I can't believe that I made such a stupid mistake and am kicking myself!!!

annlewis · Sep 18, 2012

HippyDippyLPN said:
bottom line is the patient is FINE so chalk this up to something you will never do again! I made a med error while discharing a pt in LTC my first 6 months as a nurse. Having 30 plus patients, an admission, and a discharge I was way over stretched. Thankfully the pt was fine but he did have to go to the ER to be checked out afterwards. My DON brought me in, told me my mistake, and let me cry and feel awful and then told me now is your time to get it together either you learn from this or you sink. I learned from it, made my own organized system to keep me on track which I still use even though I work in a clinic now. I have never made an error med since that incident almost 3 years later. Its good that you are feeling sorry, it means you care and are a good nurse! But DONT let this ruin your confidence. This incident will make you double check everything from now on which will prevent you from making actual major mistakes.

Hi there, could you share your system, I would love to not make any more med errors, mine have been minor but scared someday could be major.

redshott · Sep 18, 2012

i'm currently a phlebotomist and have done that same thing before... a nurse caught it and same thing- there was no damage or anything to the patient but boy do i check and recheck for the tourniquet before i leave the room! i was working overnight shifts when i did it and tried to only turn on the lights i needed- was a learning experience. but thats how we grow as healthcare professionals/nurses - don't give up!

silverbat · Sep 18, 2012

OK!! This nurse should have let the oncoming nurse know the pr was on the bedpan, HOWEVER it is inexcuseable that the ENTIRE next shift NEVER checked the pt or they would have discovered the bed pan. Yes the nurse should have been in trouble, but so should the entire next shift!!!! ARGHHHHHH!!!

Sorry, this just burned my biscuits!!!!

hurty25 · Sep 18, 2012

...the fact that we are not perfect,we make a lot of mistakes.But don't let mistakes undermine you instead learned from it...you're not the only one did a wrong act and made an incident report maybe others made a worst act than yours..

Nurse2b7337 · Sep 18, 2012

Awww...don't beat yourself up! As some of the other posters stated you've shown that you're an awesome nurse by bringing this out for all to see! If you don't make mistakes how can you learn from them? The patient was alright so that's what matters. I think it was courageous of you to bring it up to the intern also. Someone else may have covered it up and not said anything!! Kudos to you, your career looks very bright; don't give up keep on going!!

nurseprnRN, BSN, RN · Sep 18, 2012

For what it's worth, a tourniquet should never be so tight that it occludes arterial blood flow (check before you proceed, just palpate the pulse further south)-- it's only meant to occlude the superficial veins, because that's what you're looking to stick. Your patient also has deeper veins, so he did have venous drainage from his arm, and you couldn't have put it on so tight as to occlude his artery. So, no real harm done, and now you learned something.

RN Chaos · Sep 18, 2012

Hi iluvivt

Thank you very much for your good words. I have a question if you dont' mind. How many days did it take to develop compartment syndrome??? Was patient okay at the beginning and developed the syndrome later??? When I called my unit, it was about past 12 hours, and he had all good signs, such as a strong wrist pulse, able to squeeze his hand, positive capillary refill less than 3 seconds, and natural skin color when I checked the patient with intern and charge nurse.

Can they develop compartment syndrome far later days????? I'm so worried now...

RN Chaos · Sep 18, 2012

Hello everone,

I'm just so grateful for everyone's warm advices, support, and help. I will do my best to be a better nurse and forgive myself. I'm still bit angry with myself and worry about my patient. I'm going back today and will check on him for sure.

Anyways, it is always great that there are such many compassionate nurses out there trying to help each other. I wish I could be such a nurse someday!!!

God bless all of you.

