Early Medical Leave r/t Med Error

[OrthoRN20]

Feeling really frustrated and unsure what to do. I made my first medication error in the 4 years I’ve worked as a nurse last month. I work on a busy surgical/medical floor and in this specific case I had four patients that all needed pain meds every other hour. I pulled dilaudid and morphine and administered the morphine to the wrong patient. I am 20 weeks pregnant pregnant and have been dealing with brain fog. Under normal circumstances, I would have the morphine still packaged in one pocket with the dilaudid diluted, wasted, and labeled in the other. For some reason I scanned the appropriate med (dilaudid), then drew up and administered the morphine. I reported my mistake immediately, monitored the patient condition, and fortunately it didn’t cause harm. But still it really terrified me. I am no longer pulling any medications for separate patients at the same time. I know this is best practice but under normal circumstances I am extremely adept at prioritizing. 

Well about three weeks later a medication fell out of my pocket on the way to someone’s room and I enlisted a bunch of help to find it. It was found a few minutes later but I definitely was a bit of an emotional reck over it. My manager called me in to tell me she “overheard what happened” and I need to slow down and protect my license. I didn’t defend myself or make excuses. But I’m honestly really upset at being told to “slow down and protect myself” when I have already been very honest about how challenging my assignments have been. Combative patients, isolations that I have to try and trade last minute, 3 discharges followed by 3 admissions, critical staffing issues, it’s not easy to prioritize for anyone let alone someone who expressly stated they are trying to keep up. It feels like because I don’t waddle around complaining they didn’t know I was pregnant and treated me like “normal”. That being the nurse who started charging a year out of school and kicks *** at patient care. But I’m not myself right now. I feel frustrated that I’m slow and forgetful and that it seems like I’m invincible to management until I mess up. It annoys me that they are “concerned” about my errors “so close together” but not the shift where I just team lead short two nurses with a 3 patient assignment, pregnant, with a code? It’s my own fault I guess for speaking up about my brain fog because all it did was put a target on my back.

I had my last baby at 37 weeks, precipitously in 3 hours. Im sure some of that had to do with working my butt off until three days before she was born. Im almost considering asking my OB for light duty to “protect my license” since apparently I am such a hazard. Optimally I would transfer to preop or PACU but no one is going to take me on 4 months before I take leave. I know that’s probably just the emotions talking but I’m really tired. The patients are sicker and more confused than ever and it’s only going to get worse with flu season. 

[Been there,done that, ASN, RN]

First of all, MANY facilities will fire you on the spot for putting a narcotic in your pocket.

 You have been given a verbal warning.

As you feel that your pregnancy is affecting your work performance, obtaining light duty from your OB may be a good idea.

[OrthoRN20]

I’ve never come across this before. Is the method of carrying the medication because of infection control, or diversion? Every nurse I work with will usually pull their meds including pain medication, place them into a med cup or two, and into either a scrub pocket or jacket pocket. This frees your hands for other supplies as many of us do our morning assessment with the first med pass. 

[Hoosier_RN, MSN]

Diversion. And as you had happen, a med falling out. In any facility I've ever worked at, putting narcotics in your pocket would have been terminated. Your boss gave you sound advice, take it

[JKL33]

I also think it was unwise to tell anyone about any brain fog, except your personal health care provider for the purpose of getting care and/or adjusting your work as necessary. Beyond that it's just telling people that you knew of a problem and yet continued on.

I'm sorry you're struggling. I'm gonna call it like I see it. It sounds like you are someone who takes pride in being very capable. And I'm sure you are very capable--but you still need to make good choices. Being extremely adept at prioritizing is a matter of pride for you; but stuffing things in pockets and carrying around meds for different patients because you're so good at all of this has always been asking for trouble, pregnancy or no pregnancy, brain fog or no brain fog. Sooner or later there was going to come a time when you weren't adept enough to do it all perfectly. I'm not mocking you--I'm saying that because NONE of us are capable of that. This is as good a wake-up call as any. No one was hurt.

Also sounds like you often try to "do it all"--one of those who takes up slack and takes up more slack; that is another matter of pride. It often eventually causes anger--at the people who don't care/aren't grateful, and at oneself, for being silly enough to think others would care about all your efforts.

You do need to slow down. For a variety of reasons, namely patient safety and self-preservation.

I think this is a good time to take your manager's advice VERY seriously. In fact, you could choose to take her advice some of these times that you've been picking up slack. ????. I would never advise malicious compliance or anything like that....but just...you know...SLOW IT waaaaay DOWN. So that nobody gets hurt. Let your manager and admin worry about whatever work you can't get done. Take care of your patients safely and the best you can. The rest is for other people to worry about.

 

[OrthoRN20]

26 minutes ago, JKL33 said:

I also think it was unwise to tell anyone about any brain fog, except your personal health care provider for the purpose of getting care and/or adjusting your work as necessary. Beyond that it's just telling people that you knew of a problem and yet continued on.

I'm sorry you're struggling. I'm gonna call it like I see it. It sounds like you are someone who takes pride in being very capable. And I'm sure you are very capable--but you still need to make good choices. Being extremely adept at prioritizing is a matter of pride for you; but stuffing things in pockets and carrying around meds for different patients because you're so good at all of this has always been asking for trouble, pregnancy or no pregnancy, brain fog or no brain fog. Sooner or later there was going to come a time when you weren't adept enough to do it all perfectly. I'm not mocking you--I'm saying that because NONE of us are capable of that. This is as good a wake-up call as any. No one was hurt.

