advice for mistakes made at work

[hopefulmurse14]

Hello all!

I am a soon to be nursing student here in California and I just recently received a job as a patient companion at the hospital I have been interning at. For those whose hospitals title the position differently, my hospital uses patient companion's for patients who need 1:1 care: post-surgical dementia, detox, 5150, fall risk, combative, etc. My role is essentially to be next to the patient (or outside of the room if in the ED--never know what a patient on a hold is capable of) and assist the RNs and CNAs with basic hygiene and keeping the patient safe throughout their stay. I have thoroughly enjoyed my experience as a patient companion and have been able to handle some pretty intense assignments without any hiccups. That is until last week....

I was down in the ED and my patient was on a 24 hour hold for being brought in with an insanely high BAC the night prior. This patient was to be on hold until a psychiatric evaluator either cleared them as not being a danger to themselves or put them on a 5150. Long story short, my patient was cleared and the RN then began the discharge paperwork. My patient had been a handful all day: complaining about getting her seroquel and that the nurse was taking her sweat time doing everything and that her care was sub-par because she was in the "loonie bin" of the hospital. I did well at keeping the patient calm and comfortable but she really began to restless when the discharge process did not go as smoothly as possible.

Let me slightly back track as well. Prior to being cleared, the RN administered PO seroquel to the patient. Fast forward to being cleared and waiting for her discharge to be finished, the patient decides to walk out of her room and pick up her discharge information that a scribe had dropped off in a little cubbie type thing outside the room that holds the patients chart and any other important items. Well, it just so happens that the RN was also holding the patients own outpatient CVS prescription of seroquel in the cubbie (maybe because the patient was not suicidal and she thought it safe to be there with me watching the patient?). As the patient grabbed her discharge papers, she also grabbed her prescription bottle of seroquel that was right next to it. Not wanting a confrontation, I followed the patient back in her room, grabbed the medication bottle and told her, "I will put this in with your other belongings so it does not get lost." No sooner than I say that, the patient grabs her bottle because she wanted to make sure nobody stole some of her medication.

This is where I goofed up (sorry for the novel you have had to read until this point). I really did not want to cause any sort of confrontation that I felt was unnecessary, so I let the patient make sure that nobody had stolen her medication as she poured it out in her hand to count. I was completely alert and ready just in case she decided now was the time to harm herself by ingesting too many pills, but thankfully that did not happen. She did however manage to quickly pop 2 pills (a normal dose for her I'm assuming) into her mouth in a split second before putting the bottle back on the counter. Obviously this made my heart race and I quickly found the RN to cautiously explain how in the world I let this happen (even today I cannot believe what an idiot I was to let that happen).

The RN was obviously worried because she had already given the patient a dose of seroquel earlier in the morning from the order the doctor prescribed. The RN seemed very irritated at the fact that I had managed to mess up the very job I assigned to do....keep the patient safe at all costs, even if that means causing an argument with a patient who fighting comes second nature. The nurse let in on the patient, letting her know she takes too much medication and that she needs to be aware that she cannot do as she pleases while she is in her care, regardless of the fact that she was in the process of being discharged. I eventually got enough cojones to apologize to the nurse for what had occurred and asked if the patient was going to be alright. She had told me that the ER physician said that the combination of the patients personal seroquel and the dose given to her in the morning was not going to harm her and that the patient would still be getting discharged.

20 minutes go by, the patient gets changed, I walk her out to a cab waiting to pick her up and all is well except for the fact that I still felt like a complete idiot for screwing up. The nurse told me not to worry about it and that she was at fault as well for having the patients CVS prescription so close to the room but to just yell out for help if something similar happens in the future. Regardless, I took full blame for my mistake and I tried my best to move on.

The reason I am posting this is because I want to make sure that I do the right thing. The nurse said it was OK and not to worry about it (she still seemed a little irritated), but I just want to know if you guys think it is necessary to report this to my supervisor or if I should just leave it be?? I don't want to make a bigger deal about this than it needs to be because I don't want any blame to fall on the RN; however, I don't want to let this to slide and feel as if I got away with making a mistake. I am a hard working individual who takes pride in his accountability and I just want to make sure I do the right thing. Please let me know your thoughts so I can move on and stop beating myself up.

[nadairRN]

Not being there and only knowing part of what happened; I see it like this... A medication like that (Seroquel) should be locked up! Not sure what your facilities protocol is, but that is how it is most places; and that is the nurses responsibility. The patient should not have even been able to get ahold of the prescription until they were D/C'ed and on their way out. So, this is partly the nurses "fault". But you also have to look at the patient safety side of the situation. What would you have done if you was the nurse?? I know many people don't want to be in a confrontation, but while the patient is in your care YOU/NURSE is responsible for that patient. Keeping them safe is your utmost concern.

