First medication error & on new graduate orientation :(

[gardenia09]

i feel so incredibly guilty that i went searching for a forum to discuss this. i am a new graduate on an intermediate icu in orientation on my 2nd week. it has been going well and my preceptor is good. today i made a stupid, careless error. i had a patient receiving decadron 4mg bid. i gave them their 0900 dose no problem. then at 1200 i went to give them their other meds and i gave another dose of decadron 4mg that wasn't due until 2100. i had another patient getting decadron 4mg at 1200 and red the wrong emar when i pulled it up on the computer. i gave the extra dose of decadron and then looked at the correct emar again and realized i wasn't supposed to give it after my preceptor asked me what meds i had just given. i feel so bad because first off, i usually check all my meds with my preceptor beforehand if i haven't given them that shift. then idk why i didn't check the name on the top of the screen i just looked straight at the meds. my preceptor was obviously annoyed because its on her name as well but she was still supportive as i fought back tears and swallowed hard. we went straight to the anm and they said that there is no harm done, we called the md and did an incident report.

i already feel incompetent on this unit beccause of the acuity and so much to learn that very different from nursing school. i went to lunch and couldn't even swallow my food. i tried to finish the shift with some dignity but it was difficult. i went through nursing school without any incidents in clinical at all and am somewhat of a perfectionist. i am still disgusted with myself and i am sure i will have to talk about this again. how do i keep my confidence up? this is unacceptable and could have caused harm. i have been an rn for a few weeks and this is not a good way to start. they said it will never happen again now, i sure hope so!!

[bjz823]

i am like the above poster. i check my medications against the mar so many times (and the patient) that i drive some nurses nuts (oh, well)! the reason i do this is because i have the fear of making a medication mistake. in fact, the other day a patient's family member thought she saw me give two of something i only gave one of... since i check myself a million times i know i did not give two of it even though i brought two in the room (one medication was sharing a bag with others of it's kind and was not labeled otherwise. at the bed side i pulled out the right dose so i could triple check the 5 rights). she was the type of person who would have accused me of something i did not do... btw, i figure every patient and family member is that way so that keeps me on my toes.

i do not have an emar. there are only a few departments in my hospital who are electronic... however, i floated to a department with an emar that is not at the bedside. in that case i triple check at the computer (pull all my meds and proper doses) and took very few meds into the room at a time so i knew literally which pill was what... i am not comfortable with taking 25 medications into a room without a paper copy of a mar!!!

do you have emar and a paxis next to the bedside? if so, then i would treat that in the same manner i treat my paper mar. my third and final check can happen at the bedside.

in nursing school i used to be worse... i used to check the patient when i entered the room... checked the papient while doing my third check of 5 rights... and checked the patient before handing the patient his/her dose. and yes, this drove my instructors nuts... i realized by fourth semester that was a bit much.

-new grad rn:nurse:

ps.

also, i agree with the above poster that you are human take this as a learning lesson!!! those sick feelings you now have will more then likely prevent you from making any more errors in the future! i had an instructor who once told me that when you no longer have that small sense of fear of making errors is when you will make them... so now you will never be without that sense of fear.

also we are learning... nursing school is nothing like being a new grad! the expectations are high in nursing school but they are even higher with the rn title next to your name. not to mention the amount of learning we have to absorb in a short amount of time and apply at the bedside (the true test)! some days i feel like the most competent new grad around... other days i am reminded painfully that i am only a new grad. good luck to you and keep on posting... all of us will get through our first year together!

thank you so much for sharing that. i check myself so much while doing my med pass. i am calming down. i do better when others are not around me but i like to check several times. i am determined not to make mistakes. i did forget to give something and not signed off on things in school, but i am trying too get things 100%. i feel better hearing you say you do the same thing and so what if the other nurses get impatient. i am not iv certified yet. that class is coming next month. i know i will only be able to do fluids and not meds as a lpn.

[june2009]

I worked in an LTAC facility and sometimes we would have patients who were CMO and on a morphine drip. In this facility LPNs could hang IVs as long as they didn't titrate them. Well there was a patientwho was receiving 2 mg/hr (one to one concentration = 2 ml/hr). The LPN thought it was an antibiotic and running too slow (she thought it should be running at 200 ml/hr) and changed the rate to 200 ml/hr. The entire bag of morphine infused in about 30 minutes (100 mg of morphine). Needless to say the patient went into resp failure and needed a lot of narcan. The patient lived and the LPN was suspended for 3 days. She came back an still had a job and a license.

Don't feel so bad, worse things have occured!

[nerdtonurse?, BSN, RN]

Don't beat yourself up; my preceptor told me "there's two kind of nurses; those have or will make a med error, and those that lie about it."

I've made them -- I gave gabapentin that had been DC'd because I didn't check dayshift's chart to make sure they'd done their orders.

Don't beat yourself up. Just use that perfectionist streak to figure out how to make sure you never do that same kind of error again.

