Bad incident while giving Rocephin shot; need advice

[NurseCard, ADN]

(This post may get kinda long. I've been trying to figure out where to begin with this story)

Hello all. I'm new to this particular room... I work on a med surge floor that's really a mishmash of all kinds of patients, including pediatrics. Historically, our floor has taken care of patients who just BARELY need to be in the hospital (in other words, not that sick), and the rest have been shipped to bigger hospitals in a larger city one half hour away. Now, our pediatric doctors have decided that they want us to start taking care of more of their patients, that may or may not be sicker than the ones that we have traditionally cared for. They have started doing monthly education seminars for us RN's on the floor.

I feel like I single-handedly put a wrench in the works the other night. I feel like I really put a dent in the confidence that both the pediatric doctors and perhaps even the public at large in the long run, had in the nurses on our floor. Here's what happened:

At 11pm Tuesday night, I took over the care of a six week old baby that had been admitted with fever. She had had a spinal tap done and had been receiving IV infusions of both Rocephin and Ampicillin. However, earlier in the evening before I took her, her IV had came out and no one had been able to get one back in. So, the doctor ordered for her to receive an IM injection of 400mg of Rocephin at 6am.

Well....... for reasons I won't get into, it hadn't been a good night at all. And then at 6:30 am, I was scrambling to get all of my early morning meds passed and my I+O's put into the computer (we have computer charting).

The mom of the baby had refused to let the lab person stick her at 5am for her CBC, because she was flat out tired of seeing her little girl stuck so much, and of course, seeing the little girl in pain from it. However, she had agreed to let the lab stick the baby's HEEL to try to get what blood they needed, and at the same time, let me give her the Rocephin shot... IF we would wait until around 7am to do all of this. I talked to the mom, and we agreed on 0650.

So at 0645, the lab was ready to go in the room and do what THEY needed to do, and of course I needed to go in with them. At this point I was rather flustered because I was behind, I was tired, yadda yadda yadda, but okay, I was ready to go in and give the shot. I had to mix the Rocephin myself in the vial, because the pharmacy had been gone by the time the order had been written... so I mixed it with sterile water (nope, no lidocaine... mistake number 1, I know that now), drew it up in a small syringe, put a 25 gage needle on it, and thought I was ready to roll.

BEFORE I went in the room however, Karen, one of our charge nurses, saw me and said "We're giving that baby IM shots now?" I said "Yeah", she said "So that's Rocephin... does it have Lidocaine in it?" I said "no, just sterile water". Right THEN I felt uncomfortable and my instinct was to hand Karen the syringe and say "Listen, why don't you give the shot, I don't think I'd better." But I didn't do this. Mistake #2.

(note: I HAVE actually given Rocephin IM before, but it's been a long time.)

I went into the room, waited patiently for lab to finish, and then as soon as they were done, I took out my alcohol swab, firmly grabbed the baby's leg, and uncapped the needle. When I uncapped the needle, the mom (who I found out later was actually VERY young, like 18 or 19) started to FREAK OUT. I said "I don't have to put the needle all the way in", though I could have and should have used a TB syringe, mistake number 3. What did I do then? Well, I was trying to make it a quick stick..in, give the medicine, then out. I stuck the needle in and somehow, quite accidentally, DID put it too far in... and the mom started to get more and more upset. Then I tried to push the medicine in... no dice, and the dang syringe EXPLODED and the medicine went everywhere.

At that point... I took the needle out of the baby's leg, wiped her leg with alcohol, calmly placed the needle in the needle boxed, walked out of the room, to the nurses station.... and *lost it*. I mean, LOST *IT*. I thought I had hurt the baby's leg, the mom was crying hysterically AS I WAS WALKING OUT of the room... I just lost it. And when I say I lost it.... I mean.. I was talking in a VERY loud tone of voice about what I had done, what had just happened, and I was about to cry (I in fact DID cry, but I think it wasn't until I was finally behind a closed door).

After giving report and finishing up the rest of my stuff, I came home... and I was STILL crying when I got home because I was afraid that I had hurt that baby, and I was upset because I had made the mom so upset.