Tinabeanrn · Sep 19, 2012

God bless you too honey. It so honorable how you wear your heart on your sleeve and you are so humble. You dont always find that in this field. That patient is FINE :). Dont you worry. Its a life lesson. Gotta do me a favor though, gotta be all done with beating yourself up over that one. It was an honest mistake, and I think we have all done it. I have done it and the PCT said, Um Tina, are you forgetting something? I felt bad for about 2 seconds. But I have been a nurse for a while and I have learned to forgive myself right away, lol. When I was a new nurse I could not sleep from constantly thinking of what I did or should have done or may have missed. I have learned the hard way that I am not perfect. But I do strive for perfection with the idea that I will make mistakes along the way. Guess that's why we are human :). Take the advice and put it over their gown from now on. And when you precept, teach your orientee the same thing.

struggling rn · Sep 19, 2012

Thanks for all the comments. i am a nurse who started working recently. when ever i do a mistake i feel so restless and worried. i donot sleep properly thinking that i may not be a good nurse or not suitable to nursing. i will go to work nextday with lack of confidence and my mind preoccupied with mistake i did. i keep thinking about that until i do a next mistake and feel terribly stressed. i feel so terrible even for something silly. but im determined to become an excellent nurse in my future. praying to God to make me strong.

iluvivt, BSN, RN · Sep 19, 2012

No worries on the compartment syndrome based upon what you have said..the ones I have seen related to IV mishaps have developed fairly rapidly. If they are large and worsening and symptomatic they are taken to surgery immediately for decompression. I have even seen some develop from trapped blood in the tissue after an IV start. The patient was very anticoagulated and even though the IV was in the vein it was still leaking at the insertion site or on the posterior vein wall had been punctured on insertion. I have seen several develop after massive IV infiltrates and these are usually from ACF sites. ACF sites can be very difficult to detect infiltrations on. I have seen one happen b/c they did not monitor the IV site under the surgical drape. That one was horrid and we had to get an MD in that measured the tissue pressure with a special tool. The key is to monitor carefully and report any changes in condition to the MD.

I recently saw a patient with rhabdoomyolysis of both arms and developed an immediate compartment syndrome that worsened within 24 hrs and had to be take to surgery for ulnar nerve decompression. Get them to surgery fast and most are just fine.

All is OK...you did what was right...I am still learning even after 30 years as a nurse and making changes in my practice to perform better...

nurseprnRN, BSN, RN · Sep 19, 2012

"Thank you very much for your good words. I have a question if you dont' mind. How many days did it take to develop compartment syndrome??? Was patient okay at the beginning and developed the syndrome later??? When I called my unit, it was about past 12 hours, and he had all good signs, such as a strong wrist pulse, able to squeeze his hand, positive capillary refill less than 3 seconds, and natural skin color when I checked the patient with intern and charge nurse.Can they develop compartment syndrome far later days????? I'm so worried now..."

Let's review the cause and pathophysiology of compartment syndrome. This refers to a specific compartment, the muscle that is enclosed in a very tough membrane-- you've seen it if you've boned a chicken or cut up an uncooked roast for stew meat. In compartment syndrome the tissue inside that membrane swells up, making the pressure inside it skyrocket. This, in turn, prevents arterial blood flow from entering the space, and the muscle necroses. (The crush injury is what produces the myoglobinemia as the necrosed/damaged cells release their contents in to the bloodstream.) The swelling also impinges upon nerves in the area, resulting in paralysis related to ischemic nerve damage.

All of this is agonizingly painful and develops quickly. Cause is most often related to injury-- a crush injury that produces swelling, for example, but can also be from toxic substances or a primary ischemic event bad enough to cause rhabdomyolysis (lysis of the skeletal muscle cells). You can also see something a lot like it if there is swelling inside a cast, which acts like that tough membrane for purposes of preventing arterial flow and resulting in necrosis. To have so much swelling that the skin itself acted like the membrane or a cast would take an astonishingly huge infiltration...and certainly would not occur from leaving a venous tourniquet on for an hour and a half, or at all.

Diagnosing or ruling out suspected compartment syndrome is done by sticking a needle into the affected muscle and reading the pressure inside it with a little gadget. Every ER or ICU has one; before someone invented the gadget, we used to just set up a needle and a water manometer. Wish I'd invented that gadget.

Treatment is to open the compartment surgically and leave it open until the swelling goes down (and to pray for no necrosis). These people have, thus, long open incisions in their (usually) legs, gaping and open to the muscle itself. You want to take really good care of those to prevent infection.

So. Let's see what we have here with your patient. We have a period of decreased (but not completely occluded) venous drainage, no arterial occlusion, no ischemia, no compartment trauma or swelling, and no loss of function. No worries about compartment syndrome.