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

[tired_panda]

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.

[Double-Helix, BSN, RN]

OP, you know the culture of your facility best. Only you know if they take a "just culture" approach to errors and will recognize that being able to give labetalol your floor despite the policy against it is very clearly a process/systems issue, and not simply a personal error. If you believe that you will be treated fairly and reporting the event will help other patients avoid potential harm, then by all means, report it.

I would, however, avoid writing an incident report. Simply speak to your supervisor/manager and explain the steps that allowed this to occur. Let her know that you're concerned that this could happen to other staff/patients without additional education or changes in process. Truly, you did nothing intentionally and there was no harm to the patient. This is a near-miss event, and they are the best opportunities for learning. I'm proud of your for recognizing that, ultimately, this is a patient safety issue, and thank you for not taking the "every man for himself" approach that has been reflected in some of these comments.

[LessValuableNinja]

I would have given the med policy or not. Neither metoprolol nor labetolol have that profound effect on heart rate and blood pressure that would warrant the patient being on anything other than a basic Telemetry floor. Take a baseline HR and BP, give the med, recheck HR and BP in 5-10 minutes and you are done.

That would be excellent advice, if labetalol didn't peak (variable based on met/clearance) at around 30 minutes, and have a half life of 5.5ish hours, the latter less important in some patients, more important in ones with complicating factors.

I agree with those who have said the process needs work. It's important to mitigate the errors of one human. Humans involved minimally were the physician, pharmacist, nurse, and director of IT or CIO. While I don't talk about it much here, much of my background is IT management, general/project/operations management, and process analysis.

In this case, the process is/are broken. Education appears insufficient for the physician, nurse, and pharmacist. None stopped the error. The system was unable to or did not flag a medication inappropriate for the unit. No second check occurred based on unusual prescribing. And so on.

While the OP is right to accept responsibility for her part, the system as a whole failed, and does not appear to substantially exist.

While I agree with everyone advocating the nurse take responsibility for their part, I find it unfortunate that the traditional culture automatically makes it a nursing error. While there was a nursing error, we are humans, which is why a strong organization builds processes based on systems, training, and a culture of nonpunitive reporting. After all, the system appears so broken that the errors of the IT, management, nursing, pharmacy, and physician personnel were not caught. Not reporting the errors increases future patient harm, and allows the system to remain broken.

Good luck and best wishes.

[BedsideNurse]

I would double check the policy and then just let the ordering physician know next time you saw them, just an FYI for future reference, that they don't allow that drug to be given on your unit, and if pharmacy dispensed it to your unit, I'd give the pharmacist a call and let them know. I probably wouldn't make an incident report unless asked to. As an aside, there are a lot worse things you can do as far as med errors go, so I certainly wouldn't worry about this. Kudos for being conscientious but don't beat yourself up unnecessarily. Lord knows there are enough beatings in the work day. Lol.

[Guest1016389]

labetalol and lopressor are two different meds. You do not need to "learn your drugs." They may be in the same drug class but have different monitoring guidelines for IV push. You are 100% correct about everything. For the record, this same policy exists where I work, "ridiculous" as it may sound. There's a reason for it. Patients have been transferred to other units over this type of thing so they get appropriate, safe care. Kudos for doing the right Thing and trusting your instinct.

[Jailnurseat<3]

I've worked on floors where you couldn't give certain iv push meds. I don't think you should freak out, although it is good to know well which ones can and cannot be given on your unit. Side note though, doctors will never know all the specific drugs that a certain unit cannot give. They know generally what needs to be in ICU but that responsibility is usually the nursing supervisor or bed control.

[caliotter3]

Since this thread was started more than two months ago, what happened OP?

[MunoRN, RN]

While it's important to be aware of your facility specific policies, as a nurse I'm also required to apply some level of assessment as to whether these source of these policies is a reasonably competent person to dictate my practice, in other words, if a policy was clearly written by a moron then I would need to be very careful about following it, and a policy that says labetolol can only be given in an ICU was clearly written by a person not competent to be writing these sort of policies.

[Purplicious Princess]

We are all human follow your facilities policy.