This morning I went in to talk to my manager about what happened (who thankfully is a SUPER person and I love her to death), and she said "I'm not upset about what happened!!! Rocephin is a difficult and painful thing to give IM! I'm upset about the way you HANDLED the situation!"

Basically I acted very very unprofessionally... and I already KNEW that.... but apparently, when I was going off about what had happened, the family heard all of it.

Ahem...a little background about me... I have some slight psychological issues, and I'm being/have been treated for them. I have a horrible temper, and I have a strong tendency to want EVERYONE in the area to know that I'm upset about something. I can be calm one minute, and in total hysterics the next. Again, I am taking medication to help with this. =) I don't know how to think long enough to control my emotions long enough to get behind a closed door and THEN let them out.

I also deal with low self-esteem and tend to beat myself up when I make a mistake... and, I don't like to ask for help. Again, demons that I am trying to deal with and overcome.

So... all that aside... I want to make amends and don't know how to do it.

I want to make amends with the doctors. I don't want them to think that we can't take care of their patients, just because of how *I* acted. I'd love to contact the family and apologize, but I feel it inappriopriate. I'm thinking though, about perhaps setting up a time when I can meet with, perhaps just the 2-3 doctors who saw that baby in the hospital, and personally apologize for what happened and let them know that I don't intend for anything similar to happen again, and that I DO want to learn to better care for their patients.

Thanks. Any thoughts are welcome.

[prmenrs, RN]

I would go back to your NM (whom you stated was a super person), and ask her how to handle this. I doubt there is anyone who is going to recommend you for public flogging, even if you thought that might help. You didn't set out to hurt the baby.

Try to dial down the drama. You are traumatized right now, you need some rest, and then figure out what went wrong. Try to think through what might be a better way to handle things. When you start feeling upset, get yourself under control. No matter what your problems are, you need to get your job done!

If mom was so hysterical, that probably amp'd up the baby and the whole situation. Sometimes, parents need to realize that their actions and feelings affect their children, and that controlling themselves will help their child cope. Establish that early in the shift.

Taking care of mom is important. Getting her a pillow, cup of something, a hug, a sympathetic tone while matter of factly informing her what has to happen to help the child get well--all that increases her trust, hopefully. If she can't control herself, she needs to leave the room till the owie is over.

[SusanJean]

I would go back to your NM (whom you stated was a super person), and ask her how to handle this. I doubt there is anyone who is going to recommend you for public flogging, even if you thought that might help. You didn't set out to hurt the baby.

Try to dial down the drama. You are traumatized right now, you need some rest, and then figure out what went wrong. Try to think through what might be a better way to handle things. When you start feeling upset, get yourself under control. No matter what your problems are, you need to get your job done!

If mom was so hysterical, that probably amp'd up the baby and the whole situation. Sometimes, parents need to realize that their actions and feelings affect their children, and that controlling themselves will help their child cope. Establish that early in the shift.

Taking care of mom is important. Getting her a pillow, cup of something, a hug, a sympathetic tone while matter of factly informing her what has to happen to help the child get well--all that increases her trust, hopefully. If she can't control herself, she needs to leave the room till the owie is over.

Wise advice, all of it!!

[ER1010]

Can someone help me out a little. I am just starting school, and wondering exactly what the mistakes were in this situation, and WHY they are mistakes. NOt trying to rub it in...just learn. Ex: she states not putting lidocaine in the syringe. Why do you need to? Was it a bad idea to give it IM?

Any details are greatly appreciated!

Thanks a lot!

[live4today, RN]

Wise advice, all of it!!

Totally agree! :)

[Stitchie]

We've all made mistakes that catch us sooner or later; some major, some not such a big deal. I think that MattsMom has the idea right: try to deal with the problem at hand, and not let the what-if scenarios run off with your common sense.

Also, teenage moms aren't exactly the most objective of parents. It sounds to me as if she was doing her best to be a good parent, but -- they still have their own issues to deal with. And perhaps being objective about necessary procedures. At our facility we do not give Rocephin with lidocaine, even though I can understand the rationale for it (I work in a Chicago ER; when we give Ro IM, it's usually for an STD and well, our compassion and our procedure manual do not stretch that far!)

