Medication error

kittiesareus · Apr 15, 2005

Thank you all for your support, I really needed it. My next question is how do I apply for a new job having been fired from the last one for med errors? :confused:

nursemid02 · Apr 16, 2005

Thank you all for your support, I really needed it. My next question is how do I apply for a new job having been fired from the last one for med errors?

Be honest thats the only true thing you can do You have learned from you mistakes!!

laurakoko · Apr 16, 2005

I wanted to share this story of a medication error that happened last week in our facility....

This started with a 20+ year RN in L&D. She had a patient, 36 weeks preg with twins who began pre term labor. The order was for Brethine, a med used to control/stop contractions. When taking the medication from the machine, Brethine and Methergine ( a med used to CONTRACT the uterus), packagings were IDENTICAL. Both in a brown plastic box thing, and the vials, same in color. She gave the Methergine, instead of Brethine. Not once, not twice, but THREE times. A terrible mistake. Needless to say, when the labor did not stop, and the woman delivered, the nurse, and another nurse caught the mistake by taking the packages out of the trash. The twins ended up being fine after being in NICU for a while, and are doing well now, but it could have been much different. We are all human, we aren't perfect, we make mistakes. However, in our line of work, it is so important to check, recheck, recheck, and recheck. Giving medications is the MOST important task we can assume as nurses. Work days are stressful, busy, and nonstop. But in passing meds it is so important to be SLOW, TAKE TIME, and DON'T MAKE MISTAKES. Pretty much, besides patients coding, EVERYTHING else can wait until the meds are given right.

Oh, and PS. I am DEFINATLEY NOT perfect....and just knowing that can help me not make med errors. Thanks.

Charlotte M. Davis · Apr 21, 2005

I have been in the field for 40 years with 22 as a RN. We ALL make mistakes. Those who say they do not make mistakes are the ones I worry about as a nurse manager. I was told 40 years ago that for every medication error you catch that there is one you do not catch.

First, you recognized that you made mistakes. That is the first step in your personal growth as a nurse and an employee in any facility.

The second step is to own up to the mistake and be sure there is no harm done. That involves notifying the MD (hardest part for me and enough "punishment") and providing correction as ordered by the physician. I gave wrong meds as a new nurse in a job in LTC and had to call the MD at 5:30 AM. As a 20+ year nurse, I nearly gave meds to wrong resident in a new job (outdated pictures in MAR) - resident refused the meds and I verified with CNAs who she really was.

Learning from those mistakes is the third step. Medication errors, unless they result in the death of the resident, are SUPPOSE to be an educational tool not a disciplinary tool. Chances are that if you made that mistake then another nurse, especially new to the facility, has or will make the same mistake. The administration should look at these errors and discover where the problem is in the process. They should fix the process. Maybe the shift time is not highlighted, pictures missing OR not updated from the MAR (no armbands in LTC or Assisted Living), medication times incorrectly listed, or not unit dose which decreases errors. As a new person at a facility, I always double check with the staff on who is who as well as compare pictures.

I see several problems that relate to the internship. ANY student or graduate nurse should be operating under the license of a nurse in the facility. It is THAT nurse who is responsible not you for the medication errors. It sounds like that LTC facility was looking for a scapegoat OR they just wanted you there for the internship (?? cheaper or free labor). I have NEVER fired a nurse for medication errors in 15 years as a supervisor! I always turn them into learning opportunities.

To correct the problem and find another job, I would do the following. Take a medication refresher class, even though you just graduated, either in a classroom setting or online. Learn about the common medications given in LTC including times and dosages. When you interview for a job, do not offer the reason for leaving the other facility unless asked directly in the interview or on the application. The labor laws in many states say that they CANNOT ask why they left a previous job.

If they ask for that information in an interview, explain the situation plainly and with as little emotion as you can muster. "While working there as an student nurse intern, I passed medications without direct supervision of a nurse. I had two medication errors. I have learned from those errors. I was able to graduate as a nurse and obtain my license to practice. I have taken a medication refresher course and developed a plan to avoid those errors in the future". Then outline your plan: Check, check, check, check,and check again; take my time with reading the MAR and medication; if interrupted while pouring meds - start over from the beginning with that medication on your check; take the MAR with the picture to the resident when giving the medication; use other staff to verify correct resident as well as the MAR; explain what the medication is (even if they may not totally understand); and monitor the residents for effectiveness and side effects. Recognize for yourself and future employers that you will be slower at first until you become familiar with the residents.

