Medication error

RNKPCE · May 12, 2017

It can happen that orders will be inadvertently left on the MAR for IV medications when the patient no longer has an IV. Never assume that because they have no IV that it must be IM. Also not sure how long you've been a nurse but as a long time nurse I've never seen hydrazine given IM. As a matter of fact other than the flu or PNA vaccination I haven't given an IM shot of any sort my job in years. It all goes back to the 5 rights of drug administration.

For your meeting with the CNO, if you are a union hospital have a rep with you. If your record is otherwise clean hopefully admitting that you made the error and acting professionally will result in you keeping your job. Medication errors do happen and hospitals must investigate to assure this won't happen again. Medication error does not equal losing ones job.

Workitinurfava, BSN, RN · May 12, 2017

First of all you need to slow down. Yes things are time sensitive but not so much so that you make these types of errors. Ask for help from the charge if you are drowning. Get a second set of eyes involved in the situation to help alleviate your stress. Places of employment do want you to act quickly but most know that you have many things to juggle and will take a slight delay in getting things done over a med error that could potentially kill a patient. That med given IM (faster) cannot be controlled in terms of how quickly it acts on the patients BP whereas an IV (slower) medicine can. You can regulate the rate. One thing that concerns me here is you haven't mentioned your concern for that patient. If all works out for you, you can get another job but I hope that patient is okay. Start thinking more of the patients outcome when you give medications and that should help you practice nursing safer.

~Mi Vida Loca~RN, ASN, RN · May 12, 2017

Was there a reason this patient had no IV? Especially since it sounds like it was an admitted patient and like this was an acute care setting?

Every place is different so no one here is going to know what will happen or what will they will do.

I would strongly advise you though to have plan when you speak to them. Humble yourself and don't make excuses. Acknowledge what you did wrong and how you can prevent it from happening again. They want to see accountability.

So am I understanding correctly, you knew the medication was supposed to be given IV but you decided on your own to give it IM? It reads a bit confusing, so just asking for clarification.

Penelope_Pitstop, BSN, RN · May 13, 2017

Was there a reason this patient had no IV? Especially since it sounds like it was an admitted patient and like this was an acute care setting?

When I worked on a medical floor, most of my patients had IV access; however, one night I was pulled to another medical floor that consisted of the same patient population and that floor was big on removing IVs (reduction in infection potential, I think) unless necessary. It was standard hospital wide to remove IVs after 72 hours if there were no IV meds ordered and the patient didn't have a heart monitor and wasn't on seizure precautions.

~Mi Vida Loca~RN, ASN, RN · May 13, 2017

When I worked on a medical floor, most of my patients had IV access; however, one night I was pulled to another medical floor that consisted of the same patient population and that floor was big on removing IVs (reduction in infection potential, I think) unless necessary. It was standard hospital wide to remove IVs after 72 hours if there were no IV meds ordered and the patient didn't have a heart monitor and wasn't on seizure precautions.

Wow that seems crazy to me. In the OP especially since the patient was hypertensive and symptomatic and had IV meds ordered.

But in the case you're speaking of I am curious, if it was an acute care unit, what was the reasoning for the patients still being there if they no longer had a need for IV meds, heart monitors, and stuff. Why were they still in an acute care unit instead of like an observation unit or rehab unit?

I get accused of being a smart a** a lot, which I usually am, but I am not being here, I am genuinely curious because I have primarily worked in ER.

kaylee. · May 13, 2017

What kind of MAR do you use? Most should have the route on there. Alarm bells should go off in your head when you are unfamiliar with a drug. If you did for some reason think it was im, and you have never given said drug im, then you need to stop and consider.

One time i had an order for procrit, and we usually give im, but the mar said "iv". My alarm in my head made me stop to check since i had not pushed that med. turned out i clarified and the dialysis nurse does push that drug, but we dont, so it was meant for her.

The 5 rights should be cemented in ur head for the future, not just that u "know" the route, but that the route u are giving is the right one and why...

u will move on from this, but now u probably wont mess it up again. Mistakes are tools to keep us in line and train our brains to be aware of that thing in the future.

Penelope_Pitstop, BSN, RN · May 13, 2017

Wow that seems crazy to me. In the OP especially since the patient was hypertensive and symptomatic and had IV meds ordered.
But in the case you're speaking of I am curious, if it was an acute care unit, what was the reasoning for the patients still being there if they no longer had a need for IV meds, heart monitors, and stuff. Why were they still in an acute care unit instead of like an observation unit or rehab unit?
I get accused of being a smart a** a lot, which I usually am, but I am not being here, I am genuinely curious because I have primarily worked in ER.

