Gave a med I shouldn't have given... worried about repercussions

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This morning I had admission that came up from the ED. Her blood pressure was high with SBP in the 190s and the pulse was hanging around the high 90s/low 100s. The doctor saw her and put in a STAT order for IV labetolol and I gave it without question over the recommended 2 minutes for the dose I gave. She was on a cardiac monitor and I was watching the rate and rhythm closely. No adverse effects were noted, and the vitals were stable a half an hour, 1 hour, and 2 hours after administration. My shift ended and I left. I had no worries about the care I provided .

I am still relatively new on my floor, and during my inevitable post-work anxiety nightmares, I dreamt I was being fired for administering this drug. Somehow, my waking self did not remember a comment that I received once, roughly 6 months ago in orientation, about IV labetalol, but my subconscious pulled it up no problem. We are not supposed to give it on our floor (though IV metoprolol is okay) and it needs to be administered in an ICU/CCU setting.

When I am back at work, I am going to complete an incident report and inform my charge nurse but I am very fearful. I know med errors happen, but I just feel awful and cannot help but think of all the "what ifs" as far as the patient's health and my own job. I doubt any one has been in these exact shoes, but any input is appreciated. I am so worried and full of regret.

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Specializes in Med/Surg, Ortho, ASC.

I would do some serious (awake) research before filing an incident report based upon a dream.

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I'm good friends with a nurse who has worked there much longer and I sent him a message today asking about the medication. When I am at work I will access our policies to find out more but he did confirm my fears

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Specializes in ER.

It happens, it's not the end of the world. It's happened to me before where I gave a medicine that was not sanctioned in the unit where I worked. The patient was fine, and probably Administration needs to clarify to everyone that they need to inform the doctors that is not allowed in that particular setting.

Go to your unit manager, let her know that you gave labetalol and then found out it wasn't allowed. It was no harm to the patient, and she can send out a memo to everyone reminding them that this is against Hospital policy.

Some of these Hospital policies are basically nonsensical. Sometimes they are technicalities. I wouldn't worry anymore about this.

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Metoprolol is the generic name for lopressor.

Instead of writing yourself up, learn your drugs.

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That is something I needed to hear. The anxious side of me feels wholly responsible, though the logical side of me knows it is a failure not just on my part, but on the part of the doctor who prescribed it and on the pharmacist who approved it, as well as an issue with the education on my floor. A lot of the meds we pull come with warnings and I feel this is one that should be flagged. So thank you so much for the validation

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Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
This morning I had admission that came up from the ED. Her blood pressure was high with SBP in the 190s and the pulse was hanging around the high 90s/low 100s. The doctor saw her and put in a STAT order for IV labetolol and I gave it without question over the recommended 2 minutes for the dose I gave. She was on a cardiac monitor and I was watching the rate and rhythm closely. No adverse effects were noted, and the vitals were stable a half an hour, 1 hour, and 2 hours after administration. My shift ended and I left. I had no worries about the care I provided .

I am still relatively new on my floor, and during my inevitable post-work anxiety nightmares, I dreamt I was being fired for admhaving the patient on the monitir and watching her rate and inistering this drug. Somehow, my waking self did not remember a comment that I received once, roughly 6 months ago in orientation, about IV labetalol, but my subconscious pulled it up no problem. We are not supposed to give it on our floor (though IV metoprolol is okay) and it needs to be administered in an ICU/CCU setting.

When I am back at work, I am going to complete an incident report and inform my charge nurse but I am very fearful. I know med errors happen, but I just feel awful and cannot help but think of all the "what ifs" as far as the patient's health and my own job. I doubt any one has been in these exact shoes, but any input is appreciated. I am so worried and full of regret.

So to clarify, you are saying you had a dream reminding you that you were not supposed to give labetalol IV on the floor but could give metoprolol IV on the floor? These drugs are in the same class, beta blockers, so that does not make sense. Before you write an incident report, ask someone who can answer this, such as your charge nurse, the educator, your manager, or an experienced RN, for example. Kudos for having the patient on the monitor, very appropriate, and watching her rate and rhythm, as well as giving it over 2 minutes. (Checking BP is also important.)

Perhaps when this turns out to be nothing more than a bad dream, read up some more on beta blockers and other cardiac meds, such as calcium channel blockers. This could be a chance to expand your knowledge.

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To been there done that, I do know my meds. Labetalol (trandate), not lopressor. Both beta blockers, however one is approved and the other is not. And yes, in response to boomer, it seems like a silly rule and I'm sure when I bring it up to other more experienced nurses, they'll talk about how it is a little odd. But it is policy and I do wish I had remembered it. I know it's silly it came to me in a dream, but it doesn't change the fact that I did do something my facility does not agree with.

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Feel free to shoot yourself in the foot. Would you waste time finding a nurse to administer the drug, or transfer them?

Best of luck , whatever you do.

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Specializes in Med Surg/ICU/Psych/Emergency/CEN/retired.
I do know my meds. Labetalol (trandate), not lopressor. Both beta blockers, however one is approved and the other is not.

Then learn from your mistake. You found the mistake and are being accountable. I still think it is an odd policy, but I've seen sillier written policies. I would question the reasoning of the policy, but it is important to follow your facility's P&P, as inane as they sometimes may be.

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Feel free to shoot yourself in the foot. Would you waste time finding a nurse to administer the drug, or transfer them?

Best of luck , whatever you do.

I don't think I am shooting myself in the foot by accepting responsibility and perhaps inspiring increased awareness about a policy that isn't well advertised to new nurses on the floor like myself. I'm not reporting myself to the board, just putting in an incident report. My floor encourages this and I think it looks a whole lot better to accept responsibility than to wait for someone to notice and call me out on it.

If I had called the doctor, she would have cancelled the med and ordered lopressor. No time wasted, no transfer necessary

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Everything you have written here tells us that you already know what you are going to do. There is no wavering in your decision, you are quite clear that you are going to be turning yourself in and placing your head on the chopping block if they ask you to. What is it you're hoping to get by posting the thread if nothing anyone says will change your mind? Do what you need to do. Then move on.

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