Hi.this is my first time posting as I generally kisg browse this site. I actually became a member so that I could seek some advice. Please, nurses, share your infinite wisdom with me!
I have been a nurse for nearly 7 years. Within the last year I took a position at a small rehab/ LTC facility. It seems that there is this strange, unspoken policy of "hiding" issues. Be it New wounds, change in condition, med error, whatever- most everyone seems comfortable with sweeping issues under-the- rug. This inevitably results in a mountain of paperwork and multitude of phone calls/order changes/ incident reports nearly every time i work (for issues occuring on other shifts) . Whenever there is an issue, it seems its ignored until a 'float nurse' stumbles upon it and adresses it.
The last shift I worked was on a unit. And shift I had not worked on in quite some time. As I was pulling meds for a pt, I noticed that the correct dosage of a med (narcotic) was unavailable . Upon further investigation I discovered that the pt. Had been receiving double the prescribed dosage for several weeks. I wrote up the med error, obtained correct dose and carried on with my shift. Later, i was informed by coworkers that i shouldn't have documented this med error as "no harm was done' as the nurses who gave the incorrect dose could" be in big trouble! ". I honestly feel as though I did the only thing I could in my position. Although, admittedly, .the patient did not suffer any ill-effects, an error was made ( not just once but for weeks). The patient is fine, but that does not negate the error made. Also, selfish as it may sound, I have a license to protect. I would have undeniable liability had I not reported the issue- it was obvious i noted the discrepancy and began the administration of correct dosage. Im not really sure what im looking for here except maybe some validation that I did the right thing (despite the anger ive inspired in many of my co-workers
What were you supposed to do--KEEP giving the wrong dose?? No, you are responsible for your practice. Covering up others' errors is not your priority. You absolutely did the right thing!!
You said that the patient has been receiving twice the prescribed dose. Are they recording in the MAR that they dispensed the prescribed dose or the dose that they actually gave?
I'm assuming that they recorded the prescribed dose. Wouldn't that constitute fraud? Now you are looking at not only a med error, but an actual crime.
Also if anyone audits the patient record against the meds, wouldn't it look like you were diverting. The patients record would show they were getting the prescribed dose, but twice the dose was missing?
I work in LTC and have for most of my career. I have found that it depends on the nurse who discovered the error as to what happens with the reporting. Some nurses report, some will just very casually tell you "oh, by the way, you gave ______ this dose of a med and it should have been that dose." Then there are other nurses who do it right. My current place of employment usually takes a non-punitive stance on med errors unless it's a huge error that the resident becomes sick from. An example of the latter would be once an LPN had just arrived on shift and was unable to find the off-going nurse. She rounded by herself. When she got to this one women's room who had been on IV antibiotics, she saw that a 100mL bag of something was hanging and infusing at 2mLs an hour. Thinking that it was an antibiotic, she changed the rate to 200 mLs per hour so it would run in in a half hour. It was morphine that was hanging and the little 90-something year old woman got almostv100 mg of IV morphine in one half hour as she had just been started on hospice and the bag had only been infusing at 2 mL/ hour for about 45 minutes. The woman suprisingly lived . That nurse got a 3 day suspension and the error was reported to all of the appropriate people. This nurse is still practicing today but left our facility because so many people gave her crap for the error.
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
In each and every LTC facility where I have worked, the same type of "sweep under the rug" culture existed, in particular, for particular nurses. Rest assured everyone involved knows that you did the right thing, but be prepared for the backlash should you consider continuing to do your job correctly. Be very, very careful from here on out. Can almost bet a paycheck that somewhere, sometime, one of your coworkers will have "set up" a serious error for you. Remain diligent...
As far as documentation, everything is electronic. Everyone had been giving double the prescribed dose until i floated over there and found it. I luckily didn't make the error as i noticed the discrepancy when pulling the pts meds. Theywere documenting the correct dose but signing out and administering double. I havent seen a lot of reporting of errors so im not sure what the corrective action will be. I know that another nurse was fired after making a series of significant mistakes, but they didnt reallh have a choice in the matter. It was glaringly apparent that her practices were dangerous. As far as retaliation, it horrifies me to even consider the possibility of another nurse setting me up. Thats just not right.
Specializes in NICU, PICU, Transport, L&D, Hospice.
You did the right thing.
Hiding facts is not new and it is widespread. We have blown open a huge case of fact hiding in the VA. Some want to believe that it doesn't happen in the "for profit" health care world, only in government systems like the VA. That requires a special kind of naivete.
Specializes in Gerontology, Med surg, Home Health.
People who work in facilities that punish mistakes will continue to sweep their mistakes under the rug. We have to promote an atmosphere where people are free to bring mistakes forward so we can find out WHY the mistake occurred. If it is simply human error, be more careful. If it's a systems problem, then drill down until you find the basis of the problem and fix it. You did the right thing.
Thanks for your responses and for for listening.i really hope that the situation will be over and done with before i return for my next shift. I know that the nurses who made the error are angry and I do feel bad for any consequences they receive as a result of this but that doesn't negate my ethical responsibility. An error was made. The appropriate protocol was followed. It should really just be that simple. As far as notifying the board of pharmacy or BON, i dont feel its my responsibility to do so. I filled out the appropriate reports, Dr., family and patient were notified, the reports were sent to management. As far as I know, thats where my role in the process ends. Management has their own protocol as far as repoting, Quality improvement, etc. Is it really my place to notify boards?
I bet you wouldn't have made this post if this was possible but I have a question: The impossibility of pulling a correct dose means there is no way they could have gotten to the prescribed amount by pulling a larger dose and having a 2 RN documented waste of the excess, right? I don't imagine you'd have posted if so.
I just wanted to say you did the right thing!! I haven't been a nurse very long but I have run into issues like this multiple times on the unit I work on. Med errors, changes in patient condition, etc., being "ignored" and played down and I walk into a mess that isn't safe for the patient or for my license. I have reported co-workers and incurred their wrath, which is hard for me to deal with, because I am not out to get my co-workers. I understand nursing is a 24/7 job, mistakes are made, stuff gets overlooked, patient conditions change rapidly. But when patient care and safety is deliberately overlooked time and time again out of laziness and deceit I am not ok with it.
It's a hard situation to have to report co-workers, I feel for what you are going through, but you did the right thing.
You absolutely did the right thing! Think how you'd feel if you overlooked it and the pt ended up in respiratory arrest, needing intubated and transferred out. You can bet if a lawyer was ever involved, you'd be having some explaining to do. Feel good that you made the right choice for the pt!!!
If these issues are constantly happening in this facility and no corrective action Is being taken I would sit down and talk to the Don and gently explain your concern and see if they are aware of it or if they are part of the sweeping under the rug. If they seem to be trying to sweep things under as well I would report to the state asap. It's not ok for a facility to operate like that.
I've caught med errors (all minor *knock on wood*) and I always report them. In my facility you report to manager and there is a portion of paper work you fill out and the rest Is handled by the manager. Makes it easier to not be so singled out as the 'tattle tale'. However, My team on my unit is mostly very close and I tell them up front about the error and let them know according to the mars that they made the error. Every single one has Been in shock and upset that they made that error and thanked me for catching it. If I was met with hostility instead I'm pretty sure I would be looking for a different job.
Here.I.Stand, BSN, RN
5,047 Posts
What were you supposed to do--KEEP giving the wrong dose?? No, you are responsible for your practice. Covering up others' errors is not your priority. You absolutely did the right thing!!