First day without preceptor and first error

Nurses New Nurse

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Well today was my first shift alone, offically just me as the RN.:uhoh21:

I prayed to whole way to work. Oh, I was so nervous.

I took a 5 minute break to eat half a sandwich but was running the rest of the nght....PCA's, TPN, pain meds, new admit, etc....

Okay, by the end of the night I think things are pretty good...I actually got all of my work done and charting was almost complete. I was only there 10 minutes late....

So the night nurse who just came on comes up to me and says..."Is there any reason you didnt hang the rest of the potassium"?

"WHAT?", I am thinking...I am so very thorough as I am terrified of making a mistake.

The MAR showed 40 mEQs due. The day nurse had charted a time it was given. I did not know that it came in 10 mEQ bags and that I was supposed to hang another THREE bags!!!:o

I told the nurse that I had no experiencce w/ this (had only given PO before) and did not realize that I was supposed to hang more.

Although pt is fine. I feel SO bad, so stupid. On top of it, on my way out I heard the nurse tell another nurse about my error. I am not sure how I could have caught this w/out a preceptor right there. Now I am even more nervous about tomorrow!!!

I can't believe this happened on my first night on my own! I mean, I double and triple check everything! Tonight I even called a MD cuz she wrote "tab" for a medication and I wanted to clarify it was PO (a coworker said not needed, but I wanted the "correct" order).

Sorry to go on and on.

I would SO appreciate some words of encouragement, or similar tales of unintended med errors.

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

Where I work the doctors order a certain amount of K-riders to be given. Each K-rider has 10 Meq of Kcl in it. We document this on the IV flow sheet as well as on the Med sheet. We also mention in report how many they have had. I've never heard of a problem like this.

Your current system is inherently flawed.

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Specializes in High Risk In Patient OB/GYN.

Our system is pretty good. Anyone receiving situational K+ replacement (ie, not an 80year old who's been on K-Dur for 9 years) has a special order sheet for that.

The order sheet includes: dosages(incl. how to be dispensed by pharm-how many mEqs/mL, desired rate, etc), routes, recent lab values, when bloodwork is due again, when replacement was initiated, specific protocol, etc. Most are check off boxes, with some fill in the blanks.

I find it very easy to navigate, and very helpful for those unfamiliar with K+ replacement (we don't get a lot here in high risk ob).

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Specializes in Emergency.

Hi,

I hope you are not feeling too badly about this! I am still on orientation at my hospital, and only yesterday had a pt who had a critically low K, and was ordered IV replacement. This was the first time I had ever given IV K.

I was actually surprised to see that the bags were in 10mEq increments. When I got the first bag out of the pyxis, I noticed that several doses were scheduled (4 to be exact).

I did ask my preceptor about this, and she showed me how to mark the bags (1 of 4, 2 of 4, etc.), so I and the oncoming shift knew where she was in her treatment. She also showed me the hospitals policy and procedure guide for this drug.

While I do not really consider this a true error (I may be wrong), you also have to give yourself a break. You are new, you will make mistakes, and as long as you make sure you are honest and hold yourself accountable for them, you will be fine. You may be asked about it, but if your unit manager is good, she will understand that you are new, and be understanding.

I made a med error when I was still in school, and while it was not (thank God) a truly dangerous drug, it still devastated me. I accidentally gave a double dose of PO Reglan (10mg instead of the 5mg ordered). When I realized my mistake, I immediately told my preceptor, and she helped me to fill out the incident report, etc. What made it worse for me is that I had just been interviewed and hired on the same unit! I was so scared I would be fired before I even graduated and started working! When I went in the next day, and the unit manager asked me about it, I burst into tears, and could not stop crying. All I could think about was what if it had been a double dose of a really high risk med and I was responsible for harming the patient because of my mistake. She was very understanding, and although she said to me that it was a mistake that I could have avoided had I been following proper procedure (ie 6 rights), that no one is perfect and we all make mistakes. She shared a story from her early days of nursing, (she gave a sedative to a pt who was post anesthesia. The pt stopped breathing. Code called. Pt survived, but she felt terrible.

So the moral of the story, and something I have really taken to heart since my error is to always follow the 6 rights, and if in doubt, or working with a new med, look it up, ask someone, and you will be alright. I am certain the other more experienced RNs have all made mistakes. Don't let them get you down. Sometimes the seasoned RNs can be a little too hard on the newbies, and forget they were new once too.

Another good tip I learned is to sit down with your worksheets, and highlight the meds you give and make a note in the margin if it is a 1/2 tab, or a partial dose of a liquid or IV med, etc ( I use a red pen). This way when you do your meds its right there in bold colors to alert you to it.

Hope this helps.

Amy

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

This is considered an omission and an omission is a med error. If it was signed off on the med sheet and not mentioned in report, then the contributing system errors and communication errors were largely to blame.

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Yep what weebaby said.... 4 bags should have 4 times AND this should have been communicated in report "pt is getting 40mEq of K. I hung the first bag but there is still 3 bags to go" or SOMETHING.

I agree. There needs to be a better system to this et you should have been given this info in report that there was still more to hang.

Leslie

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Specializes in Adult Acute Care Medicine.

Thank you SO VERY much for all of your comments.

I went into work the next day and talked to one of my coworkers about the situation who said, "oh ya, we just take for granted that everyone knows to give 4 bags"....she also said that most nurses DO report off on how many they have hung.

