First med error - crushed a SR tablet

NC Girl BSN · Jul 13, 2009

Please don't worry about it and don't make a big deal about it when you get to work. I am a new grad 12 weeks in and a LPN 2 yrs prior. It didn't cause any adverse effects so just learn from the expereince. At the nursing home I remember crushing prilosec all the time even though it clearly said not to crush because medicare was so cheap that it would pay for the extended release.

Again, I would not get into habit of doing it again. Next time try mixing the pill with apple sauce or pudding and see if they can swallow it whole that way. Or call the doc and see if he prescribe one that not SR tab.

((Hugs))Now get some sleep.

morte, LPN, LVN · Jul 13, 2009

I had my first med error the other day and I feel so crappy; mostly because I think it was handled wrong.
I am in week three of orientation on a med/surg unit. I graduated in May.
My patient was an 80 yo with a fx pelvis after a fall. She was ordered an 180 mg verapamil. I went to give it and she said she was unable to swallow any pills. I told my preceptor and she said to just crush it. I thought to myself, hopefully it's not a sustained release, but didn't check because I assumed my preceptor would have picked up on it if it was.
I realized it was a few hours later when I looked it up and was so upset. It was nagging me and that should have been my first clue to not do it!
Pt. had no adverse effects that I saw and preceptor said it's no big deal. It was the end of the shift and I left upset about what happened. Dr. was never notified as far as I know. That was Friday and I go back tomorrow. I've spent all weekend so upset. I wish I had just called the Dr. to tell him. Now I've spent all weekend worrying and am scared to go back to work tomorrow. I know it was not handled correctly and I'm not sure what to do three days later! Any advice?

your right,it wasnt handled properly at all...your preceptor is covering his/her own butt......did this woman come from home or a nursing home? how was she taking it before? perhaps the nursing home was making the same error.....if you give IR form it is given more frequently at least three if not four doses daily......good luck

LyndzBenz · Jul 13, 2009

You really shouldn't worry over making such a med error. 1. The patient wasn't harmed. 2. Your preceptor should be like a hawk over your back, 3. Double-checking is a blessing in disguise, even if you have to say, "hold on, let me check this one more time." Do not be afraid of checking with another person who isn't your preceptor if you feel "weird" or if it just "feels" wrong. You have to get over this and get back on the horse. Not that it wasn't bad that you made a mistake, but there is something that you can learn from every mistake and that is that you probably will be more alert and double-check yourself next time. You may also have a unrealistic view of yourself that includes being a perfect nurse, and that is so far from the truth. Everyone makes mistakes. It's expected that you will make some kind of error in your lifetime of being a nurse. Just take it as a learning session, and move on.

Tulip28 · Jul 13, 2009

I was disturbed at another nurse telling you not to worry as the patient was unharmed. Yes it is fortunate that this was the case but it could have had serious consequences especially in someone her age. I don't think you need to be so hard on yourself but as the manager of a surgical ward myself I think it is important that you speak with your manager or if that is too confronting another senior nurse you feel comfortable with. If you were one of my staff I would expect you to have told the team leader of the shift what had happened and filled out an incident form.

What I do then is just follow it up with the nurse involved- not to be in trouble but to see how they can learn from the incident. You are an RN now and just because a senior person told you to do something does not cover you should it ever become a legal thing. You can seek advice but always go back to the basics and look up drugs etc. until you are confident.

Don't be too hard on yourself we have all made mistakes- but make sure you handle it right when you do and then you will not feel so guilty.

All the best in your career.

Melina · Jul 15, 2009

I agree with Tulip. While you shouldn't beat yourself about it, there should be an incident report. It isn't about getting people in trouble. It's important data that is used to create safer practices.

~Mel

mcknis · Jul 17, 2009

Yep crushing a SR is just part of the job and mistakes will be made...at least it was still given to the correct pt. You will make other mistakes, some you are aware of and others you are not. I have made many mistakes in my first year and have had incident reports filed against me, but with each mistake, you learn from them and will more than likely never make that same mistake again, or at least it will be a long time before it does happen again! Just take a deep breath and continue to go on...good luck!!!

