care errors

This post is from the perspective of being a pt and the mom of two NICU pt's for many months in a row.

I was hospitalized for 6 weeks -- 5 weeks hospital bedrest during my twin gestation pregnancy and 1 week after to pull all the fluid off my lungs following delivery. One baby spent close to 8 weeks in the NICU, and the smaller sicker one spent 4 months and 4 days in NICU. During my 6 weeks I never caught any errors in my care if they were made. I had some young nurses make uncaring remarks. An example - the nurse checked me and said I was definitely in labor, I started crying and trying to wake my DH. The nurse looked at me and said, "What are you freaking out about?" Umm, maybe because our babies are being born 10 weeks too early. :trout: I'm not going to say pushing all the fluids on me when my kidneys weren't functioning properly due to obstruction from the fetuses an error because their job was to save my babies and fix me later.

The major error in "Baby A's" care was a nurse put another baby's ID bracelet on her. I freaked out, couldn't breathe! Scared the crap out of me!

The major care error with "Baby B" was being transferred to another NICU for laser eye surgery for Stage 3 ROP. For 3 weeks while she was at the new facility, I kept asking why speech, OT, or PT wasn't coming to work with her on her nippling (she couldn't even suck 1/4 oz. in 30 min). I kept getting the answer, "The Dr. didn't order it when she was admitted. If she needed it, the Dr. would order it." Not one nurse would even check on it for 18 days! Finally, we had a new nurse. I mentioned to her that I didn't understand why no one was helping her learn to suck. That nurse checked on it, and sure enough, the admitting Dr. had written the order on admit. It was overlooked by the nurse who signed off on it, and every nurse after. That afternoon a PT came to work with her. At 21 days she was cleared by the Ped Optho and transferred back to the 1st hospital. It was too late. The damage was done. Our baby had a feeding tube placed when she was a little over 3 1/2 months old and she needed a Nissen fundoplication because her gag reflex was so hypersensitive from all the feeding tubes being shoved down her throat by the nurses who wouldn't check to see that she should be getting help from someone who had the time to work with her on nippling! Anyway, she still had the feeding tube at 15 months. We go to ST, PT, and OT 3 morning a week for an 1 1/2. I wonder how much of her therapy could have been avoided if people had done their jobs? Oh, yeah, and they told me I shouldn't make a big deal because I'm a nurse and I should know what it is like to be overworked and overlook things.

I tell this story about Baby B because it appeared to be a "minor" error, but it is an error that has had lasting effects on her and our family.

My mom was in the hospital and the RN brought all her meds in to her in a cup. Didn't check her BP before trying to give the BP medication. Luckily I was there and had her check it and, of course, it was too low and had to be held. Checking the BP before given the med seemed to be too much of a hassle for the RN. So the lowly student nurse (me), insisted she do so and low and behold, she had to dump out all the meds and go back over each one to find the BP med. This could have been really bad for anyone. My mom is terminal with myeldysplastic syndrome. Morale of the story to me -- always, always check vitals before giving meds.

I have seen many things as a nursing student that I know I would never let myself do. I have also been through ten operations as a child(13yr-15yr) I was born with hypophosphatemic rickets it is a bone disorder that is regulated by the kidney's, basically my kidney's dump my phosphorus and calcium. With this it caused bowing of my legs. Being in the hospital what seemed like every weeks for two years I have had many errors been made on me. Whether it was just plain neglect of nursing care, or medication errors.

Having gone through these things, I feel I am more aware of my actions and my care and how it can affect the my patients.

My grandmother was hospitalised two years ago with a very large abdominal insicion that dehised and needed dressings. When I called her she mentioned off hand that the nurse doing the dressing had dropped the dressing on the floor and picked it right up and just slapped it right on there like nothing happened. I told her that the nurse needed to be reported so that doesn't happen to other patients even though nurses are over worked. Someone could have gotten a very serious infection with care like that. She never did report it though.