My first med error (Rant) - page 2

I need a little support. I'm a fairly new nurse, just under a year and I made my first error on my shift last night. At my hospital, the nurses aide will collect vital signs and blood glucose... Read More

  1. by   knittygrittyRN
    It seems some places are going back to nurses doing vitals and blood sugars; at least in my area. I'm at a fairly large hospital and we have multiple trial floors where we have nurses doing all fingersticks for patients and performing at least the first set of vitals on their shift. Since we gone this route our hypoglycemic events have decreased dramatically and are addressed right away. From the sound of it, it appears eventually the whole hospital will convert in due time much to the dismay of some staff.
  2. by   RNnetwork
    I so can relate to feeling like this as a new nurse. I feel pretty seasoned now, but I can relate so much!!! You did an excellent job bc you assessed your patient, reported your error, and filed a incident report. I've worked on a lot of committees and when you do, you learn to a lot. Incident reporting isn't meant for you to be reprimanded, its to track trends. The problem isn't what you did necessarily, but there is definitely an issue with the process in place on your unit. Don't beat yourself up, take it as a chance to take the initiative to do an process improvement project. I'm sure you are not the first to do this. And doing projects like this is something to really boast about on job interviews. Learn more at
  3. by   applewhitern
    At my present hospital, only the licensed nurse can do blood sugars, period. They claimed too many mistakes happen.
  4. by   LongislandRN23
    Every favility has different protocols. I wouldn't blame the computer system this error, although I think its absolutley absurd for fsbs results to take an hour and a half to upload. I mean this is 2013 right? I do all my own fsbs. Just as if a pca/cna told you pts BP was 190/76 with the VS machine wouldn't you double check it manually? Final thought I would not go by written results thay were delagated. I would have checked it myself and def not waited an hour and a half for it to upload.
  5. by   jadelpn
    This is definetely a process issue, and should be addressed as one. However, when I rely on a BS to give or not give a medication, I find it easier to do myself, along with the first set of vitals. I think that way, I have a full assessment at the start of the shift.
    With others taking a bunch of sugars, then they are bound to forget which sugar belonged to whom.
    This information should be readily available, especially if you are responsible for medicating or not medicating same.
    But you can only go from here. It would be something that from now on, I would do as part of my assessment. And DM patients first.
  6. by   hofamb
    I just graduated NS, but have worked as a tech/aide on 2 different units within a very large research hospital for the last 2 years and have always taken the BS for every patient assigned to me. That's just how our units are set up, but we don't rely on writing the correct number, we put them in the computer (by hand) in the pts room and then verbally tell the nurse. I've never heard of any issues on either of my units.
  7. by   kathconserv
    Quote from Tait
    That is not a big deal. Believe me. You will be ok.
  8. by   nurseladybug12
    The almost exact same thing happened to me. My aide reported a BS to me, but it was for A bed, not B Bed and I gave B Bed too much insulin. I rechecked his BS after and it was 89, he was asymptomatic and we gave him some juice and crackers to hold him over until his tray came around. I was upset at the aide, but ultimately it was my fault because I did not realize we had a policy saying either we have to see the accucheck result on the emar or we have to see it on the screen of the meter at the bedside. After that, I did file a PSR, and I was never reprimanded by my manager, but I know that if I were to do this again I wont get such a great review at the end of my 6 mo probation period. I learned it is just unsafe to take the word of anyone, and if you have to take their bg again, better safe than sorry. Ultimately, you are responsible for delegating, supervising, and following up on what your aides do for you and making sure things get done right.