quinnie50 · Jul 19, 2009

i am in my 8th week of orientation and also made a med mistake...i just started working 12 hour shifts so my preceptor was changed and to be quite honest i am a little intimidated by her....we got really busy and my preceptor asked the charge nurse to help me with a blood transfusion that had to be restarted after my very sick patient spiked a high temp...the charge nurse told me to go the the pixus and get 2 tylenol...i saw my preceptor who was helping my other patient and asked her which tylenol order to use because there were a few because she had to be premedicated prior to the transfusion...and she told me just to use the prn order...i then gave the pt the tylenol because the charge nurse told me to and was later scalded by my preceptor bc it was an hour too early...then at the end of the transfusion i had an order for lasix because my pt was not voiding and had krackles in her lungs...my preceptor drew it up and told me to give it, and then was scalded again because her b/p was too low..she knew all a long that her b/p was low...i couldn't sleep that night because i was afraid i could have killed my patient...but i should have known better and asked more questions and called the doctor..i was taking care of the woman for two weeks and the family was really hoping that she would agree to hospice but she refused..i have developed a good relaionship with them and would never do anything to hurt her....i honestly never thought that nursing would be this hard, but i do love it and the gratification i get from helpingpeople is amazing....i just wish i had better instincts.....i know now to check and double check before i do anything...and i don't care if it takes me too long

SuesquatchRN, BSN, RN · Jul 19, 2009

Quitew bluntly, in LTC we crushed SR meds all the time. The resident can't get ANY benefit if he doesn't take it. We would get orders changed when possible and otherwise, if the MAR said to crush his meds we just did unless it was something that would clearly be harmful - such as Avodart - if crushed.

I wouldn't count it as an error at all.

mistyda · Jul 19, 2009

That's what my preceptor at the time said pretty much; crushing it and giving it is better than not giving it at all.

allnurses Guide · Jul 19, 2009

I had my first med error the other day and I feel so crappy; mostly because I think it was handled wrong.
I am in week three of orientation on a med/surg unit. I graduated in May.
My patient was an 80 yo with a fx pelvis after a fall. She was ordered an 180 mg verapamil. I went to give it and she said she was unable to swallow any pills. I told my preceptor and she said to just crush it. I thought to myself, hopefully it's not a sustained release, but didn't check because I assumed my preceptor would have picked up on it if it was. I realized it was a few hours later when I looked it up and was so upset. It was nagging me and that should have been my first clue to not do it! Pt. had no adverse effects that I saw and preceptor said it's no big deal. It was the end of the shift and I left upset about what happened. Dr. was never notified as far as I know. That was Friday and I go back tomorrow. I've spent all weekend so upset. I wish I had just called the Dr. to tell him. Now I've spent all weekend worrying and am scared to go back to work tomorrow. I know it was not handled correctly and I'm not sure what to do three days later! Any advice?

First of all, give yourself a break as every nurse on earth has made some kind of mistake. Treat it as a learning experience, and as a way to make you a safer nurse. A few things:

1. Listen to your gut!!! This is probably THE most important thing I can tell you. If you ever get that "I wonder if.." feeling, go and check it out. Ignoring that inner voice is so often when you make mistakes.

2. Don't assume that other people, even older/more experienced people know more than you. Sometimes they don't.

3. Whether or not the patient had adverse effects is not the point. The point is that they could have.

4. The poster who said they crush these meds often unless it's one where it could be dangerous - don't do it. That assumes that you will know which ones are ok and which are dangerous. There is a package warning on SR meds because the manufacturer thinks they can potentially be unsafe if crushed. Plus, you may be causing damage to the patients.. for example, if it's an antihypertensive - you may drop their BP after giving it, but it's going to go up again well before the next dose is due (and may not be checked during that interval).

Yep crushing a SR is just part of the job and mistakes will be made...at least it was still given to the correct pt. You will make other mistakes, some you are aware of and others you are not. I have made many mistakes in my first year and have had incident reports filed against me, but with each mistake, you learn from them and will more than likely never make that same mistake again, or at least it will be a long time before it does happen again! Just take a deep breath and continue to go on...good luck!!!

Incident reports are not filed "against" you - they are a data collection tool to track where and how mistakes are made, so that changes can be made in processes if required.

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Overall, don't beat yourself up about it.. the fact that you're so upset shows that you have a good insight into your own practice.

Pediatric Critical Care Columnist · Jul 19, 2009

Quinnie 50, those are tough lessons to learn, but they point out a very important factor in what we do. Critical thinking, that buzz-phrase that I hate so much, is vital to the safety and efficacy of nursing care. The 5 rights of medication administration aren't just something for instructors to drill you on, they keep the patient safe. Did giving the Tylenol an hour early harm the patient? Unlikely... but if it kept on being given an hour early eventually there could be toxicity issues to the lady's liver. What could you have done for the patient instead? As for the Lasix, another important thing about nursing is knowing why we're giving the drugs we give, the basics of how they work, what they are going to do to the patient, and knowing the patient's individual responses. Giving a drug known to cause rapid diuresis to an already hypotensive patient is usually unwise. This is where the critical thinking part comes in. Just because your preceptor tells you to do something doesn't mean you have to. It's obvious she was testing (hazing?) you; you did what she wanted you to and that was to make a mistake. Grit your teeth and get back in there! If this becomes a pattern, discuss it with your manager.