Try to gain some perspective. You didn't set out to hurt the baby; mistakes happen. Did the too-long needle hit the bone and that's why the syringe exploded?

If not, then maybe you should talk to the NM about why this happened. Unless the luer lock wasn't secure, then you should have been able to penetrate to soft tissue and you'll want to find out the reason why the injection failed.

Otherwise, if you fall apart, do it in the bathroom, the locker room, an empty room, or in your car. We have to deal with such drama on a regular basis that the nursing staff doesn't need to add to it. Try to learn and move past this one...it's hard, I know.

I once had to give a Tetorifice injection to a LOL who was so emaciated that even the insulin needles HIT HER BONES. It gave me the willies to think that someone was less than an inch of muscle from bone -- no fat on this LOL at all. We live with our mistakes and we go on.

Good luck, and remember, your errors are great learning experiences. Even if they terrify you.

[canoehead, BSN, RN]

I don't think it was even half as bad as you think it was. Mom was upset before you even walked in the room so that wasn't your fault. You stuck the baby but no med got in? No biggie, just needed to be drawn up again. No long term damage, and you are HUMAN.

Try to get behind a closed door before talking next time. That could really get you in trouble someday when someone hears the wrong thing. But the fact that you were upset about it says something about how you care about doing a good job. The docs, and more experienced nurses will just know you were really stressed, and will be darn sure it's perfect the next time.

[Mimi2RN, ASN, RN]

Can someone help me out a little. I am just starting school, and wondering exactly what the mistakes were in this situation, and WHY they are mistakes. NOt trying to rub it in...just learn. Ex: she states not putting lidocaine in the syringe. Why do you need to? Was it a bad idea to give it IM?

Any details are greatly appreciated!

Thanks a lot!

Rocephin injections HURT. Even mixed with lidocaine, it still hurts. My son would agree with that, he was given a dose in the doctor's office, two shots, and at 18, he still wanted mom there.

Unfortunately, it's sometimes it's necessary to give it IM, even in the hospital.

[DDRN4me]

There is NO WAY to give rocephin without pain..I have given lots of it over the years in Pedia nd asolescent offices. the medicine "exploding was due to the syringe not being securely atatched to the needle, i agree..have had that happen to me with immunizations..the key is keeping cool till youre out of earshot of the families and other patients..then its fine to fall apart! I do agree that meeting with your NM and discussing it rationally is the best eway to go. Hang in there, it is experience that makes us stronger and better nurses!!!

[LouisianaNurse2006]

Can someone help me out a little. I am just starting school, and wondering exactly what the mistakes were in this situation, and WHY they are mistakes. NOt trying to rub it in...just learn. Ex: she states not putting lidocaine in the syringe. Why do you need to? Was it a bad idea to give it IM?

Any details are greatly appreciated!

Thanks a lot!

I'm only a student, but the very few mistakes I can identify, are 1)not correcting the medication when the 2nd nurse brought it to her attention, 2) even considering asking another nurse to administer meds that she drew up, 3) not using a small enough needle, and 4) acting unprofessionally in front of a parent. All of which would have been easily corrected, but when you are in her stressful situation it is easier said than done. We have all ... been there, done that... in one way or another.

[FZ1Tom]

Not quite relevant to the incident above, which sounds pretty unfortunate but hopefully all's well that ends well.

I can definitely attest to those Rocephin shots puttin' a hurtin' on ya.......got them a couple times due to skin infections (diabetic but didn't know it yet at the time) and subsequent visits to urgent care. Right in the ol' butt cheek both times. Must be concrete mixed in that stuff, limped for a day or so.

One of the nurses joked that "when we give you a shot, we want you to know about it" :rotfl:

Tom

[chip193]

Can someone help me out a little. I am just starting school, and wondering exactly what the mistakes were in this situation, and WHY they are mistakes. NOt trying to rub it in...just learn. Ex: she states not putting lidocaine in the syringe. Why do you need to? Was it a bad idea to give it IM?

Any details are greatly appreciated!

Thanks a lot!

You mix it with Lidocaine to reduce the (very, very, very painful) sting.

Chip