Gave medications too early is this an error?

[daniela095]

Patient I had just admitted was ordered heparin subcutaneous every 12 hours. I gave the first dose upon admission and then the next morning ended up giving the next dose 6 hours after that first dose instead of 12 hours after the first dose. The computer didn't automatically reschedule the medication for 12 hours after the first dose and scheduled the next dose for 6 hours later. After I realized I adjusted the doses afterwards to be every 12 hours. I am new nurse and my preceptor wasn't concerned about it. It's bothering me because I feel as if I made an error. Would this really be considered a big deal?

[klone, MSN, RN]

daniela095 said:

My preceptor was the charge nurse the night I told her. She pretty much just said to be careful next time and didn't write a report.

As the person who made the error, you are the one who should submit the incident report.

[klone, MSN, RN]

canoehead said:

I'd respond the same way as your preceptor. You found the mistake, you realized what went wrong, and consulted with the physician and your preceptor. Youu know not to do it again. Case closed.

If you made an error every day, I'd be starting a paper trail, or if you did the same error on your next heparin order, that's unacceptable. Writing up every honest mistake isn't all that necessary, IMO.

"Writing up" implies writing up the NURSE (disciplinary action). An incident report is meant to look at processes and determine if there is a swiss cheese effect going on.

[JKL33]

klone said:

"Writing up" implies writing up the NURSE (disciplinary action). An incident report is meant to look at processes and determine if there is a swiss cheese effect going on.

Yes.

What a pet peeve of mine when people use incident reports inappropriately and then both the reporters and anyone who happened to have been involved act like they are personal write-ups! We have to actively speak against this idea that incident reports are meant to be punitive and are therefore optional based on whether or not you wish to get someone in trouble or whether you like them or feel sorry for them or anything else. Matter of fact is best. This is not only a safety issue but very much a department morale issue as well!

***

If there has been a med error, reporting it via the incident reporting system is not optional. It is not writing anyone up - it is reporting that an error has occurred.

When at all possible, focus on a process the error involves, rather than the people involved. In this case: "Q12hr medication administered 6 hours after STAT dose. EMR automatically times medication for pre-set times without regard to previous administration."

Moment of truth, though: One consistent problem that comes into play is when processes have known issues and it is decided that it can't be fixed (or won't be addressed) other than to have nurse after nurse after nurse correct it individually every time it comes up. In reality this particular med timing issue is older than the hills. That kind of thing also leads to nurses making decisions not to report things.

[EDNURSE20, BSN]

It's def a med error and a incident report needs to be done. And you manager informed. Giving a med 6 hours early is way to early to not worry about it. It was a mistake, and you shouldn't worry about reporting them. Med errors happen. It's your professional duty to take responsibility for them. As well keeping you pt safe.If something happened or someone else found out and you hadn't reported it then it would be problem. Discovering a med error and doing the right thing shouldn't get you into trouble.

[oceangirl1234]

daniela095 said:

But is this something that should have been an incident report? I realized this days later actually when I looked back since I was taking care of the patient for a few days in a row. My preceptor didn't seem to think so

Yes. As people have already pointed out, incident reports exist to identify patient safety issues. Which this definitely is.

[jaderook01, BSN, RN]

There should be a chart in the med room somewhere that tells you the time frame window during which you can give certain meds early or late. However, six hours early is definitely a problem. I think I know what your issue is. When a new medication is entered, it will sometimes have it on the MAR for the first dose to be given at the time the order was entered, and then the second dose is going to be on the usual schedule, and often that can cause numerous med errors. I think it is a computer glitch that needs to be addressed. However, until they do, as the nurse, you have to start paying attention to that and it is in your best interest to know which meds should not be given. If the first dose is a stat order, it's likely never going to be an issue, otherwise, you need to be diligent.

[Alex_RN, BSN]

Hmmm...changed my mind.

[Have Nurse, ADN, RN]

daniela095 said:

Patient I had just admitted was ordered heparin subcutaneous every 12 hours. I gave the first dose upon admission and then the next morning ended up giving the next dose 6 hours after that first dose instead of 12 hours after the first dose. The computer didn't automatically reschedule the medication for 12 hours after the first dose and scheduled the next dose for 6 hours later. After I realized I adjusted the doses afterwards to be every 12 hours. I am new nurse and my preceptor wasn't concerned about it. It's bothering me because I feel as if I made an error. Would this really be considered a big deal?

The doctor should have been notified. You know that. And yes, it is an error because you gave it other than how it was ordered, mistake or not. Hang the computer. Use your critical thinking skills and have a chat Pharmacy the next time this happens if they are the ones who do the system loading. This was preventable.

[Have Nurse, ADN, RN]

Alex_RN said:

Absolutely not. Seriously, move on.

I respectfully disagree. This was a med error plain and simple. Time to own it.

[Have Nurse, ADN, RN]

klone said:

"Writing up" implies writing up the NURSE (disciplinary action). An incident report is meant to look at processes and determine if there is a swiss cheese effect going on.

Exactly.

[K9lover, ASN, RN]

Used to be more standardized until whichever agency regulates Heparin making it a stat thing for the 'insta-DVTs' patients will be thought to get upon landing in the hospital...among the zillion and one regulations hospitals abide by under threat of not being reimbursed by CMS is Heparin having to be initiated instantly...

[CapeCodMermaid, RN]

Of course it's an error...a 6 hour error.