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Covered Up a Narcotic Med Error

Nurse Beth Nurse Beth, MSN (Columnist) Educator Columnist Innovator Expert Nurse

Specializes in Med Surg, Tele, ICU, Ortho.

Dear Nurse Beth,

The other night, during my med pass, I made an error.

I had accidentally given my pt the narcotic her neighbor was to receive. They were in separate rooms and I obviously failed at my 5 rights. I realized my error before making a second error and giving the neighbor the wrong med as well.

I stopped what I was doing, freaked out and then checked the pt, assessed her, told my most senior nurse and called the MD. The MD put an order in for this narcotic as a one time dose. Vitals were stable and the pt slept comfortably but was arousable all night.

However, my senior nurse friend advised me to not tell the DON and I listened. I didn't fill out a report. And I charted that pt requested this med. That was wrong and I'm dying on the inside. I knew not to do that, but I trusted my colleague. Stupid stupid stupid. I knew better.

Today my DON called me. The husband called the pt advocate. He's livid and said she was worse after this narcotic. I told my DON everything and she told me she would get a union rep to start an investigation. I'm so worried and ashamed. I know and knew better. I know I deserve what I get but what should I expect?

Just a little background: I am a nurse of 2 years on a med Tele floor. The med I gave was oxycodone 10 mg. And the family is livid. Please be kind although I don't deserve and be honest, thank you.

Dear Covered Up Narcotic Med Error,

There's not much I can say that you don't already know.

You acted out of fear and it spun out of control. Now you are faced with being found out, and extreme shame.

I am sorry. It seems the husband who made the complaint is reacting out of proportion.

The way out of shame is to face what you did, and forgive yourself. We all have done things in life we are not proud of, and wouldn't want others to know. You can absolutely recover from this, and go on to be a wiser, better person and nurse.

There will be consequences, of course. The facts are that, in addition to the med error, there was an error of omission in not completing an occurrence report and fraudulent charting in documenting that the patient requested the medication.

The consequences will depend on the investigation and decision of your DON. It's possible they could extend to the BON if your DON chooses to report it.

I do wish you the best.

Best wishes,

Nurse Beth

nurse-beth-purple-logo.jpg

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia.

Ouch!

Both in politics and in nursing it is a truism that the cover-up is punished more severely than the actual offense would have been.

Pixie.RN, MSN, RN, EMT-P

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN.

Though we only hear one side of this, I don't think the husband is "reacting out of proportion." A patient was given an incorrect medication and it was covered up. That does not foster trust! If I were this patient's spouse, I would start to wonder what else might have been covered up or if all staff ethics were so flexible. I am sure the OP has learned a heavy lesson from this occurrence, and it may be at the cost of his/her job. As with all things, the way out is through. Good luck.

Munch

Specializes in Med-Surg/Neuro/Oncology floor nursing..

Its the covering up part that gets me. If she would had admitted to her error up front things might not be so bad. We are all human not robots and mistakes can happen the husband might have understood this. But since the nurse went to such extensive lengths to try and cover herself it makes her look dishonest and underhanded. That's harder to forgive than a simple med error where according to the nurse the patient was fine.

Pixie.RN, MSN, RN, EMT-P

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN.

Let's not forget the neighbor patient who also got an incorrect medication according to the OP. Was that one covered up as well?

Nurse Beth, MSN

Specializes in Med Surg, Tele, ICU, Ortho.

Though we only hear one side of this, I don't think the husband is "reacting out of proportion." A patient was given an incorrect medication and it was covered up. That does not foster trust! If I were this patient's spouse, I would start to wonder what else might have been covered up or if all staff ethics were so flexible. I am sure the OP has learned a heavy lesson from this occurrence, and it may be at the cost of his/her job. As with all things, the way out is through. Good luck.

I hear you. If he's reacting to the cover-up, I agree. If he's livid because a mistake was made, he could be vengeful. Not sure if he knew there was a cover-up or not.

I read that as "I figured it out before making a 2nd error," but yes, I was unclear on that too.

Pixie.RN, MSN, RN, EMT-P

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN.

