Didn't follow through and caused med error

[Fishingaround]

Hi out there. Sorry if this is a little long winded. first a little background I am a former LVN and new grad RN. I have been working for aprox. 4 months. I must admit that I have been struggling from the beginning even though I have had very good preceptors and my management has met with me for counseling on 2 previous occasions and set plans for improving my performance. Now the problem. I had taken an order for a stat narcotic administered by the MD. I later was putting in the order and waiting for the computer to respond, was interrupted, did not chart the medication on the MAR. I did not scan the medication at the time because the MD had discarded the vial and I was going to do an override. Well it is now an hour later and (8 hours into my shift with no breaks) and I am being told I have to go for my Lunch break. I asked the nurse who was relieving me to give my 2 o'clock meds as it is already after 3pm. She did as I asked and also administered the stat narcotic I forgot to chart. I took full responsibility took appropriate steps to report the error and monitor the pt. I am devastated (read uncontrollable crying and inability to eat or sleep here) by the possible harm I could have done. My supervisor called and took me off the schedule and wants to meet in five days. In the meantime I am pretty sure I will be terminated. I just am looking for what can I say in the meeting to express my remorse and concern for the patients in my care. How can I prevent this in future. And how do I handle this on future job interviews. I know it is a lot to ask but I am very concerned for my patients and my future career.

[RN403, BSN, RN]

*hugs* We've all made mistakes. Many of us have made med errors of some kind and many of us are still employed. More than likely your meeting with your supervisor will be about what happened and how you plan to prevent this in the future. When it comes to giving meds and charting meds try to limit or ignore distractions until you are complete. I know it is easier said than done but unless it is an emergency it can wait.

Forgive yourself and learn from the mistake.

[VANurse2010]

Without more details, it's hard to gauge the seriousness of this error. For the most part, an extra dose of a narcotic is not going to cause true harm to the patient.

It sounds like you're just not keeping up - that is probably the real issue. Firing someone over this type of error would be ridiculous under normal circumstances.

[MunoRN, RN]

If the MD administered the med themselves I'm not sure why you ever got involved in the ordering/order entry/charting med given process. That should be all on the MD.

[Fishingaround]

Thank you all for your responses. RN403, lesson learned. I will remember this in the future that unless it is a true emergency I do not rush or get distracted from the med administration process. VANurse2010, I have had difficulty transitioning from the LPN to the RN role and have had some trouble letting go and delegating the LPN tasks I am working on this and have improved some but still need to let go. Perhaps you are correct and this is the true reason for my meeting and possible termination. MunoRN, I was the one to remove the medication from the pixis and my charge nurse instructed me to write the order and chart to have a record of administration. Doc was an anesthesiologist who came to start an IV on a difficult start. and did not have access to the EMR for charting. Is this an unusual occurrence?

BTW the patient was unharmed and the extra dose was beneficial in getting his post surgical pain under control.

Thanks again for your input.

[VANurse2010]

If that's the case, the doctor should have written the order and it should have been sent to pharmacy (in which case when the dose showed up in the MAR, you would document given by MD) - or he should have CPOE it when he had access to a terminal.

Is this an IVP narcotic? that's somewhat different than someone getting an extra Norco. At the same time, if anyone was that concerned about it, then the patient should have gotten naloxone.

[calivianya, BSN, RN]

I don't think what you did was horrible, by any stretch of the imagination, if the patient wasn't harmed. Yes, there was a med error, and yes, you technically were the cause because you did not chart the original dose, but there is a pretty simple fix - calling the MD, reporting what happened, and having him/her put in the order for an extra dose to cover you and the other nurse. If the patient was still in pain, it sounds like he needed his pain medicine regimen adjusted anyway.

Stuff like this happens. I backchart a lot, but I think you just learned that backcharting is not acceptable when it comes to meds. Those are things you always need to scan/chart when they were given, even if you didn't give it. If your management fires you over this, that says more about your management than it says about you IMO.

[Seaofclouds, BSN, RN]

This is why doctors should be writing/entering their own orders. One thing you could have done though, was added "already given by MD" on the actual order you wrote. That way, pharmacy would have seen it was given and the nurse (who should have checked to verify the new order) would have also seen right on the order that it was already given.

[psu_213, BSN, RN]

I would also write this up as an incident report. If the MD is going to be asking for/giving meds, he/she needs to be able to enter the order for the med(s). This situation shows how a patient could be harmed as a result of this doc not being able to enter orders, and, as such, it should be written up.

[MrChicagoRN, RN]

Was this a verbal order?

Every surveyor I've ever encountered has discouraged taking verbal orders due to risk to the patient.

while he may not have had access to the MAR, I don't see why he wouldn't have access to the EMR.

And yes, if the med had been given prior to the order being actually written, the order should also include "Given" as a notation.

[BuckyBadgerRN, ASN, RN]

I think your outcome will depend on what your PREVIOUS two counselings were for. Were they med-related as well?

[LadyFree28, BSN, LPN, RN]

I think your outcome will depend on what your PREVIOUS two counselings were for. Were they med-related as well?

This.

OP, the best thing for you to do is to be prepared to have a strategy in correcting your errors, regardless of the outcome.

I had a rough time transitioning from LPN to RN, because I was very proficient-expert as a LPN, and had to start as a novice RN; I didn't last at my first position either; however, I took positions where I can use the skills I needed as an RN to help bridge what I knew as a LPN to help with the new knowledge I have as a RN.

I have been a RN for almost two years and the second year was much better, but I attribute to self correcting my own missteps, anxiety, and lack of confidence by self-studying, making sure I am consistent with proper procedure, and soaking up information as much as possible.