anxiety about an occurance report

[Katniss88]

I am really nervous and upset about an occurance report that I was involved in. I haven't talked to my manager about it yet, but my nerves always bother me when anticipating what may happen. The incident happened the last day I worked. I came in and got report from a nurse who tends to be long winded and was trying to talk about two patients at one time just because they both had a codeine allergy. Both patients were prescribed hydrocodone for pain, so she went on to tell me that the dr switched them to oxycodone because of the codeine allergy. I didn't understand why because I have seen numerous patient's with a codeine allergy who can tolerate hydrocodone or oxycodone with no problem. So I didn't think anything of it because those were his orders. The nurse was giving both patients oxycodone for pain. One patient had orders in the computer for the oxycodone, the other patient didn't so she was charting the administration under nurses notes. So I go ahead and put the order in the computer so the administration can be charted correctly because I thought there was an order for it. We normally don't look at the charts till towards the end of our shift, unless a doctor comes and writes new orders. So while I looked in the chart I found an order for the oxycodone for one patient, but I didn't see one for the other patient. Then I thought maybe the doctor told her to give the oxycodone and d/c the hydrocodone, but he didn't write the order and she didn't either. I did find where she d/c the hydrocodone and wrote the administration in nurses notes. I didn't remember to pass this information along in report to the next nurse, so I get a phone call later saying there wasn't an order and the doctor didn't know about it. So I'm involved in an occurance report because it's a huge medication error and patient safety issue and I'm afraid of loosing my license and my job.

[Gooselady, BSN, RN]

That's a pretty understandable error. You will NOT lose your license and I doubt you'll lose your job :)

One thing off the bat -- you have to review the chart before the end of your shift, whether you have time or not. This would have prevented this kind of error.

You made some assumptions and didn't think them through thoroughly before you took action (placing the order for oxy).

When it came down to 'did the nurse or doctor forget to write the order?' just that question ALONE is worth stopping the whole train. Call the doc to clarify. One nurse can't 'hand off' a verbal order to be recorded by another nurse anyway.

In your shoes I'd approach your manager BEFORE you get called in to talk about this. That shows you are taking responsibility. Share how you got confused in report and how the mistake happened, including all the assumptions and poor choices that led up to it. Avoid hinting around that the off-going nurse led you to make the error. Your manager wants to hear that you take responsibility and she'll want to know what you do in the future to avoid making an error like this in the future :)

You'll be fine. Sometimes the only way to be wary of making a mistake is to make it and then examine what happened.

[Katniss88]

I'm going to be way more careful now. I'm really worried that she is going to ask me why I didn't call to clarify and find out why there wasn't an order in the chart or why I didn't pass it on in report. It looks like the whole thing is my fault because I didn't end the whole thing by getting it clarified.

[Gooselady, BSN, RN]

The whole thing IS due to your choices, etc. Let's avoid using the word 'fault' for the negative connotations. You WERE responsible for this mistake having occurred. That is OK! It doesn't mean you are stupid or anything. The 'fault' thing is so overrated. That's something you have to come to terms with in yourself -- that it is not a huge deal to be 'at fault'. Whatever 'at fault' means to you is what's causing problems. Does 'at fault' mean leper ? Complete and utter failure? Everyone's talking about you now, snickering behind your back?

Mistakes are the whole fault of perfectly good nurses. And those who emit an affectation that they NEVER make mistakes are lying. Period.

Instead of fearing that she'll ask WHY you didn't call to clarify or pass it on in report, TELL her how you came to make the mistake before she asks. Tell her what was going through your head and THEN what you will do next time to avoid making such an error again :) Beat her to the punch! Always tell on yourself before the manager has to come and get you. I've beat an incident report to my manager, she had no clue anything happened until I told on myself

[forgivenfaith119]

One thing I found that helped when I did med/surg is having all my patient charts with me when I got report at the start of shift and reviewing them. Yes, it may take more time but I was able to ask questions about orders if need be before the other nurse left.

[Esme12, ASN, BSN, RN]

((HUGS)) we all make mistakes...now learn from it. If/when administration talks with you tell them how sorry you are and what you learned and that you would like to do some teaching project about meds for the staff or new grads....make the negative into a positive.

[Mulan]

So the previous nurse discontinued a med without an order and gave another med without an order?

Sounds like she was at "fault" for the whole thing happening in the first place.

[Nurse Beth, MSN]

We've all made mistakes. At the time, it made sense.

In hindsight, we wonder how we could have done it.

You have some excellent advice in above posts. I hope you'll talk to your manager as they say, and then deal with the trauma. Most important, identify exactly what caused the error.

I myself was suspended for a medication error early in my career. I shared about it at Suspended For a Medication Error.

There's nothing more awful.

Best and know that we're rooting for you, friend!- Beth

[#NurseB]

I myself was suspended for a medication error early in my career. I shared about it at Suspended For a Medication Error.

There's nothing more awful.

You tell a great story. As a new RN, this is a fear of mine. Thank you for sharing!

[Gooselady, BSN, RN]

I myself was suspended for a medication error early in my career. I shared about it atSuspended For a Medication Error.

There's nothing more awful.

I cringed and winced all the way through reading this. That's exactly how you feel, from rushing to 'please' the doctor and yourself with ninja IV skillz to sick and humiliated. On top of the world (or at least, surfing just fine) to the wipe out. It can happen so fast. Fortunately the hospital I recently worked in favors the 'root cause analysis' approach to med errors and other mistakes, rather than a punitive approach. One of my friends working on her BSN attended an inservice about making medical mistakes, from surgeons to nurses and their med errors. The 'newer' thought here is that the more we openly share our mistakes and seek the root cause, the more mistakes can be prevented. The punitive approach just has people shutting down in humiliation, and also paints a false picture of what a 'good nurse' really is. He/she is a human being who must be on the constant look out against making errors, and human beings WILL make errors. It seems like a more 'mature' and useful way of handling mistakes when they happen. Definitely easier on the ole ego.

[jadelpn, LPN, EMT-B]

There is something so wrong with this picture. If you do not have malpractice insurance, get it. If you do, discuss this with them.

Any nurse who is taking upon themselves to change and alter narcotic medications without a specific MD order (and I am not sure that someone who has an allergy to codeine that this "crossover allergy" is even remotely applicable) you need to be sure going forward that you check and double check orders. Which will mean reviewing your orders first thing.

You have proof of what was told to you by the administrative notes. (Which are not orders, however, helps to justify why you proceeded in the way you did). This is a process error.

But I can't help but say it--and perhaps because I am old and jaded, this SCREAMS of narcotic diversion by the other nurse to me. Whenever a nurse blah blah's to death and then throws in some narcotic change that is blurry at best and I think that it requires extra attention and confirmation.

You had no reason to believe that the off going nurse was misleading. You had no reason to think that what was documented in the administrative notes were not accurate. The only thing you can do is learn and carry on. But do pass this by your malpractice and your union just so they are in the loop.

Best wishes and let us know how it goes.

[Graduatenurse14]

Thank you.

Wow. You are a great writer. As someone said above, I cringed and winced all the way through. I would not do well with that type of approach and hope my new employer (I'm a new nurse a week off orientation!) handles med errors differently.

I'm going to watch the TED Talk about the MD talking about MD make mistakes too to see their side of it as well.