I read that as "I figured it out before making a 2nd error," but yes, I was unclear on that too.

You are right, I just re-read again, apparently for comprehension this time. Lol

Anytime someone covers up an error it just leads to more errors. It is like a lie, you lie then have to lie to cover your lie. Telling the truth is much easier. I have made mistakes in my nursing career, I am human. My mistakes did not harm anyone, did not kill anyone. Some of my mistakes I did not know until well later at a chart audit I performed...the provider and patient were notified, the patient did not care "I was just a good nurse" the provider did not even remember the patient just the disease. We did have an in-service about my mistake. I guess what I am getting at is this once I found out I made a mistake I owned it. I would never try to cover a mistake up, if I do not make mistakes then I do not learn. I look at mistakes as learning to be better.

Covering up something to me is alarming in that what else are you going to do when it gets tough. It shows ethical attributes that are questionable. I hope you learn and never cover up work. Is your job at risk...I would give you a second chance but I would also audit your documentation and occasionally speak to your direct supervisor. If anything is amiss I would say it is not a good fit to have you on my unit. Is this harsh? Maybe but I am responsible for the patient care and I want it to be good care and all staff be above reproach.

No lasting harm was done and you really learned something. This is really going to stink for you for a while but you will go through it and come out the other side. I can tell from the things you said that you are a person of strong character. You're going to use this lesson in the future to be a better nurse and a better person.

I am curious about the MD involvement. I have heard of nurses giving a PRN type medication due to symptoms and then asking for an order to "cover it." Thi is obviosly not correct practice, but I know it happens. If a medication is given incorrectly, is it common to seek an order to "fix" it? I completely understand alerting the MD for medical reasons, but giving a order seems really shady. Could this be what the family is reacting so strongly too? In the hospital record, was there even a way to chart the medication as given without an order generating it on the EMR?

Frankly, I'm skeptical that an MD, when told a med error occurred, would give a one-time order for the med in order to help cover it up.

Did you really call and tell him flat-out that a med error happened? Or did you call him and bend the truth in order to receive a one time dose in order to cya?

Lying in order to cover an error is a serious ethical issue. I know that isn't helpful to hear at this point, but there it is. Consider it a lesson learned the hard way. I've never heard of a nurse losing her license for a med error. I have for a nurse falsifying documentation and lying.

I sincerely hope this works out for the best for you.

zoidberg, BSN, RN

Specializes in Critical Care.

I am curious about the MD involvement. I have heard of nurses giving a PRN type medication due to symptoms and then asking for an order to "cover it." Thi is obviosly not correct practice, but I know it happens. If a medication is given incorrectly, is it common to seek an order to "fix" it? I completely understand alerting the MD for medical reasons, but giving a order seems really shady. Could this be what the family is reacting so strongly too? In the hospital record, was there even a way to chart the medication as given without an order generating it on the EMR?

At my workplace, we would indeed get a one time order so that we are able to chart what medication we gave the patient, and it would be in the MAR. We would also fill out appropriate incident reports, discuss what additional monitoring is needed with the medical team (labs, vitals, etc), and talk to the patient/family up front. Being honest and telling them what happened and what you will do to continue caring for them is a good way to go. (ie You got metformin, i'm sorry, i will be checking your blood sugar all day ... or something to the sort).

Pixie.RN, MSN, RN, EMT-P

Specializes in EMS, ED, Trauma, CNE, CEN, CPEN, TCRN.

Frankly, I'm skeptical that an MD, when told a med error occurred, would give a one-time order for the med in order to help cover it up.

Did you really call and tell him flat-out that a med error happened? Or did you call him and bend the truth in order to receive a one time dose in order to cya?

Lying in order to cover an error is a serious ethical issue. I know that isn't helpful to hear at this point, but there it is. Consider it a lesson learned the hard way. I've never heard of a nurse losing her license for a med error. I have for a nurse falsifying documentation and lying.

I sincerely hope this works out for the best for you.

The "one time dose" thing happens, I have seen it. People are pretty touchy about narcotics, though. If this was something like Colace it would not even be a discussion here, though still a med error.