I know you're not being a smart...aleck. Haha.

After a few days, not all diagnoses require IV meds. A lot of neuro patients, for example. (CVA/TIA, weakness, frequent falls). Also DVTs (they're being bridged from Lovenox to Coumadin and can't be discharged until labs are therapeutic). Asthma/COPD, ARF sometimes (just waiting for labs to correct), etc.

Granted, most of these folks are probably very close to discharge, but still in need of closer monitoring than in rehab, for example.

As for heart monitors, most patients admitted don't need them, or just need them for 24 hours or so. It always bothered me when RRT nurses would chastise floor nurses for "not knowing" a patient had experienced a rhythm change. Well, no, we don't have all them fancy monitors, we gotta use our eyes. (And yes, I was also an ICU nurse, I'm not downplaying the reasoning for all of the bells and whistles).

~Mi Vida Loca~RN, ASN, RN · May 14, 2017

I know you're not being a smart...aleck. Haha.
After a few days, not all diagnoses require IV meds. A lot of neuro patients, for example. (CVA/TIA, weakness, frequent falls). Also DVTs (they're being bridged from Lovenox to Coumadin and can't be discharged until labs are therapeutic). Asthma/COPD, ARF sometimes (just waiting for labs to correct), etc.
Granted, most of these folks are probably very close to discharge, but still in need of closer monitoring than in rehab, for example.
As for heart monitors, most patients admitted don't need them, or just need them for 24 hours or so. It always bothered me when RRT nurses would chastise floor nurses for "not knowing" a patient had experienced a rhythm change. Well, no, we don't have all them fancy monitors, we gotta use our eyes. (And yes, I was also an ICU nurse, I'm not downplaying the reasoning for all of the bells and whistles).

I know some units don't have heart monitors and why although it's still always so foreign to me because I am so used to almost everyone being on a 3 lead or 5 lead. I just have never heard of someone in a acute care unit (not about to be discharged maybe that day), not having access. I guess my brain is just always prepared for the patient to go south and being prepared.

I remember I went to give report once and the nurse was like "Does the patient have access" and I was like "Ummmm of course the patient has access, what kind of question is that. :sarcastic:" She said one of our nurses sent a patient the other day with no access. :| :| I made sure that didn't happen again.

I am glad you knew I was generally curious. I have been accused a lot lately of starting stuff when I am just genuinely interested in things. lol I am like, I am smart but I don't know everything. Good grief!

Munch · May 14, 2017

RKN definitely gave you the best piece of advice, have a rep with you. Its always best to have an advocate with experience in your corner, someone who knows how to navigate through these situations.

I know at times we all feel pressed for time. But something like verifying the order and putting in an IV something that would have taken 6 extra minutes to do..if that..and you could have avoided the situation. I know its too late to say I shouldn't have..hindsight is always 20/20.

Best of luck to you. Making mistakes is part of life...some are obviously more costly than others.

Penelope_Pitstop, BSN, RN · May 14, 2017

I know some units don't have heart monitors and why although it's still always so foreign to me because I am so used to almost everyone being on a 3 lead or 5 lead. I just have never heard of someone in a acute care unit (not about to be discharged maybe that day), not having access. I guess my brain is just always prepared for the patient to go south and being prepared.
I remember I went to give report once and the nurse was like "Does the patient have access" and I was like "Ummmm of course the patient has access, what kind of question is that. :sarcastic:" She said one of our nurses sent a patient the other day with no access. :| :| I made sure that didn't happen again.
I am glad you knew I was generally curious. I have been accused a lot lately of starting stuff when I am just genuinely interested in things. lol I am like, I am smart but I don't know everything. Good grief!

Well, these patients probably did have access when admitted. The thing is, if the IV site has expired (or the patient pulled it out) and there's no need for it, why stick him again?

~Mi Vida Loca~RN, ASN, RN · May 15, 2017

Well, these patients probably did have access when admitted. The thing is, if the IV site has expired (or the patient pulled it out) and there's no need for it, why stick him again?

Because I work in an area where I love placing IV's and I always have to be prepared for them to go south. LOL SO that's what makes sense to me.

I already know after working in ER for so long I don't know how I would adjust to every working on the floor again. I would be fired within a day. Would be like "Mi Vida, I saw you hung another bolus but I didn't see an order" "Ummm yea, they patient was hypotensive so I fixed them and told the doc and now they're good" "Yes I gave them Zofran, they were throwing up" etc. etc. I have just had way to much autonomy through the years it would be a very very hard adjustment.