How to cope with a drug error - destroyed confidence

Specialties Emergency

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Hi everyone. I've been an A&E nurse for 5 years without any serious incident - even managed to avoid the plethora of complaints haha!

However recently I made a serious drug error and my confidence to practice has completely been destroyed. In a nutshell, I gave a patient with anaphylaxis a second dose of adrenaline 1:1000(!) as a fast bolus IV injection instead of IM. His ecg was, let's say 'unnerving' for about 5 minutes but then settled back to NSR. I am very well aware that it should only be given IM (I gave the first dose IM) and if given IV you should give 1:10,000 at 1ml/min but I just wasn't concentrating.

The registrar was made aware of the incident directly after I realised I'd done it.

In the past few days, I've realised that doing this has absolutely shattered my confidence and I'm at the stage now where I'm almost terrified to go back and practice. I know that the half life of adrenaline is 2 minutes so any effects were long gone after 10 minutes and there will be no lasting effects. However this isn't the point. What bothers me so much is the fact of what COULD have happened. It could easily have put him into arrest and that's what has left me feeling so bad and so guilty.

Has anyone else experienced what I'm going through? If so, please give me some pointers on how I can get over it because I feel so bad about it and my once exuberant confidence lies in ruins whilst I'm now a bag of nerves even dispensing 2 paracetamol!

I completely sympathize with your situation and I am sorry you had to experience this. As you have already stated, you should have reported the incident. While it probably would cause you some grief for a while, you would not have to bear the guilt of your error alone. Hopefully, your management could provide you some remediation and support during a probationary period. You could also have gained support from a precepting nurse while working through and gaining your confidence back. I wish you the best of luck on your road to recovering from this incident.

Specializes in Nephrology, Cardiology, ER, ICU.

Of course this shook your confidence! What caused this incident? Were you in too much of a hurry? Were you carrying more than one medication? Was the order incomplete? Once you know why the incident occured, you can work to iron out the mistake.

BTW what is a "registrar?" Here in the US, a registrar is the clerk who puts the patient's name and address and other info in the computer. Its not a medical person. (I think that is what the above poster is thinking - that you didn't report it to the physician).

Take care...

Of course this shook your confidence! What caused this incident? Were you in too much of a hurry? Were you carrying more than one medication? Was the order incomplete? Once you know why the incident occured, you can work to iron out the mistake.

BTW what is a "registrar?" Here in the US, a registrar is the clerk who puts the patient's name and address and other info in the computer. Its not a medical person. (I think that is what the above poster is thinking - that you didn't report it to the physician).

Take care...

I can't think of anything that caused this incident. It's not like we were busy, I only had that one patient to deal with. I simply was not concentrating.

A registrar is a senior doctor in the UK. I told him about it, but I did not tell the nursing managers as I should have done as the registrar told me that absolutely nothing would happen to the patient and there's no point causing myself grief and problems when they're not necessary. My managers are well known for tearing people to shreds after a minor incident - let alone a major one.

Specializes in Nephrology, Cardiology, ER, ICU.

Got it - thanks for the explanation. Is it required to complete an incident report in the UK for things like this? I can only speak to US practice but we could lose our job for not reporting errors. Maybe this isn't the same in the UK.

At any rate, am glad the pt is okay.

Specializes in Med/Surg/Ortho/HH/Radiology-Now Retired.

It's an unfortunate event, but you really MUST fill out an incident report. It's not acceptable for the registrar to basically tell you to forget it. It's YOUR nursing licence! If management find out, you'd be in an even worse predicament than how you're feeling now.

Try and take some time to process things, retrace your steps leading up to this incident and see what/if was happening/going through your mind etc. Do some self evaluation and learn a lesson from it. You're understandably distressed and shocked. It will take time for you to forgive yourself, but you MUST. It's not as though you did this deliberately, it was a MISTAKE. We ALL make mistakes. Thankfully, this one has no lasting damage. Try not to beat up on yourself, be kind to yourself. Get back on the horse and ride again. There's not many nurses who escape something adverse, be it major or minor, in their careers. Learn from it and move forward with confidence. you had confidence before, you'll regain it again. It might take time, but it will come if you believe in yourself and your abilities.

But ... you really should report such incidents regardless of what any old registrar tells you!

Best Wishes for the future. ((((hugs))))

I empathize with you...

