Drug error

xtxrn, ASN, RN · Oct 9, 2011

i was rushed off my feet and had an admission with ischaemic stroke. i asked the dr if he wants patient to have 300mg aspirin stat, he said no patient on warfarin and prescribes it, have that instead. i stupidly went and gave 6mg warfarin, turns out inr is 5.5. im handing over to night staff and he put a stat vitamin k 5mg po order and didnt even bother to tell me.
i'm really sick of nursing sometimes, why is everything blamed on the nurse?????
how serious is this i'm a new nurse..

because you did it????? it's your job to check the chart for new orders after the doc is done seeing the patient.

learn and move on.

if you're already sick of it, do you think you can do it until you're of retirement age?

coneartist · Oct 9, 2011

Typical nasty response.

It's supposed to be about team work

xtxrn, ASN, RN · Oct 9, 2011

Typical nasty response.

What did you want? You asked a question- I gave an opinion based on the information you provided.

Reality isn't being nasty- I'm sorry you're not open to hearing views you asked for. :)

If you don't want opinions, don't ask.

The patient was having an ischemic stroke - verified? Was the order for Coumadin verbal, or did you imply that it was based on the doc saying he was already on it? (not a totally off-base thought).... but you also said you "stupidly" gave it.... then asked why the nurse gets blamed..... who should get blamed?

Why does there have to be "blame"....why not accountability and get it straightened out the best you can?

It's not all the end of the world- though at the time it can feel like it.

But if you want candy-coated answers, I'm not sure what to tell you.

If it's a typical "nasty answer" why ask a question? :confused:

xtxrn, ASN, RN · Oct 9, 2011

Typical nasty response.
It's supposed to be about team work

The doc is on another team....unfortunately, they won't CYA as well as you can ---

nice add on :)

coneartist · Oct 9, 2011

The doc is on another team

Isn't that just dandy.

Double-Helix, BSN, RN · Oct 9, 2011

What does your hospital policy say? Does it say you need a PT/INR before giving Coumadin? Did the doctor write the order? Was 6mg outside of this patient's usual range?

How serious it is depends on our hospital policy and if the patient was harmed. If he was indeed having an ischemic stroke than maybe an INR of 5.5 wasn't terrible.

You didn't go into detail about how you were "blamed" and you even mentioned that the doctor didn't even tell you about new orders, so he didn't yell at you about it. As a nurse, new or not, it's our responsibility to verify that ordered medications are given under safe cicumstances. We are held accountable for a lot because it's our responsibility.

Looks like it's a good lesson learned here. Talk to your charge nurse or nurse manager if you are concerned about the repercussions, but I'd make sure you avoid claiming you're the victim and just ask for constructive advice.

coneartist · Oct 9, 2011

The night staff spoke to me like an idiot when the STAT order for Vitamin K was discovered. I was busy with another patient at the time it was written. I expect an incident report has been filled.

Yes, it was a written prescription, I would not give warfarin from a verbal order. Yeah, even an unsafe practitioner like me. I'm a dietician, physio, pharmacist, continence expert, social worker and Dr after all.

TonyaM73, ASN, RN · Oct 9, 2011

My thoughts are: #1 if the pt was already on Coumadin and has a CVA, why would the MD continue down that road? Why wouldn't he choose another blood thinner at least in the interum to hit another area of the clotting cascade?

#2 When the INR was found to be so high, did he order another blood thinner at that time or just thicken the blood back up with the K?

#3 This is a learning mistake. Always check INR before giving any Coumadin. (I still don't get the Coumadin though. Why not Lovenox, Heparin or ASA if the pt had a CVA ON Coumadin.)

#4 Take it as it comes. Yes, you made a mistake by giving the Coumadin without the INR. If there is a write up, tell them that you accept the blame of the given medicine and tell them what you have learned and what you will do in the future to prevent anything like this happening again. That is the only way to go. Blaming anyone else will be a mistake in your management's eyes. Definatley let her know what else was going on, but don't use that as an excuse.

I hope this helps and I hope you have a better day today. Yesterday is gone. Tomorrow hasn't come. The only thing you can change is today.

morecoffeepls, BSN, RN · Oct 9, 2011

It's supposed to be about teamwork, sure. But it's more about accountability and CYA. Maybe the MD is new, also. Doesn't matter. Document, "learn and move on", and don't be so sensitive. This is coming from a big baby who would probably react the same way to someone asking me if I could see myself staying in my chosen profession because I'm venting about being blamed for mistakes. It sounds like you're taking accountability/ownership for having "stupidly" done something, and that to some degree you realize that patient safety is, above all, a nursing concern. Some people may have forgotten what it was like to be a new nurse. I've heard it said that nurses are there to protect patients from doctors, something like that. Also, did you know/provide the INR p/t administration? When was the STAT Vitamin K order entered? I may have missed something. I'd blame myself before anyone else, even though I know where you're coming from. Good luck. (Was that nasty? I tried not to be.)

locolorenzo22, BSN, RN · Oct 9, 2011

Ok, number 1.....we've all been new before. We understand when things are rushed, and you're behind. BUT you have to take the responsibility for your patient. ASA is usually given as a 325mg for a ischemic stroke, or warfarin(as you alluded to).

number 2...when did you get the patient and when did you check the orders? why did you not check the INR before administering the warfarin? that is serious. I personally will NEVER give warfarin without a baseline order.

number 3...sometimes the stat orders get missed, but when was it ordered versus when nights came in?

I understand you feel vulnerable, but you made the mistake. that's why you feel "blamed". It's a error, learn from it, move on, and be more vilgilant about checking your orders and using your critical thinking.

Good luck.

PediNurse3 · Oct 9, 2011

The night staff spoke to me like an idiot when the STAT order for Vitamin K was discovered. I was busy with another patient at the time it was written. I expect an incident report has been filled.
Yes, it was a written prescription, I would not give warfarin from a verbal order. Yeah, even an unsafe practitioner like me. I'm a dietician, physio, pharmacist, continence expert, social worker and Dr after all.

An incident report should be written. That is how we learn from mistakes and make changes to (hopefuly) keep them from happening again. And if you haven't, you should write one yourself so that when the incident is reviewed, whoever reviews them at your facility is able to understand how things happened from your point of view as well. You didn't say how much time passed between when the order was written and when night shift arrived, but I am assuming it was more than an hour or night shift wouldn't have been upset about it. Being busy when something is written does not relieve you of the responsiblity of checking orders, ESPECIALLY when you already know that you have given warfarin to someone with an INR of 5.5 and has just had an ischemic stroke. Physicians should not have to tell you that they wrote an order. You didn't mention having asked anyone for help...in these situations, if you're too busy to review labs and check for/carry out new orders, ask for help. You might get sighs and eye rolling but I can't imagine that a (good) charge nurse wouldn't be willing to jump in and at least help you out.

And I am sorry, but you have got really horrible attitude. You screwed up. Everyone has made a mistake at one point or another. Lose the attitude, learn from it, and move on.