As charge nurse, am I in trouble for versed and fentanyl error by new grad?

[Nurse Beth, MSN]

Dear Charge Nurse,

Even under pressure, it's important to prioritize patient safety and follow established protocols when administering medications, especially powerful ones like Versed and fentanyl.

This scenario has a lot to unpack, including your responsibility for the error. Additionally, a lot must be learned to prevent this from occurring again.

Patient Safety

To ensure the patient's safety during and after the procedure, it is crucial that the sedative Versed, when used for conscious sedation, is administered in a location that is staffed with trained nurses who can assess and monitor the patient.

It is not so much who administers the drug but that the patient is adequately assessed and monitored to prevent potential complications. It is important to note that the doctor is not responsible for monitoring the patient during and after the procedure-that's nursing responsibility.

 You need to be familiar with your facility's policy on conscious sedation since it seems to be a standard expectation from doctors.

As the charge nurse who authorized this procedure on your unit, what was your plan of care for this patient, including the assessment, monitoring, and documentation? Do you have immediate access to the reversal drug for Versed, and do you know how to administer it?

Getting in Trouble

I understand that you are worried about getting in trouble, but it's crucial to remember that several factors could contribute to the situation. For instance, you may have a culture where doctors' orders are prioritized over nursing policies, and the administration doesn't back up the nurses.

Your nurse manager is responsible for providing proper training and guidance on handling these incidents so you feel confident responding to doctors and have the support you need.

Verbal Orders

As a charge nurse, following your facility's policy for verbal orders and using a read-back or repeat-back process is essential.

It is crucial to emphasize the importance of medication safety for new graduates and to lead by example by role-modeling safe practices.

When a physician provides a verbal order, and you pass it on verbally to a new nurse, instructing them to administer the medication, it leads them to believe that they do not need to review the order independently and that verbal orders are acceptable.

However, this conveys the wrong message. The administering nurse must review All medication orders thoroughly to avoid errors and ensure patient safety.

Delegation

You did not seem to ensure that the new graduate knew what to do or understood the potential concerns. The 5 rights of delegation were not followed:

• Right task
• Right circumstance
• Right person
• Right supervision
• Right direction and communication

New Grad Support

You didn't appear to supervise the new graduate but instead sent her into the room with two medications and some verbal instructions. Since this was an uncommon procedure, it would have been appropriate for you to accompany her into the room to provide guidance and support.

If you handed the versed to the new nurse and told her to give it to the doctor, how did she know how much to administer? Did she identify the patient? How was the Versed administration documented?

If a medication error occurred due to a miscommunication or misunderstanding of your instructions, it's essential to take the following steps: 

Patient Assessment and Monitoring. Ensure the patient's immediate safety and well-being. Monitor their vital signs and neurological status closely to assess any potential adverse effects of the medications.

Document the Incident. Accurately document the incident, including your instructions to the nurse, what occurred, and the patient's response. Be factual and objective in your documentation.

Notify the Chain of Command. Report the incident promptly to your immediate supervisor or manager. They need to be informed about what happened and should be involved in addressing the situation.

Root Cause Analysis. Work with your manager and the team to conduct a thorough root cause analysis to understand why the error occurred. Determine what breakdowns occurred in communication, education, or adherence to protocols.

Follow Hospital Policies. Comply with your hospital's policies and procedures regarding medication errors and adverse events. This may involve completing incident reports and participating in investigations.

Support the Affected Nurse. If the nurse involved is a new grad, consider offering support and additional education to help them learn from the incident and prevent similar errors in the future.

Learn from the Incident. Use this experience to reinforce the importance of medication safety, effective communication, and adherence to protocols within your team.

Regarding whether you may be in trouble, the outcome may depend on the specific policies and procedures of your healthcare facility and the results of the incident investigation.

Medication errors are taken seriously, but the focus is typically on learning from them to prevent future occurrences rather than punitive measures.

Your role as a charge nurse involves overseeing patient care and ensuring proper procedures are followed. Continue collaborating with your manager and the team to address issues and improve patient safety practices.

Best wishes,

Nurse Beth