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.

[klone, MSN, RN]

This seems like more a process problem. Why did the physician give a verbal order? As someone else mentioned, TJC states that verbals should not be given/followed except for in code situations.

[MunoRN, RN]

If your new employers sees this as a reason to terminate you rather than a teaching opportunity I would question if that's really someone you want to work for.

As a way of dealing with this in the future, other than telling the anesthesiologist to write and chart their own orders, would be to chart that the med was given within the order: "Morphine 2mg IV x1, given by Dr Smith at 1230".

[VANurse2010]

This seems like more a process problem. Why did the physician give a verbal order? As someone else mentioned, TJC states that verbals should not be given/followed except for in code situations.

TJC can "discourage" whatever they want, but they don't regulate the practice of medicine.

[Fishingaround]

Thanks everyone for your support and advice. It has helped me to see how I can better handle it should such a situation arise in the future.

[klone, MSN, RN]

TJC can "discourage" whatever they want, but they don't regulate the practice of medicine.

Of course. But facilities may lose CMS certification/reimbursement if they do not pass their JC survey. Thus, it's pretty important, if a facility uses JC for their surveys, to follow their regulations.

[goosecreekgirl]

Dont be too hard on yourself. The patient is fine. It is a mistake you will never make again. Every nurse I know has a "horror" story of their own. Sending you hugs.

[VANurse2010]

Given that every hospital I've worked at has allowed verbal orders, I don't think this is as big as issue as you're implying - and they've all been TJC accredited.

[klone, MSN, RN]

Don't know what to tell you. Eliminating verbal orders except in emergency situations has been a NPSG for several years.

[MunoRN, RN]

Don't know what to tell you. Eliminating verbal orders except in emergency situations has been a NPSG for several years.

That's never actually been a NPSG, discouraging the use of verbal orders when practical has been part of the NPSG on communication, which is a National Patient Safety Goal, but not yet a NPS "Standard". NPS "Goals" are things they would like to see happen some day but currently don't meet the level of compliance needed to make them a "Standard". NPSG are widely not followed by JC accredited facilities, often for good reason. But it's important to remember that the JC is not able to make any regulations, it is only able to enforce CMS regulations and measurements such as Core Measures.

[Been there,done that, ASN, RN]

Stop beating yourself up. I have seen this same error between 2 seasoned nurses.

How was the narc dispensed? Was there no record that it HAD already been dispensed? The nurse relieving you also has some culpability . I would have given the scheduled RX, but NEVER have ASSUMED a stat was not given. Relieving nurse needed to close the loop with you before administering.

[CCRN2BE]

If I'm understanding this right, the MD ordered and then GAVE the narcotic to the patient, correct?

I have taken many verbal and phone orders from physicians, however, I have never and will never chart the administration of a medication (narcotic or not) on behalf of anyone. That includes physicians.

[MunoRN, RN]

If I'm understanding this right, the MD ordered and then GAVE the narcotic to the patient, correct?

I have of course taken many verbal and phone orders from physicians, however, I have never and will never chart the administration of a medication (narcotic or not) on behalf of anyone. That includes physicians.

Why would you not chart that another nurse reported to you that a med was given? Do you just leave that charting action blank? Or do you disregard that you were told the med was already given and give it again?