Drug error

[coneartist]

I was rushed off my feet and had an admission with ischaemic stroke. I asked the DR if he wants patient to have 300mg Aspirin STAT, he said no patient on warfarin and prescribes it, have that instead. I stupidly went and gave 6mg warfarin, turns out INR is 5.5. Im handing over to night staff and he put a STAT vitamin K 5mg PO order and didnt even bother to tell me.

I'm really sick of nursing sometimes, why is everything blamed on the nurse?????

How serious is this I'm a new nurse..

[Sparrowhawk]

I have to agree, you really have a bad attitude about it. How serious? WEll, that depends...and it depends a lot on your attitude and how you approach it. Just sayin.

Orders get missed. My question is, when you noticed it, did you go ahead and do it or let night shift do it...

We have to own up to our mistakes, even if we think they're not our fault. A good attitude will go farther then a bad one.

In my experience, doctors never tell you they did an order. And I agree, asking for help in those times is a very good idea, esp for a new nurse.

[Tait, MSN, RN]

I have found that coming onto shift I have to work very consciously to be polite and good natured even as previous shift nurses run up to me screaming "thank God you are here I need to get out of this hell hole!". I take the oncoming shift with a grain of salt as most people

1. don't want to be at work

2. are stressed over the impending shift

3. had someone pee in their Cheerios prior to shift.

I don't have much to say on the admin of the Coumadin that hasn't been said, however I wouldn't let the other shift make you feel bad about the missed K order. Shift happens.

[dudette10, MSN, RN]

I'm confused. Was the PT/INR lab already on the chart from the ER but the doc missed it when he wrote the admission order? Then, you gave it because you also didn't check the lab values at admission to your unit?

A practice I follow with ER admissions is to review all lab values, home meds, and see if admission orders have already been written by the time the patient comes up. A couple of times with admission orders already in place, it's clear that the doc missed (or was never told of) important lab values and home meds, e.g. continue home KCl when the K+ is >5, no PT/INR daily order on a pt taking home Coumadin, no insulin regimen on home med rec for a pt with a DM history (have to go back and check with the pt...yep, they forgot to mention it to the ER nurse...), etc.

I also re-review the home med rec with the patient/family because the chaos of the pt's ER experience influences whether they remember all their home meds. Nine times out of 10, a med has been missed. The patient's are also more than willing to contact whoever was with them to verify dosage or frequency when I explain the importance of knowing their home treatment regimen. If the patient is still unsure, I tell the doc about it, and he/she orders the med at the dose/frequency desired.

Your admit history and review of the chart is very, very important to managing the patient's care. Yes, although it seems the floor nurse is often blamed for doc or ER oversight, just a few precautions during admission procedures can save your butt and the patient's.

[aheartsaverrn]

Wow that sounds stressful. I'm a new RN as well. As far as "how serious" it is really depends on how the patient is. How did everything turn out? Talk with your manager. Do you have a preceptor still or are you past that?

What was your documenting like around this? Did you speak with the doctor?

I know it's scary that we new RN's are the last stop-gap. I'm struggling with that as well.

[MomRN0913]

A few things to be said here.

We are human, so we will make errors. The right way is to take responsibility and accountability. I made one (a few actually, but this was a bigger one) and a Dr caught it. A cool Dr luckily, and we did a write up, I chose to write myself up. The NM counseled me, instead of incriminating me and said the best thing to do is take accountibility. She was right. I didn't even get written up, just an incident report was filed. But I learned from it. The mistake was mine. It was in a harried situation, yes, but the mistake was mine and I owned it.

I can see where you might have jumped on a doctors order as a new nurse. But it is the responsibility of the nurse to review lab values. If you reviewed them, that would be teamwork. The Dr may have not seen it, ordered the patients usual course, but you as the nurse could pick that up by reviewing before administering the med.