BACK UP your verbal statement with a written letter outlining the situation and your plan of correction to be included with your application if asked on it or in the interview.

Good Luck, Charlotte

lildk77 · Apr 23, 2005

How seriouse is a med error that involves signing out on a med that hasnt been gave yet???????? Need to know for a friend.

stevierae · Apr 23, 2005

I wanted to share this story of a medication error that happened last week in our facility....
This started with a 20+ year RN in L&D. She had a patient, 36 weeks preg with twins who began pre term labor. The order was for Brethine, a med used to control/stop contractions. When taking the medication from the machine, Brethine and Methergine ( a med used to CONTRACT the uterus), packagings were IDENTICAL. Both in a brown plastic box thing, and the vials, same in color. She gave the Methergine, instead of Brethine. Not once, not twice, but THREE times. A terrible mistake. Needless to say, when the labor did not stop, and the woman delivered, the nurse, and another nurse caught the mistake by taking the packages out of the trash. The twins ended up being fine after being in NICU for a while, and are doing well now, but it could have been much different. We are all human, we aren't perfect, we make mistakes. However, in our line of work, it is so important to check, recheck, recheck, and recheck. Giving medications is the MOST important task we can assume as nurses. Work days are stressful, busy, and nonstop. But in passing meds it is so important to be SLOW, TAKE TIME, and DON'T MAKE MISTAKES. Pretty much, besides patients coding, EVERYTHING else can wait until the meds are given right.
Oh, and PS. I am DEFINATLEY NOT perfect....and just knowing that can help me not make med errors. Thanks.

There is SOMETHING wrong with this scenario. First off, an RN with 20+ years experience in Labor and Delivery--or even an RN with a YEAR'S experience in Labor and Delvery----would be cognizant of the fact that these are 2 diametrically different medications--very different actions---and would be, or should be, exceptionally cautious when attempting to stop a premature labor, and, ultimately, delivery.

I don't CARE if the packaging is identical--you READ the label. You understand the ACTIONS of the drug you are giving.

Methergine, except under very exceptional circumstances, is meant to be given ONLY IM. In fact, in the operating room, we inject it DIRECTLY into the uterus, which is muscle, to clamp down and stop unwanted bleeding immediately. Also, wherever I have worked, for the past 30 years, Methergine was REFRIGERATED. Terbutaline is not.

Did she give the Methergine IV? Did she give it sub-q, as Brethine (Terbutaline) is supposed to be given? I am betting she gave it via the incorrect route--- Another unnecessary error.

Inexcusable, in my opinion--and she did it 3 times? How could anyone consider that acceptable? Was the family informed of the repeated error, as is their right---or was it kept from them?

None of us is perfect--but this is sloppy, careless nursing. I think that this nurse should consider early retirement before she kills someone. I wonder how many times she has made the same error before--and simply covered it up?

Assess, reassess, intervene, keep the doctor informed of changes in the patient's condition. Surely this patient's contactions were VERY intense. Surely this nurse assessed her for PAIN on a scale of one to ten--or DID she--and how did she intervene? Or did she? Did anyone LISTEN to the patient? Where was the OB all this time? No meconium; no fetal distress; no PROM? Was she on a fetal monitor? No decels? Did the patient end up having an emergency C-section due to fetal distress? I am surprised her uterus didn't rupture.

So both meds come in a brown vial--so what? I think Lasix comes in a brown vial, for that matter--many IV meds do. What's next; someone confuses Nipride and Dopamine and hangs the one that was not indicated--and kills a patient--because "Both came in clear vials, and I didn't take a second to read what I was giving...but it was an honest mistake?" Please. I am ashamed, and frightened, if this is any indication as to the future of nursing common sense, responsibility, critical thinking, accountability, and advocacy.

All that said, apparently this has happened in other facilities----several times. That shows that there is more than one person out there who doesn't bother to read labels; simply looks at what she assumes is familiar, color-coded packaging. Here's a link to read about it, and a warning:

http://www.ismp.org/MSAarticles/brethine.htm

Bottom line; READ THE LABEL--several times, if you need to--and understand the action fo the drug you are giving. Don't we double check meds in their generic white or amber bottles, with similar labels, at home, before dispensing them to ourselves or our family members? Why do our patients deserve any less?

