Did I make a med error?

[DH1234]

The doctor order 75ml/hr of Normal Saline to run continuously. Also, the doctor order an antibiotic, which requires it to be hung with a flush bag. I have seen nurses in the pass set the flush of normal saline to the continuous rate the Dr order, so they did not have to use more than one bag. Therefore, I hung the antibiotic, and set the rate of the normal saline flush bag to 75ml/hr. However, the oncoming day shift explained to me that since the antibiotics is running over 4 hours not just 30 minutes using the flush bag as the continuous fluids is not okay which makes sense. Therefore, I told her I would hang another bag of normal saline to the IV pump and Y site it to the secondary infusion w/ the flush bag. However, I forgot to change the rate of the flush bag from 75ml/hr to a KVO rate such as 5ml/hr. I am terrified I made a medication error.

will i get written up this. I am terrified that I will get in trouble

[klone, MSN, RN]

I don't understand what you mean by "flush bag" - I assume the abx are in a bag of fluid (50 or 100ml). That's your secondary. Your primary should be set at 75ml/hour per the order, and that acts as the "flush" for the antibiotics. Or are the antibiotics running through a separate IV site?

Is the patient at risk for pulmonary edema? Do they have CHF? How long did you run fluids at 150/hour total?

[DH1234]

So basically I have two channels on my IV pump set up. One has the secondary infusion of antibiotics going through it and the flush bag or primary fluid that is normal saline is going at 75ml/hr. However since the abx are running for 4hrs he wouldn’t get any of the fluids for 4hrs. So the oncoming nurse told me to hang normal saline at 75ml/hr in another channel and y site to the infusion that’s already running.

And I forgot to change the rate of the primary infusion for the secondary to something like 5ml/hr. Therefore once the abx is done running both primary bags of fluid are going to be running.

No pt does not have CHF but the other may have pneumonia which scares me. Also, I just remembered my mistake after I came home and was getting ready so technically the 150 ml/hr will not be given right way because of the Iv abx going

[klone, MSN, RN]

At our facility, we would expect the nurse to self-disclose, it would be mentioned at the leadership daily safety huddle as a "no harm" event, and we'd all move on. I would not write up a nurse or otherwise discipline her for this. I would say "Okay, what did you learn?" and then acknowledge that it's an error you likely will never do again, and it was a good learning experience and will make you a better nurse.

[JKL33]

27 minutes ago, DH1234 said:

Also, I just remembered my mistake after I came home and was getting ready so technically the 150 ml/hr will not be given right way because of the Iv abx going

You know what, I haven't had to do this for awhile but there have been times that I just call back and let the patient's current nurse know. No need to lose sleep over it. Follow your facility's practices for reporting near-misses.

It's okay.

PS - the underlying principle of ^ is to take care of the patient. If a phone call can help prevent a difficulty, do it.