First med error...Advise..please.

DeeAngel · Dec 12, 2016

I don't know a single nurse who hasn't made a med error. Deal with it and be careful not to make the same mistake twice. That's all you can do.

BedsideNurse · Dec 12, 2016

Two things: everyone beats themselves up--at least a little-- when they miss a medication or are super late with it or whatever. No avoiding the nurse guilt, although you ruminate about it more when you are new. We all want the best for the patient so when we jack something up we feel bad. But what you need to remember is some things are sand box and other things are life changing. Basically if no one dies or has irreversible harm, in the scheme of life, it's a good day. Not that "not killing someone" is my standard of nursing care, but it helps to keep things in perspective. There are certainly worse scenarios than missed Flagyl, like the hair raising story above about killing someone with digoxin or nearly killing someone with epi. Which leads me to my second point, the epinephrine dosage error is one that I narrowly avoided as a newer nurse (luckily I clarified the dose with doctor before giving), and it's an error that I've seen happen a *number* of times, several with very bad results (MI, patient death), and it hasn't been just new nurses involved; two were old ER nurses who were great nurses. It is good to keep in mind that generally speaking you only give 1mg of Epi IVP to someone "who's dead." If they have a pulse you will be giving much less. We get so used to the 1mg of Epi IV because most of the time that's what we are dealing with in ACLS or code scenarios, and we aren't used to the "micro dosing" more often given in CCU's and ICU. As I've gotten older I find I am more likely to repeat a dosage or ask the question to be sure than when I was younger. Strangely, as I think back, I felt reluctant to ask for some reason, like I was afraid the doctor would think I didn't know what I was doing or something. Don't be reluctant! Most of the time they will appreciate you being careful with the patient, and if they act irritated who cares. And you don't have to ask as though you are totally clueless. Use a matter of fact tone, and have a confident demeanor, after all, you are working together to take care of the patient, and patient safety is a vital and mutual goal. So any time you are giving a high risk drug it's a good idea to double check the dose and route, and think about how fast to push and side effects, etc... Oh, while I'm at it, I just thought of another error that's easy to make: If someone is on a vasoactive drip, like Levophed, don't flush anything or piggy back something into the line. Also, if it's dc'd don't just disconnect it and flush it with 10cc NS. In either case you will inadvertently bolus the patient with Levo and HR and BP will go through the roof. This sounds very self evident, but when it's crazy busy and/or the IV tubing is a tangled ball of yarn, it's a mistake that is easily made and I've seen this a number of times as well. Carefully labeling all your lines, and taking a moment's pause to think about what you are doing, helps avoid this. Anyhow, don't stress too much about rather routine med errors. It happens, and assuredly it will happen again. Just try to avoid the big ones by being very careful with the drugs that can easily hurt people.

offlabel · Dec 12, 2016

Won't be your last or most serious. Be up front and honest, own it. Don't ever try to cover it up.

When immediate ownership and honesty follows an error, the net effect over time is a rise in esteem and credibility that would not have occurred were the error not to have happened in the first place.

JadedCPN, BSN, RN · Dec 13, 2016

Like most everyone has said, it sounds like you've done the right thing in this situation. You realized your mistake, you immediately corrected it and notified the appropriate people, and you feel bad about it - that is completely normal! As others have said, in the grand scheme of things it wasn't a big deal but I don't agree with some posters who said they wouldn't have notified anyone. I'm all about CYA, and when it was that significant of a time gap from when it was due and when you discovered it, I think you were completely appropriate to notify the people that you did.

Every nurse has made a med error. Don't beat yourself up, just learn from it and take it with you to become a better nurse.

chiromed0 · Dec 16, 2016

Medicine or nursing is not perfection. It is practice and mistakes happen. Missing a flagyl is no big deal. How many patients miss their dose as out patients? I had a doc freak out b/c a pt. on a heparin drip got locked and sent to imaging so she lectured me on getting clots, blah, blah blah...except I wasn't the one who did it. Besides, the patient wasn't stroking or even had true stroke signs (had she done a proper workup). But I digress...that was life threatening (potentially) and it happened b/c a transporter told the "new nurse" to "hep lock" the pt. so he thought they meant to stop the heparin drip and didn't know the drip was continuous. Nobody "hep locks" hardly anymore, it's a "saline locked" but the words were there and the confusion was too. I took it on the chin for him and then corrected him on what to do next time (just jumped the gun--chewing this dude out would have only led to him quitting and me stuck covering his shifts. Not good). Anyway, we all make mistakes. If you were on the provider side you would see mistakes all the time that are caught by office staff and pharmacies. Just learn and do the best you can--write it down and get a system.