Adverse reaction to IM- how serious is this?

rn/writer, RN · Nov 6, 2008

a)i feel horrible. my goal is to help her and the thought of causing her harm is very distressing. she is already suicidal and certainly doesn't need more problems or pain =(.
adverse reactions happen. unless the patient has a history of such reactions, you usually can't anticipate them. please, do not internalize this and make it personal. of course, you wanted to help and not hurt your patient. but you can't protect her from life. bad things happen.
b)i'm concerned about my job and the consequences. i'm already not liked related to politics. this would be the first adverse reaction i have ever had. since it is infection, i'm sure that it will be researched thoroughly. hospital injections are dangerous.
it's a rare nurse who has never had a patient develop an adverse reaction. adverse reactions are not about the nurse's skill--they are about the patient's response to either the medication itself or the mechanical irritation of the injection.
things i've been thinking about:
in this psych facility, there are seriously few places of privacy and we often end up giving patients ims in the bathroom (dirty!!). i think i should have used a longer needle; it might have irritated her subq tissue. i try and do z-track, but it is difficult for me. i am not coordinated and trying to keep the tissue to one side while pulling up the syringe to pull up for blood is difficult. the alcohol possibly did not dry long enough. i probably put the gloves on too early and may have touched something.
i can appreciate your wanting to approach this with humility, but if you just lie down and die, you offer yourself as a willing scapegoat. this rarely has good results. answer inquiries about what you did truthfully, but do not hang yourself out to dry as you did in the above paragraph.
seriously, if you were acting as a witness against yourself, most of your "testimony" would be objected to or stricken from the record by the defense attorney as being full of suppositions and conclusions. do not do this. answer questions honestly, but don't volunteer your "conclusions."
can anyone give me wisdom on how serious this is? could my job be threatened..license?? if it is hard and swollen does that mean that po antibiotics won't reach the site and she'll need i&d? am i panicking more than i need be? there is really nothing i can do now, except for making sure that it does not happen in the future, but i feel sick =(.
we here at allnurses can't give you legal or license advice, but i do think you are panicking unnecessarily.
as for making sure it does not happen in the future, good luck with that. as i said earlier, adverse reactions happen.
just, please, don't present yourself with this "spilling your guts, airing your dirty laundry, confessing to anything and everything" mentality, or you will make it easy to pin everything on you.
what tells me that you are beating yourself up is that you are dredging up all kinds of "stuff" that might be at fault. most of us know when we are about to take a chance. unless you can think of a crystal clear moment of truth, stop trying to think of every negative possibility to hand them on a silver platter.
thank you
the two biggest problems i see here are related. first, you are making yourself far too responsible for this patient. you will not last long in psych (and i'm speaking as a former psych nurse) if you feel sorry for the patients and want to protect them from experiencing further pain. their lives come with pain. many of them are probably tougher and braver than you or i know how to be. yes, you can empathize, but it's really not healthy for you or for them for you to identify with their suffering to the point where you end up feeling soooo responsible for something like an adverse reaction which was likely out of your control.
even if something you did contributed to the problem, you didn't intend to cause her harm. that means you get to care about the fact that she has a sore spot on her anatomy, and you get to learn better technique, but you don't get to fall on your sword to atone for your sins.
the other problem is that you seem to be willing to be perpetrator, judge, jury, and executioner, all at the same time. i get really unhappy when i see nurses do this to themselves.
if, after an honest accounting of the facts (minus your speculation that you might have done half a dozen things badly), someone advises you to do anything differently, thank them, and say that you will certainly take their thoughts under consideration.
one last thought. don't be afraid of suicidal patients. be cautious. be vigilant. but don't walk on eggshells because something you do might put them over the edge. that's an open invitation to be manipulated and it sets you up for a very bad time. your feeling unsafe also gets communicated to the patients, and pretty soon everyone is jittery and insecure.
i didn't intend for this to be so long, but i hate to see a newer nurse's conscientious attitude and desire to be humble make her put her neck on the chopping block. there are those in authority who would gladly lower the axe if they thought it would smooth things over. please, please, please, respect yourself and your career and don't make it easy for them to do you wrong.
addendum: it might seem like i'm scolding you. my intentions are just the opposite. i want you to stop scolding yourself. i hope that this "incident" is ruled a simple adverse effect and you are not left holding the bag.
just wanted to let you know that i'm on your side.

inthesky · Nov 6, 2008

rn/writer, thank you so much!!

This is truly what I needed to hear. I have a very bad habit of being really hard on myself and panicking. I posted here because I know I tend to do this and it can be hard for me to differentiate between the true and the paranoid.

thanks again =)

tryingtohaveitall · Nov 6, 2008

I think RN/Writer did a great job of reassuring you. You seem very caring and responsible, GREAT qualities in a nurse. The trick is to be concerned and accept responsibility when an action causes an adverse problem, without letting it incapacitate you. Unfortunately, we are all human and things happen. Learn from it and go on, and don't let this hinder you from being the wonderful nurse you are.

cherrybreeze, ADN, RN · Nov 6, 2008

I agree in that, you can't be blaming yourself this much. Other RN's have given this patient IM injections, so it may not have even been the one YOU gave. Perhaps it was the fact that she got 3 that did it...which is STILL nobody's fault, you don't know how a body will react. You can't go back and question your technique, you did things right, especially if you give IM's all the time, as you say.

I wouldn't even worry about the fact that it was given in the bathroom...I don't think a bathroom is necessarily any more "dirty" than the bed the patient lies in all day. You cleaned the site, your needle didn't touch anything before you gave it...end of story. Even if something HAD been on your gloves, after cleaning the site, you wouldn't have touched it, right? So that's irrelevant (and you wear the gloves to protect YOU, not the other way around).

Having compassion for the pt's situation now is OK, but don't think that means having to come down on yourself. That won't help either one of you.

inthesky · Nov 7, 2008

thanks so much!!!! I went to work feeling much less sick. The patient got a medical consult and was placed on avelox 400 for five days. The doc seemed more concerned about why the patient received thorazine IM initially. Our psych docs can be quick to order IMs. They might not always think about the risk anytime you compromise anyone's skin integrity and introduce any foreign object. I maintain that IMs are for someone about to act out or someone who is vomitting.

I have been reading the nursing textbooks again and I'm going to work as hard as I can to use better technique next time.

The healthcare industry seems unpredictable.. what will be taken seriously and/or exaggerated and what will just pass by?

Keepstanding, ASN, RN · Nov 7, 2008

nothing your told us makes me think you are in the wrong. ease up on yourself sweetie ! you can't carry the weight of the world on your shoulders every day. hang in there :heartbeat