 30 mg. Then I thought, crap maybe I have pulled it out on the the trolley and given it to another patient instead. I was already behind on my meds run and carried on untill it was done. I then told the RN from the other side what had happened, she didnt seem too phased about it. I searched through the bin for a sign that it had been administered to another patient and I couldnt find it anywhere, with or without the pill. I narrowed down the patients I may have given it too to 2 and monitored them religiously for the rest of the afternoon.... there was no sign of a change of state with either of them.

The worst part about it all is that I was so busy and scared that I left without saying anything to the charge nurse, handing this information over or writing an incident! Its not that I was trying to cover my self up but I had no time, and I wasnt sure how to explain my self...

So to summerise: I have either lost a medication or administered it incorrectly to the wrong patient. The patient it was supposed to go to didnt get her antihypertensive for the day. the two patients that may have had it were ok when I left but im worried something has happened over night..... the other RN said its ok and just to monitor them in case, which I did But I am terrified of two things: 1) something adverse happening to any of the patients involved 2) being called and questioned about it by my colleagues.

Its my day off and I feel sooooo guilty about this all and I dont know what the right thing to do is. do I call the charge nurse and explain what happened, go in and write an incident report or do I wait and see what happens? ... some non-judgemental advice would be much appreciated :)

[I<3H2O, BSN, RN]

I would have immediately returned to the facility and filled out the incident report when I remembered. If that wasn't feasible, I would have at least called the charge nurse and reported it.

[xoemmylouox, ASN, RN]

I'm sorry that you do not want to hear judgement, but you may or may not have harmed an unknown number of patients. You may have given patients a medication they don't take (or worse may already take - double dosing them) and/or did not give a patient their daily dose of an important medication. I don't buy the whole "Its not that I was trying to cover my self up but I had no time". You make the time. I think you just want to hear reassurance that what you did was ok. You won't find that here because it isn'tok. We all make mistakes, but you own up and always put your patients first. I hope you learn from this.

[KRVRN, BSN, RN]

Report it. Remember this incident. Don't do it again. Learn.

You can't take it back. All you can do is learn from it and move on.

[CardiacKittyRN]

You need to report the incident immediately. It's honestly going to look worse on you now that time has already past and you left without filing an incident report. Mistakes do happen and no pt was harmed, but you still have an obligation to report it. This is something you make time for. Cardizem, the medication that got mixed up can also be used to treat arrhythmias as well as HTN so it's an important medication not to miss a dose of... I am a new grad too so I know how horrible & scared you must feel. In the future just take your time & be more careful.. Do the 5 rights EVERY TIME with EVERY patient.

[cardiobaby]

Thanks for the comments. I reported it to the cnm and i am going in to write a medication error form tomoro. The patients are fine aswell.

[Jillybean48]

Yes, everything they said plus this: It's always better for you to self report rather than someone to report you. Someone will always find out. It's one thing if you didn't realize you made an error and you left the facility. But you knowingly made an error. I know that the problem is that you really don't know exactly WHO the error was made on, but still there may have been at least two errors made. The patient that was supposed to receive the med may not have received it; therefore his/her vitals should be monitored since it is a cardio med. Then we have another possible error where someone else, but we don't know who, may have received this med. I would say in this case every patient on this hall should have their vitals monitored as it is a cardio med. It's always, always, always better to self report and to be honest... even if it means they escort you out that door. At least your patients will be safer and you will be able to sleep.

[Been there,done that, ASN, RN]

You discovered a missing med, period. You don't know if you gave it, didn't give it, gave it to the wrong resident.

Did you ever think it wasn't there in the first place??

You've blown this one pill waaaay out of proportion.

[nurseprnRN, BSN, RN]

You discovered a missing med, period. You don't know if you gave it, didn't give it, gave it to the wrong resident.

Did you ever think it wasn't there in the first place??

You've blown this one pill waaaay out of proportion.

That was my first thought exactly.

[BSNbeauty, BSN, RN]

I think you did blow this whole thing out of proportion too. The only thing I would have done different was to make sure the patient got her cardizem. You should of put in a missing dose request for pharmacy or let the doctor know that she didn't get her one dose of medication. I seriously doubt you medicated the wrong patient. Maybe the medication was just missing for whatever reason.