Fluid Med Error

Been there,done that, ASN, RN · Jul 8, 2023

Any medication error is significant. " I didn't go back in to scan it in". You have a very important electronic check to perform. Next time, don't worry so much about lunch.

JBMmom, MSN, NP · Jul 8, 2023

As you pointed out there was no harm to the patient in the end so this error presents a very good learning opportunity. You thought you had grabbed D5NS so when the provider changed the order you would have been fine if you had scanned it and then realized that it was 1/2 NS. You're going to be hard pressed to find many people that say it's fine to skip scanning, especially in this day and age when nurses are being called out for many errors in public ways. Some very rightfully so for circumventing safety processes in place, and some in error when there truly is a system failure that led to a problem.

However, we all know that sometimes things like scanning get missed and it's usually not a problem. We get distracted, we just forget, etc. You will certainly be more mindful of similar situations in the future and you, and your future patients, will be better off with your new vigilance. Everyone has made mistakes, it's how you let them improve your practice that's really the important part.

delrionurse · Jul 8, 2023

Almost made this same mistake. Except the scanner caught it. Grabbed the .45 NS w/ dextrose. The bags are all layed out in the supply closet, easy to grab the wrong one.

akulahawkRN, ADN, RN, EMT-P · Jul 9, 2023

I haven't (yet?) made this specific mistake... because I caught the fact that I grabbed the wrong fluid bag as I was getting ready to spike and flood a line. Quite literally every time that I open a new fluid bag, I squeeze the bag to check for leaks, check the expiration date and I verify that the fluid bag is the one I intended to grab. This check is automatic and is done every time. It takes less than a couple seconds to perform. What I find is that the times I have grabbed the wrong fluid is 100% because the bag had originally placed in the wrong bin on the stock shelf. It's LR or NS that is misplaced into the wrong bin and usually there's a 2nd or 3rd bag still in that bin.

Yes, we all do make mistakes, but if you follow the med check rules every time, you will make very few of them.

JzK CCRN, BSN, EMT-I · Jul 10, 2023

Been there, done that...

So, without knowing anything about the patient, let's analyze the physiology behind this.

NS is isotonic and will replace intravascular volume. So in the case, of sepsis, dehydration, things like that, NS (or in my research, LR) is a better choice.

D5 1/2 NS is isotonic in the bag but hypotonic in the body. Sugar gets used by the cells and 1/2 NS rehydrates the cells. It's one of the reasons why it's often used as maintenance fluid.

That being said, if there's one thing I learned was that for these 12hrs, I'm there for benefits of the patients. If I don't eat, if I walk a bit more... I can use to loose few lbs. Overall, as long as I have AB, I'm good (wipe my own A$$ and Breath on my own. The rest is blessing. So SLOW DOWN, breath, ALWAYS ask yourself self WHY, why is specific fluid ordered vs the other, why is one med given vs another, ask those questions EVERY DAMN DAY, for every patient, EVERYTIME. At first, you'll be going home 1-2hrs later then everyone, but with time and experience, you'll (1) be a SAFE Nurse and (2) you'll be the most knowledgeable where you're seniors will hate you ? bc you're smarter then they are.

Newgradtrauma · Jul 10, 2023

Been there,done that said:

Any medication error is significant. " I didn't go back in to scan it in". You have a very important electronic check to perform. Next time, don't worry so much about lunch.

I wasn't the one worried about lunch. My charge nurse told me I had to go now because I had already told her I needed to finish some tasks on my patients. I'm trying not to read into your comment but I feel like it's probably unnecessary to add the last sentence.

Newgradtrauma · Jul 10, 2023

JzK RN said:

Been there, done that...

So, without knowing anything about the patient, let's analyze the physiology behind this.

NS is isotonic and will replace intravascular volume. So in the case, of sepsis, dehydration, things like that, NS (or in my research, LR) is a better choice.

D5 1/2 NS is isotonic in the bag but hypotonic in the body. Sugar gets used by the cells and 1/2 NS rehydrates the cells. It's one of the reasons why it's often used as maintenance fluid.

