Almost made my first medication order while on orientation how do you get over it.

Nurses General Nursing

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So it Sunday...my first weekend working on the unit (I'm into a second week of orientation) Census low,quiet,a guess typical "slow" weekend day on the unit...so my preceptor gave two patients (I'm on two patients now) My first patient assignment went smoothly although quiet chalenging;a lot of PO meds,2 insulin shots,one lovenox shot and a antibiotic to hang...(my preceptor was walking me through hanging the antibiotic)..well minutes later I'm on my second patient assignment not quiet as overwhelming as the first one but still chalenging enough;a lots of PO meds and one shot...so I double checked my meds at the pyxis,and also before entering the patient room,I recognized that one med had to be cut in half so I was thinking to myself ok I do that at the bedside,so as I was opening the meds and putting in the cup I forgot to cut it in half (I didnt triple check my meds,which I usually do but I guess I was so overwhelmed and lost with so many meds that I forgot!! Plus being observed by preceptor doesnt help) Well my preceptor caught me right before I was about to administer the med I was to split in half,thank God she was there to watch over me...I felt so bad since I never made medication error back in school,now I worry my preceptor will hold this "incident" against me....I have a feeling she arleady thinks I know nothing.Yes I do realize that I have a lot things to work on since I never worked in acute settings but I'm trying hard to be the best I canI'm also realizing how important is to triple check meds,no matter how fearful,teary,overwhelmed one can get (especially new grad) This incident totally screwed my day and I'm beginning to doubt my ability to be provide a safe care for the patients.

PS.ups sorry I meant ERROR in the title of the thread! heh!!!

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Specializes in LTC, Disease Management, smoking Cessati.

Were you supposed to give the whole pill only cut in half for easier swallowing, or were you supposed to only give half of the pill? If you only forgot to cut it you are making a mountain out of a mole hill. I know you want to do everything right, and should always strive for that... however, I wouldn't be beating myself up too much... we all have made mistakes. Your preceptor is there for a reason, and that is one of them! Hang in there.

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It's okay. "Almost" is the word here. Don't let fear get a hold of you. You realised your mistake, go with it from there:)

We can't always predict situations but we can and should decide what attitude to take. So take the one of learning and move on to be beest you can be.

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Were you supposed to give the whole pill only cut in half for easier swallowing, or were you supposed to only give half of the pill? If you only forgot to cut it you are making a mountain out of a mole hill. I know you want to do everything right, and should always strive for that... however, I wouldn't be beating myself up too much... we all have made mistakes. Your preceptor is there for a reason, and that is one of them! Hang in there.

No,no trust me I'm not being hysterical..it was a blood pressure pill (metoprolol that came in 25mg and the patient had an order for 12.5) so definitely this mistake was not a trivial and the patients blood pressure could have drop low.

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Specializes in Maternal - Child Health.

1. Breathe.

2. Use your critical thinking skills to assess the situation, develop a plan, implement the plan, and evaluate how its working. Sound familiar? :)

You're on orientation for a reason. Your preceptor properly supervised you and prevented an error. Good for her! Now, let's talk about how to prevent that situation from ever happening again.

This is an excellent example of of a "systems error," meaning that there were a series of events that created a situation which left you vulnerable to committing a med error. If it had happened, you would have been blamed, but the blame should be shared by the people responsible for the glitches in the system that allowed it to progress to your hands.

Your pharmacy apparently does not stock the dose of medication ordered, necessitating that a pill be split. Why did pharmacy accept an order for a dose of medication they didn't carry? Why did pharmacy not contact the ordering physician and request an alternate order for a similar medication in a dose that they stock? Or, why wasn't the pill split in the pharmacy, labeled and sent to your unit? Sending the incorrect dose of a medication to a nursing unit is asking for trouble. Was the dose clearly labeled by the pharmacy as one that needed to be split? Or, alternately, was there a bold-type warning on the MAR that the medication provided by pharmacy was not the same as the dose ordered by the physician? If not, why not? Someone in pharmacy is falling down on basic safety precautions.

I can almost guarantee that if you came that close to a med error, then one or more have already occured, whether recognized or not. It is entirely possible that other nurses have given the full pill without recognizing their mistake, or gave it, realized their mistake and opted not to self-report it for fear of discipline. This is a predictible error.

So we have a system that allows:

1. physicians to order medication doses that pharmacy does not stock.

2. pharmacy to send doses of medicine to nursing units that do not match the orders.

3. no obvious visual clues or warnings to the nurse that a medication dose must be altered before it is administered, such as special labeling or bold notations on the MAR.

Your job now is to determine how you will address this to prevent future errors on your part, and to make the hospital leaders aware of a dangerous situation.

You could decide for yourself that you will not leave the Pyxis until you have the correct dose of medication in hand, meaning that you will split the pill right there and then, so that you won't arrive in the patient's room with an excessive amount of medication. This is what many nurses do with narcotics. Have someone review your waste with you before you ever leave the Pyxis. That will prevent future errors on your part.

Next, you must decide how to address this to your leadership so that other nurses don't have the opportunity to make the same mistake. Perhaps your preceptor and nurse manager can work with you on this. This is one problem I have with reliance on bar-coding as the "ultimate" medication safety device. It wouldn't have prevented this error, yet so many people believe bar-coding to be almost infallible as a safety system. Snort!

