Fluid Med Error

[Newgradtrauma]

Hello! I'm a new grad nurse, passed my NCLEX late Feb. I just need some advice or encouragement. I made a med error with fluids. I grabbed d5 w/0.45NS instead of 0.9% for a patient. The patient got the whole bag but another nurse noticed the error and I talked with the Provider about my error. She was not upset or super concern and we just went through all the proper follow up for the error, we checked her labs and everything was fine she had actually improved. I'm just having a really hard time not beating myself up about it. Logically I know experienced nurses make mistakes too and I've seen it happen but I just can't shake the horrible feeling. 
side note: I did scan it , noticed it was ns not LR and the order was originally for LR but asked the doc if she would be OK changing it to NS and she was. I didn't go back in to scan it in(this is where the error would have been caught) but I went to lunch and made a mistake. No harm was done, just to my soul ? 

[delrionurse]

JBMmom said:

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". 

I can't see  how admin goes about their day knowing floor nurses who are working 12 hours (which turn out to be longer) shifts get no break, no 30 minute, not even a 15. No one accounts for if the nurse get a break, but the sitter or housekeeper gets an accounted for break. I sat at the nurse station and watched a sitter get relieved for a break, the relief said 'the supervisor told me to come relieve you.' Huh? There's time for a sitter  to get a break but not the nurse who is prone to med errors, someone dying, someone bleeding out? 

It's all cookie cutter for administration, just blame the nurse for poor time management skills, poor communication skills 'they just didn't ask for help'. Well, when all the nurses are tied up, there is no one available. Admin doesn't account for an I.V. that infiltrated, a pump that doesn't work, equipment that isn't working. It is nice to know that the OP works for an organization that takes accountability for the nurse/staff to get a break. 

[jobellestarr]

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.

Yeah, that post was rude. I'm sorry for your error. And we are all capable of making them. You handled it well and took responsibility for your mistake. And you learned from your mistake. Now please be kind to yourself. ❤️

[Newgradtrauma]

JzK RN said:

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. ?

I'm sorry it can across I didn't fully read your replies and only wrote about the lunch. I did a bunch of research and reading about the different fluids anyway and loved your info on that. I quickly wrote about the lunch because I barely had time to reply and wanted to ask a question. Sometimes it's a lot to respond to everyone and every piece of advice, that doesn't me I am not taking it in fully or am not extremely appreciative. 

[JzK CCRN, BSN, EMT-I]

No worries ?

All good . 

[LML131, RN]

Don't beat yourself up.. I know, easy to say but from what I read. You did all the right things. You acknowledged your mistake, went to the provider and took accountability. Followed your hospital policy about med error etc. You are a great nurse!! We have ALL had med errors.. I've been an ED nurse for over 20 yrs and can without a doubt tell you... if someone says "oh I've NEVER made a med error" they are either lying, didn't even know they had done it or haven't done it yet!! Take time for yourself and then move on.. If you are in a facility that does support self reporting errors, have a non punitive culture?? GTFO and go elsewhere 

~does *NOT support 

[JKL33]

marienm, RN, CCRN said:

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.

This is an important comment for people to mull over.

At some point in my career, I finally started categorizing things in my mind as "actually urgent/emergent" vs. "administrator fantasy." Just my way of keeping things simple. It turns out to be very useful concept, as much of what we feel sooooo pressured about is simply an administrative preferences and demands. They are very good at applying a lot of pressure about an innumerable amount of things. Of course, in reality there are more levels of priority than the two I mention above, but starting with just the two is very eye-opening.

Taking lunch NOW because reasons certainly falls into the latter category.

Hospitals [and other health care sites] are not nursing, they are where we do our work. Business ethics sometimes align with nursing ethics...and often don't. We have to be willing to perform our professional duties according to the ethics of our profession, and mostly forget trying to prioritize things that are not essential parts of the ethics of taking good, safe care of patients.

[MaxAttack, BSN, RN]

Just a fun aside: LR (or any balanced crystalloid) is almost always the better fluid vs NS.

Just a personal crusade of mine. I'll link to an article by Josh Farkas.

https://emcrit.org/pulmcrit/smart/

[strength4unityRN]

Scanning meds can catch errors & has helped prevent med errors but scanning isn't always 100% going to catch all errors. 

I have had computers go down, barcode won't scan, scanner stop working, EMR decided to reboot. Very annoying. Especially if it's a pressor & the patient needs it now. 

Get in the habit of looking at your meds before you give them. Look once & look again. Does what I have in my hand match what the order says? Remember your 5 rights. Right med, right dose, right route, right time, right patient.

[Nicole Zapata MSN]

In high reliability organizations, there is an emphasis on reporting errors and near misses without placing blame on any one person, but instead looking at where the breakdown occurred in the organization to contribute to the error. I'd encourage you to reflect on where the breakdown occurred (ex: pressure to go to lunch) and also look for opportunities in your organization to serve on committees that focus on med errors. To err is human and sharing your experience may help prevent another nurse from making a similar error and possibly improve workflows at your organization. Serving on such a committee may also help you heal. Thank you for sharing your experience.