[truern]

I worked in an LTAC facility and sometimes we would have patients who were CMO and on a morphine drip. In this facility LPNs could hang IVs as long as they didn't titrate them. Well there was a patientwho was receiving 2 mg/hr (one to one concentration = 2 ml/hr). The LPN thought it was an antibiotic and running too slow (she thought it should be running at 200 ml/hr) and changed the rate to 200 ml/hr. The entire bag of morphine infused in about 30 minutes (100 mg of morphine). Needless to say the patient went into resp failure and needed a lot of narcan. The patient lived and the LPN was suspended for 3 days. She came back an still had a job and a license.

Don't feel so bad, worse things have occured!

Huh?? We don't hang morphine unless it's in a PCA. No mistaking a PCA for a routine drip.

[carolinapooh, BSN, RN]

The other nt, I even had 2 female pts with the same last name in rooms right next to eachother! Talk about an error waiting to happen!!

OMG!!! Who let THAT happen?

We've MOVED pts to keep that from happening - not often, but in the two times I've seen it, we moved someone to the empty room. Pts and families are always very understanding when we explain why!

And to the OP - if it makes you feel any better, I know someone who, within their first six months on the floor, gave PO liquid methadone IV (that wasn't me - I once gave morphine instead of hydromorphone, though - and felt equally daft when I did it).

It happens. Fortunately there was no harm done, it sounds as though it was handled appropriately, and you've learned from the mistake.

[carolinapooh, BSN, RN]

Huh?? We don't hang morphine unless it's in a PCA. No mistaking a PCA for a routine drip.

We have put pts on a morphine drip who are at end-of-life.

[rnto?]

I once double checked all of my meds, because I was on a long term care floor and I didn't know the patients that well. So I had Mrs. H and Mrs. M (not real initials) in the same room. I got all of Mrs. H's meds ready, double checked the dose's and the MAR's, yes, these are all Mrs. H's medications and they are correct dosages, walked into the room, saw Mrs. M, checked her name band, yes, you're Mrs. M, and gave her Mrs. H's pills. I still feel bad, and it was a few months ago.

[ChiSmile6]

I have done the exact same thing..walk out of a patient's room with all the meds and check AGAIN maybe for the fourth or fifth time..just because I want to be XTRA sure...might sound crazy but it's what helps keep me feeling sane!

[nurseme3, LPN]

Mistakes happen and you learned from it. We are all human, and I wish you the best as you continue in your career.

[spongebob6286, BSN, RN]

I worked in an LTAC facility and sometimes we would have patients who were CMO and on a morphine drip. In this facility LPNs could hang IVs as long as they didn't titrate them. Well there was a patientwho was receiving 2 mg/hr (one to one concentration = 2 ml/hr). The LPN thought it was an antibiotic and running too slow (she thought it should be running at 200 ml/hr) and changed the rate to 200 ml/hr. The entire bag of morphine infused in about 30 minutes (100 mg of morphine). Needless to say the patient went into resp failure and needed a lot of narcan. The patient lived and the LPN was suspended for 3 days. She came back an still had a job and a license.

Don't feel so bad, worse things have occured!

that was scary! he could have died!

[mnscotti]

Ok, so here is where I sound like a jerk. Too many people are giving you questionable advice. "Don't feel bad"?, yes you should feel bad. You are only human? Yes you are and we all make mistakes. But for god's sake, feel bad! This is how we learn. This is what guilt is for. Don't get me wrong, obsession and incapacitation does no good, but if you get anywhere near complacentcy knowing that, hey we are only human, and its ok to make mistakes, we will be that much more susceptible to let our guards down.

As a new nurse myself, I have no doubt I will make errors similar to yours if not worse. But I will feel bad and will not seek forgiveness because I won't deserve it. Our mistakes and our remorse for them make us better nurses. Once we can blow off mistakes and let it flow off our backs, we should get a desk job and get out of the way of those who can fight the good fight.

I fully support you and am glad you have such passion for your actions. My whole point was to bring us all back to the fact that embracing our errors is not the same as dismissing them as inevitable...even if they are.

[mnscotti]

Ok, so here is where I sound like a jerk. Too many people are giving you questionable advice. "Don't feel bad"?, yes you should feel bad. You are only human? Yes you are and we all make mistakes. But for god's sake, feel bad! This is how we learn. This is what guilt is for. Don't get me wrong, obsession and incapacitation does no good, but if you get anywhere near complacentcy knowing that, hey we are only human, and its ok to make mistakes, we will be that much more susceptible to let our guards down.

As a new nurse myself, I have no doubt I will make errors similar to yours if not worse. But I will feel bad and will not seek forgiveness because I won't deserve it. Our mistakes and our remorse for them make us better nurses. Once we can blow off mistakes and let it flow off our backs, we should get a desk job and get out of the way of those who can fight the good fight.

I fully support you and am glad you have such passion for your actions. My whole point was to bring us all back to the fact that embracing our errors is not the same as dismissing them as inevitable...even if they are.