Take care.

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Specializes in Critical Care, Patient Safety.

Cut yourelf a little slack. The point of going through orientation and training is to learn and become more proficient in handling patient care. No one expects perfection right out of the gate. You realized your mistake and have now learned from it.

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1. Breathe.

2. Use your critical thinking skills to assess the situation, develop a plan, implement the plan, and evaluate how its working. Sound familiar? :)

You're on orientation for a reason. Your preceptor properly supervised you and prevented an error. Good for her! Now, let's talk about how to prevent that situation from ever happening again.

This is an excellent example of of a "systems error," meaning that there were a series of events that created a situation which left you vulnerable to committing a med error. If it had happened, you would have been blamed, but the blame should be shared by the people responsible for the glitches in the system that allowed it to progress to your hands.

Your pharmacy apparently does not stock the dose of medication ordered, necessitating that a pill be split. Why did pharmacy accept an order for a dose of medication they didn't carry? Why did pharmacy not contact the ordering physician and request an alternate order for a similar medication in a dose that they stock? Or, why wasn't the pill split in the pharmacy, labeled and sent to your unit? Sending the incorrect dose of a medication to a nursing unit is asking for trouble. Was the dose clearly labeled by the pharmacy as one that needed to be split? Or, alternately, was there a bold-type warning on the MAR that the medication provided by pharmacy was not the same as the dose ordered by the physician? If not, why not? Someone in pharmacy is falling down on basic safety precautions.

I can almost guarantee that if you came that close to a med error, then one or more have already occured, whether recognized or not. It is entirely possible that other nurses have given the full pill without recognizing their mistake, or gave it, realized their mistake and opted not to self-report it for fear of discipline. This is a predictible error.

So we have a system that allows:

1. physicians to order medication doses that pharmacy does not stock.

2. pharmacy to send doses of medicine to nursing units that do not match the orders.

3. no obvious visual clues or warnings to the nurse that a medication dose must be altered before it is administered, such as special labeling or bold notations on the MAR.

Your job now is to determine how you will address this to prevent future errors on your part, and to make the hospital leaders aware of a dangerous situation.

You could decide for yourself that you will not leave the Pyxis until you have the correct dose of medication in hand, meaning that you will split the pill right there and then, so that you won't arrive in the patient's room with an excessive amount of medication. This is what many nurses do with narcotics. Have someone review your waste with you before you ever leave the Pyxis. That will prevent future errors on your part.

Next, you must decide how to address this to your leadership so that other nurses don't have the opportunity to make the same mistake. Perhaps your preceptor and nurse manager can work with you on this. This is one problem I have with reliance on bar-coding as the "ultimate" medication safety device. It wouldn't have prevented this error, yet so many people believe bar-coding to be almost infallible as a safety system. Snort!

Take care.

Wow I never looked at it from that kind angle but when I read your post I must admit you are completely right.

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Specializes in Medical Surgical Orthopedic.

If I'm giving 1/2 of something, I usually write "1/2" on the back of the tablet packet when I pull it. I always check everything again before I give it, and our computers tell us when the scanned dose is "incorrect" and needs to be adjusted....but the computer is not always correct, and I am not always correct either.

When I mess up on anything, I let my preceptor know what I think went wrong and how I plan to prevent it from happening again. That seems to make us both feel a little better ;)

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Specializes in Acute Care, Rehab, Palliative.

Where I work 12.f of Metoprolol is a common order and it is up to us to recognize the need to split. We stock the med in bottles and slpit the tab after we take it out of the bottle. The other half goes back in the bottle.

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Specializes in burn/ trauma.

its okay. really. :) . i came here almost 8 years ago. from another country. i was really tough. it still sometimes is. but believe me most nurses/ preceptors are nice. they understand. and you are only on your second patient. even if they did not.... this too shall pass. any thing you feel is only for a few months. more over they will soon get bored w/ you. soon they'll find another new orientee to snicker about........:yeah: hang on tight.

P.S. I precept now. and always remember how i used to feel as a new nurse.:nurse:

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Specializes in Army Medic.

More than likely your preceptor noticed it from the get go and didn't just suddenly catch you towards the end - but was trying to see if you'd recognize the mistake or not.

Everyone makes mistakes, that's why you are not on your own yet. Take that for what it's worth and learn from it.

Letting the mistake weigh too heavily on you now is going to affect your performance with other patients.

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Specializes in OB/GYN, Peds, School Nurse, DD.

Well, it may be the first but it won't be the last. Does that help? No? It's true. Everybody will make a mistake sooner or later and if they say they don't, they're lying. Mistakes arise usually because we're tired, overwhelmed, or distracted. Even experienced nurses will make mistakes from time to time. Heck, I've been a nurse 32 years and I made an insulin mistake 2 weeks ago. :confused: How did that happen? Not paying as close attention as I should, I guess. Thankfully nothing bad happened, but I won't make that mistake again,that's for sure.

Okay, pick yourself up, dust yourself off. Pity party's over. You're not an idiot, you're just new. Someday you'll be old and you'll be precepting some new nurse who's scared out of her mind. Remember this experience.

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