Also sounds like you often try to "do it all"--one of those who takes up slack and takes up more slack; that is another matter of pride. It often eventually causes anger--at the people who don't care/aren't grateful, and at oneself, for being silly enough to think others would care about all your efforts.

You do need to slow down. For a variety of reasons, namely patient safety and self-preservation.

I think this is a good time to take your manager's advice VERY seriously. In fact, you could choose to take her advice some of these times that you've been picking up slack. ????. I would never advise malicious compliance or anything like that....but just...you know...SLOW IT waaaaay DOWN. So that nobody gets hurt. Let your manager and admin worry about whatever work you can't get done. Take care of your patients safely and the best you can. The rest is for other people to worry about.

 

I deeply appreciate your response. So much of what you said assisted me in identifying my own faults, and you did it kindly. I think a lot of it is pride. I was a CNA and am one of those nurses that got into the business of nursing with the goal of “helping people”. I have been repeatedly disappointed by my inability to do it all. Already I have started pulling narcotics individually and saying NO to anything that stands between me and the patient room. I am better utilizing my ancillary staff and it feels wholly unnatural to me which is a big red flag. But overall I feel clearer. No longer is it “water for 6, narc for 3, walk for 2” now it’s “narc for 3, enlist help”. And it has actually increased my productivity. I have a lot of fears surrounding being disliked by my coworkers or viewed as lazy. But this supposed self sacrificial attitude has done nothing but put me further behind and made me unsafe. I think I will evaluate my improvement and check in with my manager in a couple weeks. If I’m still experiencing work performance issues I’ll talk to my OB about light duty. 
 

[Nurse Beth, MSN]

This doesn't sound right. Meaning your normal practice is to stick morphine in one pocket and dilaudid in another?

You scanned dilaudid in the pt's room, then put it down, reached in your other pocket and administered morphine?. 

From a manager or BON POV-this sounds more like diversion than pregnancy brain fog. 

[OrthoRN20]

3 hours ago, Nurse Beth said:

This doesn't sound right. Meaning your normal practice is to stick morphine in one pocket and dilaudid in another?

You scanned dilaudid in the pt's room, then put it down, reached in your other pocket and administered morphine?. 

From a manager or BON POV-this sounds more like diversion than pregnancy brain fog. 

Our morphine is single dose vial (2mg) but dilaudid is not and must be wasted at the Pyxis before being taken to the room. My intention was to give PRN dilaudid to the patient who was reporting severe pain after physical therapy. My stupid way at the time of differentiating them was one is already diluted and in a flush with the empty vial (the rest wasted in the trash with another RN) in one pocket, one is a one-dose vial undrawn. In my mind I thought “go to severe pain room first, then scheduled morphine room after”. When I got to the room I scanned the correct medication, assisted pt back to bed with physical therapy, took their blood pressure, and drew up the morphine to give. I should have never pulled both to begin with but I never thought I would be dumb enough to confuse them and should not have taken up any tasks in between. Upon partial administration of the wrong medication I stopped, assessed the patient, and called the doctor. I wasted the rest of the unadministered dilaudid with my charge RN and wrote an incident report because at this point I would have to pull another scheduled morphine for the patient who needed it but only scan one. We give a lot of pain medication on my floor (up to every hour for multiple patients) and it’s the only place I have ever worked. I honestly think I became overly confident and a little desensitized. This has been a major wake up call. 

[ClaraRedheart, BSN, RN]

On 12/17/2022 at 12:34 AM, Been there,done that said:

First of all, MANY facilities will fire you on the spot for putting a narcotic in your pocket."

Whutttt? Wowza. I guess I could see why. I don't work in Med-Surg anymore, so it's no longer a necessity, but I used to pull morphine or dilaudid, draw up my portion for the patient in the room, and then waste later ALL the time. I will still put narcotics in my pocket, but only if I'm in a hurry and going room to room. The meds for the first patient stay out, second go in the pocket. 

I will definitely change practice. Don't want to ever give ANYONE a reason to suspect anything. 

[JKL33]

On 12/17/2022 at 1:34 AM, Been there,done that said:

First of all, MANY facilities will fire you on the spot for putting a narcotic in your pocket.

Just as an aside, my opinion has been that ^ these kinds of rules are NOT about patient safety but generated by inane admins who have gotten away with pretending that the main or perhaps only reason a nurse would ever put a med in a pocket would be to divert it--NOT the fact that nurses are at baseline trying to multi-task beyond human capability. Now, I can think of many words, but  none of them are sufficient to describe what an utterly crappy (yet brilliant) bunch of BS that is.

[chare]

1 hour ago, JKL33 said:

On 12/17/2022 at 1:34 AM, Been there,done that said:

First of all, MANY facilities will fire you on the spot for putting a narcotic in your pocket.

Just as an aside, my opinion has been that ^ these kinds of rules are NOT about patient safety but generated by inane admins who have gotten away with pretending that the main or perhaps only reason a nurse would ever put a med in a pocket would be to divert it--NOT the fact that nurses are at baseline trying to multi-task beyond human capability. Now, I can think of many words, but  none of them are sufficient to describe what an utterly crappy (yet brilliant) bunch of BS that is.

This is what you get when policies are written by those that either aren't currently working ar the bedside or never have.