Forgot to restart my patients fluids

[daniela095]

I gave an IV push med to one of my patients today and had to unhook them from the continuous lactated ringers infusion to do so. After I was done I forgot to hook them back up to the infusion. It was end of shift and I'm freaking out hoping the next nurse saw and hooked him back up. Has this happened to anyone before if so was it ever a big deal?

[iluvivt, BSN, RN]

It is a medication error.It is an ordered IVF at a prescribed rate and was not reinitiated after the IVP medication. You should have looked at your IV set up and added a T extension type tubing or dual lumen extension set at the hub of the IV catheter.If its not set up that way you can prime your add on tubing with a normal saline prefill and add it on and redress the site as needed.You can also give it push at the closest Y site if compatible and if not you can also put the fluids on hold or pause ....give an adequate amt of Saline Flush...then your agent (the prescribied medication ) and another normal saline flush.You also want to solve the problem for the next nurse so you lessen the disconnections.Much better to lessen disconnections and keep a closed system.

[MunoRN, RN]

The commonly used definition of a med error comes from the NIH which is "A medication error is 'a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient". Nurses often confuse a variance from the 5 rights (or 14 or however many you subscribe to) as being a "medication error" even though that's not what a medication error is. The 5 rights help avoid medication errors but failing to follow the 5 rights is only a medication error if there is a clear potential for harm or actual harm. Going some fairly short period of time without IV fluids running may in some cases present a clear risk for harm, but it also often doesn't present any clear risk of harm.

[osceteacher]

Its not that common, it doesn't happen to every guy and it is a big deal!

Wait, wrong topic.

Its not a big deal, its a mistake, they happen. The liklihood of harm is minimal, all you have to do is admit the mistake, learn from it and move on. Not all medication errors are 'big deals'.

I once gave an Adcal D3 to a patient by mistake, I admitted my error, learnt from it and then moved on. Thankfully my manager used common sense and obviously gave me a letter on file but did not start alarming me by making a big song and dance of it.

There will always be those who want to use the scare tactic of blowing things out of proportion, all med errors are important to highlight, but no, they're not all big deals.

[Been there,done that, ASN, RN]

Its not that common, it doesn't happen to every guy and it is a big deal!

Wait, wrong topic.

Its not a big deal, its a mistake, they happen. The liklihood of harm is minimal, all you have to do is admit the mistake, learn from it and move on. Not all medication errors are 'big deals'.

I once gave an Adcal D3 to a patient by mistake, I admitted my error, learnt from it and then moved on. Thankfully my manager used common sense and obviously gave me a letter on file but did not start alarming me by making a big song and dance of it.

There will always be those who want to use the scare tactic of blowing things out of proportion, all med errors are important to highlight, but no, they're not all big deals.

Failure to restart the fluids would be a VERY big deal if : they were hypovolemic, hypotensive, or in DKA. The rule is... do no harm... not the minimal harm.

[psu_213, BSN, RN]

Considering that we don't know if this was maintenance fluids at 75 mL/h or a bolus, it is a little much, IMHO, to label this a "big deal." At that same time, we also don't know enough about it to be able to say "no big deal, everyone does it, don't worry."

Write up an incident report. As I have said on other threads, part of the point of incident reports is to look for patterns. If the risk group at your hospital is getting several reports about IVF not being restarted after IVP meds, then there might be some sort of process error that needs to be looked at. Or, at the very least, reeducation on the subject.

[Medic_Murse, BSN, RN, EMT-P]

I see you Ashton Kutcher...you're not gonna "Punk" me!

[Guest219794]

The commonly used definition of a med error comes from the NIH which is "A medication error is 'a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient". Nurses often confuse a variance from the 5 rights (or 14 or however many you subscribe to) as being a "medication error" even though that's not what a medication error is. The 5 rights help avoid medication errors but failing to follow the 5 rights is only a medication error if there is a clear potential for harm or actual harm. Going some fairly short period of time without IV fluids running may in some cases present a clear risk for harm, but it also often doesn't present any clear risk of harm.

That is an interesting definition, and not one that most of us think of.

I once gave the wrong IV abx, There was no harm and it was actually also an appropriate abx for the condition. I treated that as a medication error, and never would have considered it otherwise.

[daniela095]

Thanks for the replies. The fluid was LR for pancreatitis. However, for those saying that I'm covering up a mistake/ hoping no one notices isn't true. I should've said in my original post that I wasn't even sure if I connected the tubing back to the patient or not. Meaning it's possible I could've reconnected them but didn't remember if I did. Therefore it is possible this is me being paranoid and possible that I did make the mistake but cannot remember. The thought of wondering if I reconnected them and restarted the infusion came to me way too late to call the unit and tell them as it would've been 14 hours after I've already been gone anyway. If I infact did make this mistake and it was to be brought up to me the next time I go in I would of course own up to it. So no, I'm not trying to cover anything up. I've been a nurse for a month on orientation with good preceptors and the problem isn't that I need better guidance because I am learning a lot from them. That doesn't mean mistakes aren't to happen. A preceptor isn't with me over my shoulder everytime I'm with a patient. They aren't supposed to be since I am learning to be independent. I am sure I'm not the only one who has made a mistake like this. I will learn from this anyway and will always remember to reconnect if I have to disconnect in the first place. If I am going to make a mistake like this I'm glad it was on a continuous fluids infusion and not a life depending medication etc.

[CalicoKitty, BSN, MSN, RN]

Thanks for the replies. The fluid was LR for pancreatitis. ...

...

If I am going to make a mistake like this I'm glad it was on a continuous fluids infusion and not a life depending medication etc.

Just FYI, the fluids for pancreatitis are often important, if not one of the main treatments. The Pt is NPO and any oral intake can lead to more juices being pumped out. The Pt requires fluids. May not be "life or death" for a few missed hours, but necessary to keep them hydrated among other things.

Fluid resuscitation in acute pancreatitis

If it was for someone that was admitted a while ago (days), been treated, recovering well, eating and drinking fine, and the doc never cancelled the order, on the other hand..

[osceteacher]

Failure to restart the fluids would be a VERY big deal if : they were hypovolemic, hypotensive, or in DKA. The rule is... do no harm... not the minimal harm.

Yes, I agree some are, some aren't.

[peachtreednurse, RN]

It's been my understanding that any deviation from the patients plan of care, or physician's orders, constitutes an "error"...the onus of the commission or omission, determined once reported and investigated.