Stupid mistakes

[New picu]

Hello all,

I've been a nurse for about three years but have recently moved from rural setting to a big city PICU. Last night, at the end of a long night shift I made a mistake that took all of my confidence away and has made me dread going to work.

My patient was a fresh post op retroperitoneal tumour removal who had blood pressure issues during the procedure. I'm still orientating to the unit, but each nurse I've been buddies with has allowed me different levels of responsibility over the patients. It was fifteen minutes after our shift ended and the nurse that I was buddied with was giving the oncoming shift report while I did some last minute things in the room. The patient had been fairly awake most of the night, intubated, and having a lot of anxiety over the tube. Her heart and respiratory rate spiked to extreme tachy and she was at her most anxious - just wanting that tube gone. The M.D came in to see her while I was I there trying to calm her down and rhymed off a bunch of orders to me, including 'get me 50 of midazolam.'

I'm not going to lie, I was pretty panicked because of my patient condition and this being a completely new setting to me. I didn't clue in that what she wanted was a dose of 50mcg/kg. I think it was the combination of not being used to working with those types of dosing because most of my experience is adults and the situation, but I went and Drew up 50mg of midazolam in a syringe. I should have clarified, but with the pressure I just went and did it. I gave it to the nurse I was buddied with to have it double checked, and when she asked 'so you want 50mcg/kg instead of her ordered 25?' then when she looked at what I had in the syringe and looked back at me very worried, I realized what I had done. The M.D was right there as well. I felt like I was going to throw up. I quickly fixed my mistake and the patient got the right dose, after another double check. I tried to brush it off because I don't want my co workers loose confidence in me when I am this new, but I feel so stupid now. I know that no harm came to the patient, but i still can't get over that I did something that... Well stupid. I'm absolutely dreading going back to the unit.

[Ruby Vee, BSN]

We all make mistakes. Thank goodness you checked with your preceptor! Just remember, the next time there's a mistake made, it might be the preceptor making it, so stay vigilent!

[ICURN3020]

Never, ever be afraid to ask a physician for clarification. I've had to ask certain ones to repeat themselves two or three times before.....it's often with a physician with a strong accent or a mumbling, half asleep one, and sometimes they get huffy and even spell out the name of the medication, etc.

They can get upset all they want....I will continue to ask them to repeat themselves until I have clearly understood them and then I always read back their order to them....just to be sure.

It's better than having to hang up and call them right back as you try to decipher in your head what they said/meant and realize you don't know for sure.

And it's definitely better than causing serious harm or death to someone, in addition to ruining my own career/life/mental sanity.

[calivianya, BSN, RN]

I don't work with peds and I never have before, so I have a lot of sympathy! If the MD tells me to grab a certain amount of something, I usually just grab it. I'm not used to having to double-check for weight, either. It's a whole different world in peds.

The advice about something just looking like "too much medicine" is a good one. I have caught myself before I finished pulling a med by this principle. By this point, I'm sure you have good instincts, so take a close look at what you're doing. If it looks wrong, it probably is.

Good luck in getting your confidence back. In all honesty, your coworkers may gossip about it for a bit before it dies down (I know mine do when they catch someone make a big mistake), but they will forget about what happened eventually. You just have to prove you're safe from here on out. Go back in with a smile on your face and some confidence, even if it's just an act at first. If you act like this has destroyed you, they will believe that it has and you will never get their trust back.

[canoehead, BSN, RN]

If you are using three or more vials, get someone to double check.

Repeat back any verbal orders the doc gives. Then they know you heard correctly and you're on it, and you get clarification.

[toomuchbaloney]

You are okay.

Take a deep breath.

The MD was standing in the PICU and determined that the best and safest way to obtain a medication was to give you a verbal order??? That is the first error right there, the MD should have written the order in the chart so that you could complete it.

The physician opted to give you an incomplete verbal order apparently expecting that you would "fill in the blanks" of the prescription? That is error number two.

You didn't ask for clarification, you panicked and tried to please the doc...error number three. You then corrected this error by KNOWING that you DIDN"T KNOW if the dosage was correct and paying attention.

Had errors number one and number two not occurred you would have been fine and wouldn't feel so guilty and shell shocked.

How/where the heck did you get 50mg of midazolam?