First med error...Advise..please.

allnurses Guide · Dec 11, 2016

Always let your supervisor know that you are overwhelmed.

Sometimes they may be able to find someone to help you out

a little bit, and sometimes maybe not but at least you have

asked, let them know you are in the weeds, and covered your

"butt" that way.

Having said that... you are going to make med errors. You did

everything right by letting the doctor know, letting the supervisor

know, and not trying to hide it, in which case the patient would

not have gotten their full course of Flagyl. You will make

mistakes.

You will come up with your own system for keeping up with

everything you have to do. I have worked with nurses who,

at the beginning of the shift, wrote down EVERY single thing

that had to be done, for every patient, on a piece of paper to

keep right in front of them. Wrote down every med, and

what time to give. Wrote down every treatment, wound

care, etc.. Every time to get vitals, blood sugar, etc.

You weren't negligent, not by any stretch. :)

Joanie49 · Dec 11, 2016

Thanks you, what you said means a lot. I know mistakes DO happen and we are only human. It is my first error so it kind of hit me hard. I normally do write down what I have to do in detail but it JUST so happens that same night I forgot my "normal" report/ to do list and had to use a generic one which I am sure did not help either :/

Double-Helix, BSN, RN · Dec 11, 2016

I just started a new position working in quality and patient safety. One of the biggest eye-openers to me, as I investigate safety events, was learning that errors are almost never related to just one failure (such as human failure). There are almost always at least one of more contributing process or environmental factors that make that error possible. For example, do you have an electronic medication record that can flag you when medications are overdue, or are you using paper? If paper, is the layout clear?

Since you identified that one thing that contributed to this error is that you forgot your normal report sheet, I would consider making copies to leave at work. Also realize that no report sheet is substitute for the actual medical record. You might consider changing your practice so that you review your MARs at a few different points throughout the shift to ensure you didn't miss anything.

With that said, NurseCard is completely right. Errors happen, every day, not because we are negligent or careless, but simply because we are human. You did the right thing by reporting the error and I'm happy that you received a supportive response. You can go one step further by helping to identify ways it could have been prevented, and either sharing with your colleagues or initiating a process change in your facility. That's how we all become safer.

loriangel14, RN · Dec 11, 2016

Where I work this would be an " oops I forgot to give it". The supervisor and doc would be left out of it.

Mistakes happen. Don't beat yourself up.

CalArmy · Dec 11, 2016

You will have med errors. The fact that you owned up to it and notified the necessary parties is the correct action. No matter how long you have been in nursing, you will always feel bad about it. You are human.

NightOwl0624 · Dec 11, 2016

Meds are given late for many, mant reasons. Most of them won't even be close to being your "fault". I wouldn't be too upset about this, but you may want to think about different approaches to try to prevent it. On our EMar system, a little icon appears when a med is overdue by more than 60 minutes. Usually it is for insulin automatically timed but the person did not order a meal yet. Anyway, I try to look for those things frequently to prevent this from happening. I also try to write down times of meds at the beginning of my shift if I have time. Still, these things do happen, we are human after all. You will find what works for you!

Ruby Vee, BSN · Dec 12, 2016

Everyone makes mistakes. Everyone. Anyone who tells you they've never made a med error is either lying or too stupid to realize they've made one. What matters most is what you do AFTER you make the med error. First, you recognize you've made one. Kudos to you! A lot of people wouldn't have caught it.

Second, the minute you realize you've made the med error, you set about mitigating any possible harm to the patient. You admitted your error, reported it to the appropriate person, and rescheduled the med. Not a big deal in the greater scheme of things. I once watched a nurse give 1 mg. of epinephrine IV push instead of the 0.1 mg. that was ordered on a fresh-out-of-the-OR heart whose blood pressure dipped once too often and quite too low. As his blood pressure shot past 200/100 on the way north, the surgeon at the bedside asked her "How much epic did you give?" and her reply was "What you ordered" as she tried to hide the empty syringe behind her back. He asked her three times, and each time the response was the same: she lied. The chest tubes were full of bright red blood, and then they overflowed. There was a trail of bright red blood following us as we pushed the patient down the (fortunately short) hallway back to the OR. He survived, but Jane's mistake caused a second surgery. I never really trusted her again after that. In contrast, Linda, the new grad who pushed 5 mg. of digoxin (0.5 mg was ordered) immediately recognized and admitted her mistake. No one worked harder than Linda to save that man's life, and no one was more devastated when he died. Linda's mistake wasn't only her own -- there were communication errors along the way and others had their share of the blame to take. Linda went back on orientation for an indefinite period and handled it with grace. Her reputation for "killing a patient her first day off orientation" faded a lot faster than anyone could have anticipated because she was such an exemplary example of grace under pressure. She's now an NP, and a very well respected one.