That being said, if there's one thing I learned was that for these 12hrs, I'm there for benefits of the patients. If I don't eat, if I walk a bit more... I can use to loose few lbs. Overall, as long as I have AB, I'm good (wipe my own A$$ and Breath on my own. The rest is blessing. So SLOW DOWN, breath, ALWAYS ask yourself self WHY, why is specific fluid ordered vs the other, why is one med given vs another, ask those questions EVERY DAMN DAY, for every patient, EVERYTIME. At first, you'll be going home 1-2hrs later then everyone, but with time and experience, you'll (1) be a SAFE Nurse and (2) you'll be the most knowledgeable where you're seniors will hate you ? bc you're smarter then they are.

Maybe you can't give me some advice. In the ED I work in the charges are incessantly on us about if we have taken lunch or not. I never ask to go to lunch because sometimes I feel like it just isn't ever the right time. How should I go about this with my charge nurse? I'm never complaining about lunch, I actually tell people to lunch everyone else before they do me so that I can get my patients taken care of.

JzK CCRN, BSN, EMT-I · Jul 10, 2023

In you're original statement, it appeared that going for food seemed to be very important. There was no indication from how unit functions, to charge nurse, etc etc.

This situation could have easily been related to rushing towards something. Therefore, my response and few other's, included these points. But your reply omitted other things I wrote, (the physio, the AB, slowing down) and only came back with break time section.

I don't believe that anyone here wrote anything along the lines of derogatory towards you, on contrary, you've been supported.

So to unharm and heal you're soul ? when you're asking for feedback, be willing to accept it, learn from it and move on. ?

Been there,done that, ASN, RN · Jul 10, 2023

Newgradtrauma said:

I wasn't the one worried about lunch. My charge nurse told me I had to go now because I had already told her I needed to finish some tasks on my patients. I'm trying not to read into your comment but I feel like it's probably unnecessary to add the last sentence.

How would I know you were told to take lunch? The break situation has become an ongoing problem in nursing. Administration knows we are legally entitled to a break, they also know they are overworking us to the point that it is not safe to leave our patients. I have had supervisors tell me to lie that I got a break. But.... that's another thread.

JBMmom, MSN, NP · Jul 10, 2023

Newgradtrauma said:

I never ask to go to lunch because sometimes I feel like it just isn't ever the right time. How should I go about this with my charge nurse?

This has become one of the BS parts of nursing administration because it's something they can point to and say "we ensure all of our staff get appropriate breaks". They aren't the ones concerned about patients getting the BEST care, but they expect all of the safety and competence required in addition to getting breaks. They will say you need to learn how to prioritize your time, they will blame time management skills, but in the end you have to be able to stand up for yourself and your patients. I completely understand a charge coming to you about breaks, sometimes I have to be that person on my unit, but if I'm coming to ask someone else to take their break it's also part of my job as charge to help them get things done, or do them myself, in order to make that happen. We're all overworked at times these days and sometimes the administration is only out for their bottom line, not yours or the patient's. As best as you can, take your time, ask for help, and if you absolutely cannot take your break, bring that to their attention.

marienm, RN, CCRN · Jul 10, 2023

The lunch break thing is important but it's also a bit of a red herring here OP. The fact will be that you will ALWAYS have multiple demands on your time and multiple things to prioritize. In this case, you chose to skip a step of med administration because someone else was demanding that you go to lunch. The next time it will be a staff member wanting help transporting, or a patient trying to jump out of bed, or a code, or a provider mad that the labs aren't drawn yet for their patient, etc... In each of these cases you have to decide which one to give your attention to "I can help you go to CT in 2 minutes when I finish this med" vs "I'm sorry Mrs. Smith there is an emergency and I will be right back."

Sometimes there will be a "right" answer (if the provider is mad that you didn't draw a stat troponin, that's a pretty high-priority thing and you should have done it first). Other times there won't be one "right" answer but you need to develop a mindset that lets you finish one task efficiently but completely and correctly before moving on to the next thing. Part of developing your flow as a nurse means listening to everything and putting it in your queue but NOT getting sucked in to feel like you have to do it right this second. Unfortunately distractions are part of the environment and won't change. The opportunity for growth is to develop a mindset of owning your own response to the environment (even though it would be great if the charge nurse wasn't badgering you, you chose not to scan the bag). This is often part of the growth of a new nurse so you are right on track.