fellow nurse, small error...what to do?

[BigMar]

Today at work, i was assessing a pt's skin and noticed an approx 3-4cm bruise with raised, palpable hematoma at her deltoid. I asked, "what happened here?" and she said, "the other nurse gave me that really painful shot for my diarrhea right there." This pt is on SQ, SUBQ!!! sandostatitin for a high-output fistula q8h. From what I inferred, the "other nurse" had given this med IM. It is very clearly, and has always been, ordered as a subq medication (and is never given IM, as far as I know). If I assume correctly, and I recognize that assuming is a bad thing, this is a med error--WRONG ROUTE.

My dilemma is this: Should I address this with my fellow RN directly, or write up a med error report that will involve the DON and powers-that-be and become part of the pt's medical record? I am sure this caused minimal harm to the pt and hopefully the hematoma will resolve without complication. The pt also, technically, received this medication, although the absorption may be different... arghhh. The nurse is very sweet and I don't doubt her safety, in general. I also don't want to bring it up to other nurses on the floor for fear of being gossippy or undermining...

Any suggestions would be appreciated.

[BigMar]

Thanks for the advice. there were a few responses to my question that were a bit reactionary, but yours was actually constructive. I am NOT a tattle tale and I was concerned about if I should and how to approach the other nurse, that is why I posted.

And, btw, the injection site where the bruise and hard, painful lump was was exactly one inch below the acromion process on the front part of the upper arm, right where you you put an IM, not the back of the upper arm which is the site for SQ injection in the arm. The pt is also really skinny, no extra fat in the arm (can hardly pinch enough to get it in the belly), so there would be no reason to inject a SQ med there.

And one more thing in my defense. I would never report an incident based on assumptions. I just inferred from what the pt said and the location of the lump what had happened and thought that this may need to be addressed somehow. It would be irresponsible of me to completely disregard the notion entirely. Hence the post. At the facility where I work, all med arrors have to be reported into a database that tracks them. The purpose of filling out the incident report is not to get the other nurse in trouble.

Please. Cut me some slack.

[logans_mommy]

I am only a nursing student and dont really have any insite other than you should do what you feel comfortable with. If you dont document this it could come back to bite you in the rear. Especially if something comes of the bruise and the patient mentions to a DR. or Super. that she had mentioned it to you. You are not being a tattle tale by protecting yourself. You sound like a great nurse and should not question yourself!!! These people telling you not to tattle arent going to pay your bills when you lose your license!!! (not that you would for something so small but you get the point)!! Good luck!

[Baddmedicine]

Aww, BigMar, I truly apologize, for I didn't make myself clear. My comments weren't directed at you, as you were asking for other opinions. If you were someone who always ran to a manager, you would've done that first and never come to a forum for advice. Obviously, you would chart what you observed and what the patient said. How you handled it from there would depend on the approachability of the nurse responsible. Since you didn't see the actual injection, the only thing you know for sure is that the site was wrong. It would be a teachable moment and one the other nurse isn't likely to forget. It would also be an opportunity for her to clean up after herself. If she doesn't want to take responsibility for any of it, then you have to decide from there how to handle it. I'm certainly not suggesting that you cover it up but it's nice when we are allowed to have the opportunity take care of our mistakes. If she is ethical, she will self report but will also have already initiated a plan of action to avoid the error in the future.

Please accept my apologies...

As we support and care about our sister nurses, self reporting becomes less threatening and more of a learning experience. Nurses have a tendency for some reason to eat their own. When we develop rapport with other nurses, they become excellent resources.

[PJROR]

I guess I work in a facility were often patients say one thing and it is another. Depending on the cognitive ability of the patient depends on how I would approach the situation. Patients with dementia etc can tell you some odd things. Also is it possible she had another injection there of something else. You may want to check your MAR. I am not sure if I would jump to conclusions. I know you have to cover your butt but you canget into legal hot water to if you accuse and have no hard evidence.