New nurse still on orientation and first med error?

[sleepdeprived1]

Let me just start off by saying im extremely cautious about giving meds and checking and double checking them because I dont want to make a med error but on my last shift a patient got up and requested her "warm pack" (that she already had in room)be warmed up and a cna working (who is also very new) warmed it for her i thought nothing of it and charted a nurses note on my patient including the note about the "warm pack" she received. My orientator read this and said does she have an order for a "warm pack"? when it dawned on me OMG:cry: u do need an MD order for heat. well the patient didnt have an order (huge lesson learned for me and the cna and no harm done to patient). my orientator helped me modify my note to remove the "warm pack" part. I said what if I didnt take it out of note?? she told me i would have been written up!! well im obviously terrified of that and especially any harm to be done to patient and feel like a honest person and always hear stories of risk management control in hospitals..and how they are there to not reprimand but try and prevent future errors so being an honest person I feel bad for leaving that out and im sure patient will be asking for another "warm pack" on next shift and say oh i got one last shift...ANYWAYS just want to know from other experienced nurses who maybe made an error like mine..do u really get written up if no harm done to patient and first type of error. hope this is my LAST error but just in case...

[Susie2310]

Esme, thank you for your reply. I am happy that we are both in agreement. I also really appreciated your kind words in regard to my husband. Yes, it was terrifying. We were very fortunate.

[dudette10, MSN, RN]

No one will lose their job over any of these, but they will have a write up in their file. (We tend to use med errors as a learning opportunity).

Where I work, there is a difference between a "write up" and an "incident report."

In the very few incident reports I have done, my narrative included a chronological explanation of events without names. If risk management wants to know "WHO DID THIS?" they should be smart enough to figure it out from other parts of the med record. I do it this way because incident reports should be nonpunitive, and it is intended to point out system errors. With the way I write incident reports, RM and the NM will have to do the work to make it punitive, if they so desire.

A write up is a reporting of another nurse's error with names/events and is punitive. If the write up of which you speak goes in the nurse's file, that's not an incident report at my facility, and it does nothing to point out system errors. Not sure how your facility does it.

ETA: Every time I've written an incident report, I've always told the nurse who was involved in the error, although the report itself never mentions the nurse, just as a heads-up. I would hate to be blind-sided by something, and I won't put a colleague in that position.

[dudette10, MSN, RN]

With tylenol, there are good reasons not to give without an order too; if a patient has renal failure or an infection (your example of sepsis) one would not want to jump in and give tylenol. My husband has had acute renal failure with sepsis: I am very glad a nurse didn't give him tylenol.

At the risk of sounding clueless, I have to ask why renal failure and sepsis would be a contraindication to Tylenol. I've been googling, and there are plenty of links to acute hepatic failure, but not acute renal failure. (There are some links suggesting--not proving--that long-term Tylenol use can be a contributing factor in chronic renal failure.) In addition, there are order sets for sepsis that include Tylenol as an analgesic choice.

[Susie2310]

At the risk of sounding clueless, I have to ask why renal failure and sepsis would be a contraindication to Tylenol. I've been googling, and there are plenty of links to acute hepatic failure, but not acute renal failure. (There are some links suggesting--not proving--that long-term Tylenol use can be a contributing factor in chronic renal failure.) In addition, there are order sets for sepsis that include Tylenol as an analgesic choice.

In my husband's case, sepsis led to acute renal failure. Acute renal failure means there is an abrupt decrease in blood flow to the kidneys. NSAIDS can slow blood flow to the kidneys (Mayo Clinic: Acute kidney failure). Another reference (Mackenzie Walser MD in his book Coping with Kidney Disease, mentions that NSAIDS including Tylenol have the potential to cause kidney failure). These are the main reasons I am glad my husband was not given Tylenol when he had sepsis and acute renal failure - his kidneys were failing; he didn't need a medication that could further compromise their function when they were already severely compromised. Since being discharged, his nephrologist has also told him to avoid Tylenol. These are my thoughts about my husband's illness. I cannot speak to there being order sets for sepsis that include Tylenol as an analgesic choice. I am just glad that for the reasons I gave above, that my husband was not given it, or any other NSAID. He needed antibiotics, and he needed fluid boluses, which he got.

[wooh, BSN, RN]

At the risk of sounding clueless, I have to ask why renal failure and sepsis would be a contraindication to Tylenol. I've been googling, and there are plenty of links to acute hepatic failure, but not acute renal failure. (There are some links suggesting--not proving--that long-term Tylenol use can be a contributing factor in chronic renal failure.) In addition, there are order sets for sepsis that include Tylenol as an analgesic choice.

Long term acetaminophen use is possibly contraindicated for renal patients, but from what I've seen, short term use doesn't seem to be an issue. (Of note, tylenol isn't an NSAID.)

[Susie2310]

Long term acetaminophen use is possibly contraindicated for renal patients, but from what I've seen, short term use doesn't seem to be an issue. (Of note, tylenol isn't an NSAID.)

You are correct, tylenol is not classed as an NSAID.