Eastern RN

Specializes in ER, Paeds, Gen Surg.

I feel for you girl. One lie - led to another, and as well you involved a co-worker. I graduated from nursing school in 1982. I have made med errors. Thankfully none of them had adverse effects on the patient. I can't recall the errors now, but I know I reported them to the nurse in charge promptly, and completed an incident report. I think I was directed to meet with the DON for one of the errors, but otherwise, no fall out. Listen. We are all human. And I think you got bad advice from the senior nurse you consulted. As for the family being angry - that's something you can't control. And - you have no idea of the family dynamics associated with the gentleman and the patient. You are a fairly new nurse. I have no doubt this incident will be one you learn so much from. Come clean with all of it - deal with it - move on. Best of luck to you! As for getting a prn order from the Doc to cover the medication - that's not proper practice for the nurse, or the Doc.

3ringnursing, BSN

Specializes in ICU; Telephone Triage Nurse.

Sometimes we make mistakes and become terrified. That fear can pave the way for behavior we later regret. In hindsight this is obvious, but at the time when the whine of panic is loudly drowning out all rational thought bad choices can be made.

I'm far from perfect, therefore I would never cast a stone anyone else's way. The important thing to remember here is coming clean and cooperating fully with whatever the investigation asks of you.

This is not a total loss in terms of life a lesson if you learn something from this series of mistakes. No one is immune from errors, and you wouldn't be the first to try to hide one out of fear.

Mavrick, BSN, RN

Specializes in 15 years in ICU, 22 years in PACU.

OK, you know you made a mistake. Actually two of them (the "crime" and the "cover-up"). You are now prepared to go through the punishment.

The rest will have to just play itself out. Occurrence report, meeting with DON, possible report to BON or State if the facility has been sloppy about narcotics in the past. Stick to the facts. Don't embellish or blame. Suck it up. Unless they try to blame YOU for a host of sloppy practices in the past or throw YOU under the bus because a family member is getting lawsuit happy. Then you will need a lawyer familiar with BON disciplinary actions and your life will be Hell for a few months/years.

Take responsibility for what YOU did and try to stop there. You are not the worst nurse ever, nor are you a particular hazard to the entire World! I hope they don't blow this out of proportion and make it a Federal case. The healthcare profession is supposed to be using these incidents to improve practice rather than punish.

Question that came to mind though is, Why would your "senior nurse friend" advise you not to tell the DON? Has she been burnt by the DON for something minor? Has your workplace been a Hell Hole that would throw good nurses under the bus to cover for their poor practices?

cyc0sys

Specializes in EMS, LTC, Sub-acute Rehab.

Meanwhile, at my facility.[ATTACH=CONFIG]25868[/ATTACH]

I am curious about the MD involvement. I have heard of nurses giving a PRN type medication due to symptoms and then asking for an order to "cover it." Thi is obviosly not correct practice, but I know it happens. If a medication is given incorrectly, is it common to seek an order to "fix" it? I completely understand alerting the MD for medical reasons, but giving a order seems really shady. Could this be what the family is reacting so strongly too? In the hospital record, was there even a way to chart the medication as given without an order generating it on the EMR?

In ltc this is quite common, and even in hospital care I have seen doctors write orders for a one time dose, I don't think it is so much shady as I don't think the md is really clued in to the med error aspect and is just trying to be helpful.

If a medication is given incorrectly, is it common to seek an order to "fix" it?

Yes. I had seen this many times at my former LTAC. We did not have scanners and our narcotics were in a locked cabinet with paper charting. It was not unusual to grab the wrong but similar narcotic: Percocet versus Norco, etc. We would then get an MD order to balance everything out for pharmacy oversight. If there wasn't an easy fix or we gave an entirely inappropriate med, or there was potential for harm, then we would call family/MD/DON.

Family upset? What family? Our patients were the forgotten. DON upset? Our DON had too much on her plate to worry about something that we already mitigated paperwork-wise.

I know this sounds terrible but we really did provide the best care we could, compassionately, while overworked and chronically understaffed.

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