I made a drug error last week, not by commission but by omission. I wasn't able to give a dose of due antibiotic to one of the patients. It would have been still ok because the antibiotic could still be given as long as the last dose's peak level doesn't come down. But the bad thing is that the patient's mother found out about it, and made a scene about the petty incident.

As a saying goes, "Past is past." And you should get over with it and not keep punishing yourself from the mistake. It's part of the learning process to make mistakes sometimes and always remember that we are humans! We are not robots made into precision and accuracy. We are prone to mistakes sometimes no matter how careful we are.

The fact that you are as concerned as you are is an indication of your commitment to provide good care.

You are probably much less likely to make a consequential error now.

9309

Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.

Making a med error does cause a great deal of anxiety and stress afterwards. I made a relatively minor error last year (gave the wrong dose of hydrocodone to a patient). The patient began having hallucinations and I became absolutely freaked out. I was so stressed out after the incident that I didn't even want to go back to work. My manager was really nice about it and helped me fill out the incident report.

The outcome of that med error really resulted in a change of practice for me. I am really, really cautious now with my medications. I check, double check and triple check (and then do one more just to make sure). I feel that the experience made me a safer nurse. Please remember that something good will come out of this experience. The fact that you are so upset about what happened shows that you are a good nurse who cares about providing excellent care.

It's an unfortunate event, but you really MUST fill out an incident report. It's not acceptable for the registrar to basically tell you to forget it. It's YOUR nursing licence! If management find out, you'd be in an even worse predicament than how you're feeling now.

Try and take some time to process things, retrace your steps leading up to this incident and see what/if was happening/going through your mind etc. Do some self evaluation and learn a lesson from it. You're understandably distressed and shocked. It will take time for you to forgive yourself, but you MUST. It's not as though you did this deliberately, it was a MISTAKE. We ALL make mistakes. Thankfully, this one has no lasting damage. Try not to beat up on yourself, be kind to yourself. Get back on the horse and ride again. There's not many nurses who escape something adverse, be it major or minor, in their careers. Learn from it and move forward with confidence. you had confidence before, you'll regain it again. It might take time, but it will come if you believe in yourself and your abilities.

But ... you really should report such incidents regardless of what any old registrar tells you!

Best Wishes for the future. ((((hugs))))

Do follow policy, tell whoever you're supposed to tell.

Stop thinking you will never err, as you are only human. We always must strive for perfection, even though this is unrealistic. Time will ease your fears, as will a thorough review of how the error occurred. If you can't figure out why it happened, just accept that it did, thank God the patient is alright, and strive to be more careful. Triple check yourself, ask a colleague to confirm the meds with you, do whatever you must do to restore your confidence.

We'd worry if you did NOT feel bad.

Specializes in med surg, geriatric, clinical, pool.
Hi everyone. I've been an A&E nurse for 5 years without any serious incident - even managed to avoid the plethora of complaints haha!

However recently I made a serious drug error and my confidence to practice has completely been destroyed. In a nutshell, I gave a patient with anaphylaxis a second dose of adrenaline 1:1000(!) as a fast bolus IV injection instead of IM. His ecg was, let's say 'unnerving' for about 5 minutes but then settled back to NSR. I am very well aware that it should only be given IM (I gave the first dose IM) and if given IV you should give 1:10,000 at 1ml/min but I just wasn't concentrating.

The registrar was made aware of the incident directly after I realised I'd done it.

In the past few days, I've realised that doing this has absolutely shattered my confidence and I'm at the stage now where I'm almost terrified to go back and practice. I know that the half life of adrenaline is 2 minutes so any effects were long gone after 10 minutes and there will be no lasting effects. However this isn't the point. What bothers me so much is the fact of what COULD have happened. It could easily have put him into arrest and that's what has left me feeling so bad and so guilty.

Has anyone else experienced what I'm going through? If so, please give me some pointers on how I can get over it because I feel so bad about it and my once exuberant confidence lies in ruins whilst I'm now a bag of nerves even dispensing 2 paracetamol!

As my nursing instructor once said to us as students, "if any nurse said she has never made a med error, she is lying."

Which is true when you think about it. We are human therefore we will make mistakes. Doesn't mean its OK, but it has happened to everyone, they just don't say anything.

How do you cope with a med error? Learn from it and move on to being a better nurse.

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