Its pretty scarey that a better system is not in place! I work in a top 10 major teaching hospital too....we are moving to totally computerized orders and charting, so this problem will go away...still I am going to talk to my manager (who will be back from vacation next week), about changing entries in the MAR.

Again, thank you so much! Entering the nursing profession is so stressful in so many different ways, and your feedback has helped to ease some of that stress!

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Specializes in Neuro, Critical Care.

We give KCL in 10 MEq bags if running through a Periph IV. We give 20MEQ if through Cline. Depending on what the pts. K was, that depends on how much KCL we give....we have a unit protocol.

The day nurse should have said..pt x's K was 3.3 today and so I treated it with one bag of 10CKL and she still needs three more..40 total...

Then we put it on our MAR: 0100 (initial) and (10mg)..that way the next nurse knows whats been given even if you forget to tell her how miuch you have given. Also, if im not sure sometimes Ill ch eck to see how much the RN pulled from the pyxis..but you have to be careful with that.

Not such a huge deal, re test her K, shes most likely fine.

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Specializes in ER, OR, MICU.
Thank you SO VERY much for all of your comments.

I went into work the next day and talked to one of my coworkers about the situation who said, "oh ya, we just take for granted that everyone knows to give 4 bags"....she also said that most nurses DO report off on how many they have hung.

Its pretty scarey that a better system is not in place! I work in a top 10 major teaching hospital too....we are moving to totally computerized orders and charting, so this problem will go away...still I am going to talk to my manager (who will be back from vacation next week), about changing entries in the MAR.

Again, thank you so much! Entering the nursing profession is so stressful in so many different ways, and your feedback has helped to ease some of that stress!

Wow this is a recipe for disaster. . .they "just take for granted" that it is assumed everyone knows 40 meq is given in 4 bags? ? ?

I hope you do feel better about this because this is NOT your fault at all. Usually K is defaulted into 10 meq bags because it is OK to give 10 meq in a PIV. . .anything more than 10 meq should go into a Central line cuz it is very painful when infusing. We have 10 and 20 meq bags. How would you know how much to even give if it wasn't marked on the MAR appropriately? Also how would you, as a new nurse, know that you can't give more than 10 meq at a time in a PIV if you weren't precepted on it. Thus, you wouldn't have questioned if 40 meq was truly given.

If your manager doesn't see this as a problem then I would try to talk to someone above him / her because what other things do they "take for granted"????:uhoh3::uhoh3::uhoh3:

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Specializes in ICU, SDU, OR, RR, Ortho, Hospice RN.

Awwwwwwwww hang in there.

Crapola happens but learn from this and move on.

Sounds like you had an extremely busy night and did good to get through.

Sounds like this was not passed on to you in the correct manner.

Go back to work with your head held high.

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Specializes in Oncology.
Don't be so hard on yourself, I would have done the same thing. About the K+, the other nurse should have written that she only gave 10 meq. If someone signs off next to 40 meq on a MAR they are saying that they gave the entire 40. How were you supposed to know how much was already given, what if she had given 20 meq instead of 10? It would be safer to have the dose listed at 10 meq with 4 different times that need to be signed off on.

WeeBaby is 100% right -- our pharmacy dispenses KCL IV in 20meq bags -- so if a pt is ordered to receive KCL 60meq IV, the order will be written KCL 20meq IV infuse over 1 hour x3 for a total infusion of KCL 60meq. That way this will let us know its 3 bags and when we document the order on the MAR we leave three spaces to be filled out.

It was a simple mistake -- not too life threatening --- and we all know that KCL never gets in on time like the docs want. It never goes in over an hour unless its in a PICC, CVC, or Port, because it burns and irriates in the PIV.

Just learn from this experience and move on...this makes you a better nurse now. :)

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Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

hi,

Dont feel bad, I am a new grad and made my first boo boo the other day. I came in at 7:00 for my shift and was rounding and doing 8am meds, when i found out one of my patients was going to MRI very soon. So I had to assess her and give meds before they came to get her, well a second later they were already waiting. One of her meds was lisinopril and I was in such a hurry I looked at the wrong set of vitals and thought her pressure was fine, when really it was 85/50 and I gave her the lisinopril based on looking at the wrong one and didnt even realize it till later. When she got back from her test a couple hours later i recheck it and it was up to 92/50-somthing. Before i give bP meds I also ask the patient if they are dizzy when standing etc, which she wasn't she was totally asymptomatic, but my heart dropped when i realized what i had done. I had to tell my precptor and the charge nurse and they made me feel better aobut it. I called teh doctor becuase they told me too and he was also fine with it and just decreased her dose. The night shift never even mentioned her low BP to me in report- it was 70/40 earlier in the night, but none the less I learned a lesson about being less rushed when giving meds.

So I understand where the OP is comming from, as I am sure many others do also. It is especially hard to make a mistake when you are a new grad and are trying to prove that you are capable of being a good nurse, but I guess being a good nurse also means admitting when you make a mistake.

Sweetooth

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Take a deep breath. No one is perfect.:idea:

At my work the riders k+ or mag -have to be checked by 2-RNS w/ the order and signed off on the MAR.This is to prevent or assure no mistakes are made. We get usually 40meq riders. 1-bag.This may differ from facility to facility.

Don't beat yourself up. When your new you always feel like your walking on eggshells anyway. Experience comes w/time. If you have any questions always double check w/someone else. They prefer you to ask, than assume your a miss know it all and make a big mistake.Believe me it is not worth it.Better to be safe than sorry..

Best wishes to ya.

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