Accused of making a medication error

**canoehead, BSN, RN** · Dec 8, 2017

Do you not sign the med bag when you hang it? We do, and it would answer your question.

I'm disgusted that they accuse you of this, but don't tell you what patient so you can go review the chart. You are entitled to investigate the situation to defend yourself. Like you said, it may have been hanging from a previous nurse (hell, maybe from a previous patient!). Did they look to see what the Pyxis says? Can you make yourself a printout of all the meds you removed that night?

ONCRN2017 · Dec 8, 2017

Thanks for your reply! No unfortantely we do not sign meds. Just IV fluids and tubing we sign.

And that is smart about Pyxis. I wouldn't know how to go about doing that and everytime I seemed to ask questions regarding the situation it was brushed off as it's fine it's not a big deal but to me and for me it is. My confidence is already at a low because I'm a new grad I don't need something else knocking me down farther if it isn't true.

But yes they had no idea even room numbers. I had a good idea based on what I remember from the patient who would have probably received that medication but she was already discharged and I'm not sure if I would have remembered her name to look. So without managements help I'm pretty helpless in ever finding out.

ONCRN2017 · Dec 8, 2017

Another reason I strongly feel I didn't do it is because we just got new IV pumps that we scan and are connected to the MAR. If the medicine was overrides I would have had to program this medicine by hand opposed to the pump automatically putting in my rate and such which means I would have been more likely to remmeber specifically hanging the med and putting in the information since that's different then what in use too. But I did not have this happen. So frustrating.

TriciaJ, RN · Dec 8, 2017

If this was me I would approach the shift lead who pulled you aside and say "For the record, I did not hang any Diflucan that evening. If anyone has reason to think it was me, they need to show me why they think that. Otherwise, I'm not owning this one."

Then you continue to do your job with your head held high. Somehow, it makes me think they know who did this but are covering for that person. The whole thing just smells off.

ONCRN2017 · Dec 8, 2017

Honestly I kind of want to agree. Because I know who the day shift nurse was before me that night. She had 3 discharges and two admissions and I know she was super busy and saw that management/ charge nurses had given a couple of her medications when I was looking at past meds given (such as pain medication and such). But then I feel like if that's the case and they didn't want to get them in trouble then why even bring it up to me. I mean I can see wanting to protect someone but to shift blame on someone else instead is kinda crazy.

ONCRN2017 · Dec 8, 2017

Also regardless if the patient was harmed I would asssume it would be illegal to not fill out an incident report. Can they do one on my behalf? Or would I be required to sign off on it or report it. I feel like I should be filling out my own report that way I can say why it happened in which I would never do without seeing the proof I did it. But maybe they can fill it out for me? Idk

JKL33 · Dec 8, 2017

Also regardless if the patient was harmed I would asssume it would be illegal to not fill out an incident report. Can they do one on my behalf? Or would I be required to sign off on it or report it. I feel like I should be filling out my own report that way I can say why it happened in which I would never do without seeing the proof I did it. But maybe they can fill it out for me? Idk

Yes, if a nurse finds an error, s/he could fill out an incident report. I suspect they didn't fill one out, though, just by the way it sounds like this went down.

I'm sorry you're still awake, BTW! :)

I think you need to revisit this with your manager. It is not okay. And you have the opportunity to set a precedent with regard to how you expect to be treated during your course of employment. Ask for a meeting at his/her convenience. During meeting, state that you're having a hard time with how this went down and you need some details. Ask manager to run the Activity Report for your username on that date. If they balk, say, "I care about doing my best. If a mistake has been made I need to review it carefully in order to know how to prevent anything similar in the future."

"I do suspect there's a possibility that this accusation has been made in error, and if that's the case I deserve to know that."

If manager tells you not to worry about it, I would find out if there has been an incident report filed and especially whether this is (or will) be noted in your employee file.

What to do next depends on what happens with all of this ^

Be pleasantly assertive (not aggressive). Do NOT accuse anyone of anything. Don't whine, cry, babble on and on, huff and puff, sigh, roll your eyes. Keep your sentences focused, make good eye contact, and wait calmly and patiently for manager's replies.

TriciaJ, RN · Dec 8, 2017

Yes, if a nurse finds an error, s/he could fill out an incident report. I suspect they didn't fill one out, though, just by the way it sounds like this went down.
I'm sorry you're still awake, BTW! :)
I think you need to revisit this with your manager. It is not okay. And you have the opportunity to set a precedent with regard to how you expect to be treated during your course of employment. Ask for a meeting at his/her convenience. During meeting, state that you're having a hard time with how this went down and you need some details. Ask manager to run the Activity Report for your username on that date. If they balk, say, "I care about doing my best. If a mistake has been made I need to review it carefully in order to know how to prevent anything similar in the future."
"I do suspect there's a possibility that this accusation has been made in error, and if that's the case I deserve to know that."
If manager tells you not to worry about it, I would find out if there has been an incident report filed and especially whether this is (or will) be noted in your employee file.
What to do next depends on what happens with all of this ^
Be pleasantly assertive (not aggressive). Do NOT accuse anyone of anything. Don't whine, cry, babble on and on, huff and puff, sigh, roll your eyes. Keep your sentences focused, make good eye contact, and wait calmly and patiently for manager's replies.

This is perfect. Could not have said it better.

TriciaJ, RN · Dec 9, 2017

Honestly I kind of want to agree. Because I know who the day shift nurse was before me that night. She had 3 discharges and two admissions and I know she was super busy and saw that management/ charge nurses had given a couple of her medications when I was looking at past meds given (such as pain medication and such). But then I feel like if that's the case and they didn't want to get them in trouble then why even bring it up to me. I mean I can see wanting to protect someone but to shift blame on someone else instead is kinda crazy.

I can only speculate at this point. Maybe the nurse in question is someone who is well-liked but going through a personal crisis or just error-prone lately. Maybe she can't have another error without getting into serious trouble. If your record is clean, maybe someone thought you could absorb the hit without too much damage to your career.

If that's the case it's a very bad plan. Full of backfire potential and throws an innocent person under the bus. At some point in the near future ask HR if you can review your personnel file. You want to make sure it isn't marked by a bogus accusation.

MunoRN, RN · Dec 9, 2017

As someone who follows up on medication errors, I find the actions of manager concerning, and arguably grossly negligent.

The purpose of investigating and discussing a medication error with those involved is to figure out the root cause of the error, and to purse ways to alleviate the cause of the error. If the manager who spoke to you didn't even know what patient this involved or when the medications was given, they should not be in that job.

So long as your facility receives medicare reimbursement they are legally required to abide by "meaningful use" charting requirements, which means there must be a record of the medication administration your manager is claiming was a medication error. There's no benefit in telling someone they made a med error without being able to facilitate the scientific process that should occur as a result which starts with assessment. Technically, the nursing process is borrowed from the scientific process, if your manager is a licensed nurse and they are purposefully avoiding use of the nursing (scientific) process in investigating this issue then they are failing to meet the requirements of their license.

RainMom · Dec 9, 2017

And that is smart about Pyxis. I wouldn't know how to go about doing that and everytime I seemed to ask questions regarding the situation it was brushed off as it's fine it's not a big deal but to me and for me it is. My confidence is already at a low because I'm a new grad I don't need something else knocking me down farther if it isn't true.

Ask pharmacy to print you a report of your pyxis activity for the day in question.