GLORIAmunchkin72 · Apr 23, 2005

"TECHNICALLY" speaking we are supposed to sign for the med right after we administer. But in reality not everyone follows all the rules to a T. I tend to have the opposite problem. I say, if you sign for it, try to give it as soon as possible.:)

How seriouse is a med error that involves signing out on a med that hasnt been gave yet???????? Need to know for a friend.

orpassion · Apr 24, 2005

Composure is a constant demand for nurses. Being efficient in tasks, being sympathetic and attentive can take all of one's focus. Take a deep breathe, and focus on "you" as you do certain actions; then switch and focus back entirely on the patient when you have completed your action. I find this helps avoid errors.

The fact that you care so very much, I think you will improve. Composure; and focus on you and your actions.

best of luck from this O.R. nurse

Kittiesareus,
Compose yourself and strive to do better. The fact that you are a student means that you in the learning process and have not achieved perfection (yet). Nurses, doctors, pharmacists, they all make mistakes. Not once, not twice, not thrice, in the course of their careers whether or not they 'fess up to them. So cheer up!:)

pwp1289 · Apr 24, 2005

we are totally using bar code administration for all meds--po iv and iv p/b--will tell you "invalid med/has already been given " you have to "zap" each pill bubble if dosage requires more than one, and it even tell you when you are past admin time--(you have to give a reason) and it will also tell you if the time span between admin times is too short !!!! didn't klike system when we started but now think it is terrific--i know it has kept me from making errors with meds !!

qje999 · Apr 30, 2005

This is terribly embarressing and I am so ashamed to have made such stupid mistakes. I am a nursing student about to graduate and "was" working in a long term care facility under an internship. I have worked there for 3 months. today I gave the wrong person someone else's meds, and they were extensive. However this was not the first time awhile back I misread the time on the mar and gave someone their coumadin twice. Pretty dumb huh? My question is, am I just to dumb to be a nurse? This is the ONLY thing I have ever wanted to do in my life, be a nurse. How could I have made such stupid errors and to get fired right before I graduate. I need advice on how to improve myself and how I will ever work again.

everyone makes mistakes. you have to read things carefully, but i don't think there is a nurse that exists that hasn't made a error in the meds.I myself gave someone , another persons meds, and took it so hard, but we are not perfect. we try to do our best, but it happens. this patient was ok, and not harmed by it, but i felt awlful for weeks. They didn't let you graduate? What will you do now? is there any way you can speak to the person who was involved with the firing, and maybe they can give you some advice to help you. good luck.

pooh54 · Apr 30, 2005

What are you talking about? All nursing students give meds.... I was giving IV meds second semester of my first year. I gave PO meds the second DAY of nursing school......Did you have an opportunity to give meds as a student? If not, I wonder where you went to school.......

"I wonder where you went to school?" Every state has regulations regading nursing students and what they can or cannot do. In ny state, we could pass po meds but weren't even allowed to do a heparin flush on a hep lock!

Been there, done that!

We all make mistakes and we are the one's that punish ourselves the hardest when we do. Accepting that and learning from our mistakes help us in our practice. It makes us better nurses. Hugs to you and keep going, you'll make an excellent nurse.

jude11142 · May 4, 2005

I think that every nurse has at one time or another has made a med error. The main thing is to learn from it. You realized how serious of an error you made, so now you need to learn from it. When I first started working in a long-term facility, I was petrified of the med pass. But, I got over that fear and became more focused and confident as time went on. You need to stay focused during your med pass and try to concentrate only on that. I don't know if you are getting distracted or if you are feeling rushed?? Like others have said, "Check, double check and check again"!!!

Don't let this experience kill your dream of nursing. Next job, make sure that you get a good orientation. I would make that one of my priorities when job searching.

Never hide the fact that you made an error. I am always very leary working with a nurse who says, "I never made a mistake" or one that is always finished with her med pass when it takes everyone else 2-3hrs or with somebody who "knows it all"...............Admitting that you made an error is not something any of likes to do but.............it's the right thing to do and it is how we learn. So try not to look at it as a mistake but as a learning experience.

Hang in there,

JUDE