As for if you should mention this to your supervisor. In my opinion, if it were me, I would. It's not about getting anyone in trouble or taking the blame, it just seems like it is a learning opportunity. Though it sounds like the incident was an accident, it should not have happened. Maybe think about bringing this to the attention of your supervisor and discuss what happened and the flaws in the incident; this could help to prevent this from happening in the future and keep your patients safe.

BEST OF LUCK!!

[Been there,done that, ASN, RN]

Getting you ready for the real world.

Cluster "you know whats" happen ALL the time. No matter how hard you work or how diligent you are... stuff happens.

The nurse was just as much to blame as anyone, her irritation was with the patient and the situation. Personally, I can't fathom why this type of patient was sent home with a full bottle of her much coveted Seroquel.Too bad she didn't pop her extra dose during the cab ride that the system paid for.

Start growing your hide now... you'll be needing it.

[Been there,done that, ASN, RN]

Not being there and only knowing part of what happened; I see it like this... A medication like that (Seroquel) should be locked up! Not sure what your facilities protocol is, but that is how it is most places; and that is the nurses responsibility. The patient should not have even been able to get ahold of the prescription until they were D/C'ed and on their way out. So, this is partly the nurses "fault". But you also have to look at the patient safety side of the situation. What would you have done if you was the nurse?? I know many people don't want to be in a confrontation, but while the patient is in your care YOU/NURSE is responsible for that patient. Keeping them safe is your utmost concern.

As for if you should mention this to your supervisor. In my opinion, if it were me, I would. It's not about getting anyone in trouble or taking the blame, it just seems like it is a learning opportunity. Though it sounds like the incident was an accident, it should not have happened. Maybe think about bringing this to the attention of your supervisor and discuss what happened and the flaws in the incident; this could help to prevent this from happening in the future and keep your patients safe.

BEST OF LUCK!!

No damage control possible with a patient like that, zip, zero, nada.

[mrsboots87]

I don't really have advice on if you should bring it up or not, but I can say that even though it is your job to keep a risky patient safe, you also cannot physically restrain them when they are not combative. So outside of grabbing her arm and prying the bottle from her fingers them running away while she screams down the hall, there isn't much you could have done. And prying the bottle from her hands would not be ok anyway. This honestly sounds like it's more of the nurses fault then your own. Patient medication shouldn't just be left were anyone could see it and grab it. What if another patient or even staff member saw it and grabbed it? That would be on the nurse and she would be in a lot of trouble. Each facility has their own policy on what exactly to do when a patient brings their home meds in, and I have yet to find one that thinks putting it in a cubbie in a generally "public" area would be ok. Most hospital in my area require that a patient give the medication to pharmacy and then it gets returned once they are discharged. Outside of the possibility of theft, this may even fall under HIPAA since the med bottle would have the patients name on it and anyone walking by that cubbie could see it.

Anyway, try not to beat yourself up. While you should not let the patient take the bottle and could have attempted to get the bottle from her in a nonphysical way instead if letting her open and take two meds, none of that would have occurred had the nurse not left prescription meds out in the open where the patient could grab them.

[jadelpn, LPN, EMT-B]

The only advice I can give is research if you are eligable for your own malpractice insurance. If you are, get it. So going foward, if you are stuck in a really poor process, you have some protection.

[CVICU-Nurse1.5]

Mistakes happen, its how one learns. In any job, we all were new and hesitated somewhere along the way.

[chiandre]

Regardless, I took full blame for my mistake and I tried my best to move on.

I admire your honesty. You will make an awesome nurse. Learn from the mistake and move on.

Successful people make mistakes, acknowledge the mistakes, and never make the mistakes again. Unsuccessful people will never acknowledge or learn from their mistakes. So they will continue to make the mistakes.

Bravo, bravo, bravo...and please DO get a malpractice insurance.

[iluvivt, BSN, RN]

You can't control some people. Now you know not to trust people with this type of history. Perhaps you could have talked her into counting them for her and perhaps not. She probably would have popped two in her mouth the minute she got discharged anyway. The best thing would have been to give her back her RX as she was exiting and keeping it locked up before that. The RN assigned to this patient is ultimately responsible for the patient though and she should have made sure the patient did not have access to that medication. Learn from it and them let it go because the RN is responsible and knows it! No need IMO to report it and drag it out..the MD determined the dosage was OK for her already.

[Esme12, ASN, BSN, RN]

multiple threads merged as per the Terms of Service.....

[applesxoranges, BSN, RN]

Why was the pills in the box where anyone can walk up to them and grab them? That's why all belonging should be secured.

[LadyFree28, BSN, LPN, RN]

I'm going to echo a few things already stated:

Get malpractice insurance. There are hairy situations that occur everyday; so protect yourself.

Also, STOP beating yourself up; since experience is (most of the time) the best teacher, you know what and how to be prepared when the next pt interaction comes around; you will have a system of being aware, asking questions, and preparing for the unexpected.

Best wishes.