During shift report one nurse endorsed a run of k+ to be given. The oncoming nurse looks at the labs. K+ is 4.2 and the patient is renally compromised. She calls the MD, figuring he may have made an error. He did. He was looking at the labs to the prior day. Happened to me too, a PRBC transfusion order for a patient with a hgb of 9.6...... I said to myself 'The lab isn't going to release this, let me call the doc and ask why" he told me he say the previous days hgb, cancel the transfusion.

It happens, but placing blame elsewhere will just hold you back. I guarentee you will make a few more mistakes. The key is to learn from them so you never repeat the same one.

[Esme12, ASN, BSN, RN]

I was rushed off my feet and had an admission with ischaemic stroke. I asked the DR if he wants patient to have 300mg Aspirin STAT, he said no patient on warfarin and prescribes it, have that instead. I stupidly went and gave 6mg warfarin, turns out INR is 5.5. I'm handing over to night staff and he put a STAT vitamin K 5mg PO order and didn't even bother to tell me.

I'm really sick of nursing sometimes, why is everything blamed on the nurse?????

How serious is this I'm a new nurse..

Unfortunately, it is a big deal to give a blood thinner when the blood is already too thin. I know that it seems that everything is the nurses fault but that's because we are so smart and important that everyone depends on us to do it right.....at least it's what I tell myself. He should have checked or at least asked what the INR was but you should have checked before you gave it. It should be just fine and it takes time to get all your ducks in a row to know what to do, ask and look for. Lesson learned, don't make the same mistake twice and move forward. I know that with MD order entry it is a pain when the MD doesn't make it known about a stat order. It's impossible to get them to behave and yes it's another responsibility for you too check.

We ALL have days when we are fed up with nursing and being everybody's scapegoat and punching bag.:hdvwl:

As a new nurse it can be over whelming......but it gets better!!!!:hug:

[beast master RN]

lol nice job taking some criticism/advice when you ask for it, why post a question then get all but hurt when people try and help..? time to grow up a little

[leslie :-D]

esme, you'd be the perfect mentor.

you are always thoughtful, educational, and tolerant.

keep it going, girl.:redpinkhe

leslie

[indigonurse]

It has everything to do with accountability and nothing to do with blame.

[Anna Flaxis, BSN, RN]

I was rushed off my feet and had an admission with ischaemic stroke. I asked the DR if he wants patient to have 300mg Aspirin STAT, he said no patient on warfarin and prescribes it, have that instead. I stupidly went and gave 6mg warfarin, turns out INR is 5.5. Im handing over to night staff and he put a STAT vitamin K 5mg PO order and didnt even bother to tell me.

I'm really sick of nursing sometimes, why is everything blamed on the nurse?????

How serious is this I'm a new nurse..

I'm a little confused about the sequence of events. Did the patient come through the ED? Did you check and see what the patient had already been given in the ED? Did you check the labwork that had already been done in the ED? Had the patient had a swallow assessment to determine whether it was safe to give meds PO prior to administering any PO medications?

Is it right to say that the patient came to the unit with holding orders from the ED physician, and that the admitting physician was evaluating the patient and writing orders on the unit?

If so, slow down! Let the admitting physician take the time they need to evaluate the patient and write the orders. You take the time to do your head to toe assessment, look up their labs, check the ED chart forms to see what happened in the ED, and then, when the admitting physician is finished writing the orders, go over those orders for anything STAT.

I don't know how your facility treats medication orders, but this should be evaluated from a system perspective, as in, what part of the system broke down and caused this to happen, and is there any way to improve that part of the system so it doesn't happen again? If you have good management, your willingness to learn from your mistakes will go a long way.

So, next time, take a breath, take a step back, slow down, and use the nursing process. The first step in the nursing process is assessment.

[Esme12, ASN, BSN, RN]

esme, you'd be the perfect mentor.

you are always thoughtful, educational, and tolerant.

keep it going, girl.:redpinkhe

leslie

Thanks Leslie....I try.:) We all remember that one time when...... We need to be better to each other as nurses, as humans. I've been dumped on a few times and I've decided to be better than that..

[Ms.RN]

I dont understand. Why did she give a coumadin when a physician write an order for a vitamin K injection? Is it because doc told her that she is on coumadin?