Inform your manager of your mistake before she hears it from someone else. Call her, text her, send her an email in the middle of the night, but make sure the first person she hears of it from is you -- and that you recognize your mistake, you realize how devastating it could have been to the patient, and you're focused on ways to prevent such a mistake from happening in the future. (One of my former managers remarked "It's really hard to give you negative feedback when you've already beat me to every point I was going to make and you're beating yourself up about it."

Don't let anyone think you take your mistake lightly.

I worked with a gal who defibrillated toothbrushing artifact. Twice. "Oh, I shouldn't have done that," she said afterward. And giggled. She was gone in five minutes.

Figure out, to the best of your ability, how the mistake happened and what you'll do about it. A guy I worked with was distracted by family when he drew and sent the wrong labs on a patient. The plummeting glucose was missed because he sent a CBC instead. An hour later, when the labs weren't back and he realized his mistake, the Accucheck sugar was in the teens. If the family feuding in the patient's room is going to distract you from doing safe patient care, evict them.

And my last point -- forgive yourself. That one is the hardest to do, but the most necessary. Once you've worked through that it happened, why it happened, what the effects on the patient's status were or could have been and communicated with your manager that you take it seriously, go home and journal about it or cry about it or whatever you do. Then forgive yourself. Not forgiving yourself leads to more anxiety and less confidence at work, almost guaranteeing that you will make another mistake.

You did all the right things. Pat yourself on the back! And then forgive yourself.

Sour Lemon · Dec 12, 2016

I would have just re-timed it without a second thought or notifying anyone. In the grand scheme of things, that is a "small potatoes" error.

Jules A, MSN · Dec 12, 2016

They happen and like others have said they happen to everyone. Don't let this shake your confidence but keep it in mind as you go forward and try to figure out what you might have done differently to avoid it in the future. You handled it appropriately and I appreciate the fact that you are so thoughtful about it. These are the signs of a great nurse in the making, imo.

sweetmissdixie · Dec 12, 2016

Every single nurse, whether they're aware of it or not, has made a med error at least once (Amelie Hollier, DNP, FNP-BC said something to that effect). We're human! I have missed a med before and had to give it late then adjust the treatment schedule - I don't know any nurses who haven't. Earlier in my career I also gave 2 norcos instead of 1 because I wasn't reading the order carefully. Luckily, everything was still kosher with both of my patients. But I definitely understand that feeling of guilt and remember feeling absolutely sick when it happened. Frankly, I think that's a good sign - you understand the potential ramifications of a serious med error.

The most important thing you can do is use this as a learning experience. It seems like you are aware of the circumstances that led to the error - so now you must plan ways to try to avoid that again (e.g., asking for help earlier before you get overwhelmed). Also, learn from other nurses' mistakes - I am thankful my errors were relatively harmless, as I knew nurses who incorrectly calculated Lasix and Heparin drips, gave the wrong insulin, etc., and harm did come to the patient. Reevaluating my practices (taking time to slow down and read carefully), holding other nurses accountable for double checks (no "I trust you"), getting enough sleep (I was a night-shifter), and asking for help (whether it was from the CNAs, pharmacist, other nurses, etc.) were all changes I had to make when I was new to try to prevent more, potentially serious errors.

The bottom line is don't beat yourself up too much. Learn and grow from this. To paraphrase Dr. Hollier again: There's a reason they call it nursing practice - you have to practice every day.

sweetmissdixie · Dec 12, 2016

These are the signs of a great nurse in the making, imo.

Agreed!