I'm sorry this will be long. I am having some questions about the peer review process.
I just finished a 12 week orientation in my hospital's ICU. On my 4th week I had a med error where I incorrectly programed a bolus of propofol for a patient on the vent that was becoming agitated. I thought I was administering it in mgs, when I was really administering it in mgs/kg -- much, much more than what I was trying to give. I found this out when pt's BP decreased, from fairly normal 100-120s/60-70s to the lowest at 79/30s-40s (sorry, I don't have the exact numbers in front of me). The monitor alerted me to the change in VS, so I immediately checked her Propofol and realized that, even though I'd started the bolus several minutes ago (going to have to look back through the whole chart to see exact time frame), the bolus was still infusing. I immediately stopped the propofol and either restarted or increased the pt's pressor (sorry for fuzzy details, it's been 8 weeks, but I do know that I brought the BP back to systolic 100 within 10-15 minutes). Immediately after changing the medications, while waiting for a few minutes to pass to recheck VS, I informed my preceptor. She and I talked about what happened. I had not yet previously given a Propofol bolus but had known that it was an option to do because I had seen her give at least one of my previous patients a bolus of propofol. I thought I knew how to program it in correctly but this situation showed that I obviously did not. I have given several boluses of propofol since then on other patients and have done it correctly, if not hyper-vigilantly.
This happened right before shift change. After stablizing the patient, I told the oncoming nurse what happened and let her know why the Propofol was stopped even though pt was having intermittent agitation. We figured out together how much propofol the patient received and I didn't leave until VS were back WNL. Ultimately there was no long-term poor outcome to the patient but I am completely aware that things could have gone VERY differently.
I was notified that this situation was reported ~3-4 weeks after it occurred (I have no ill will towards the night nurse for reporting it, it was a legitimate error and I learned a lot from it). During one of our standard meetings with my new supervisor and my preceptor, the supervisor asked about it and we told her what happened. Orientation continued on as usual.
Last week I finished out my last week of orientation and met again with my supervisor (preceptor absent due to illness). Towards the end of the ~45 minute meeting she said that she did need me to make a statement for her as the situation will go to Peer Review in a couple months. She told me about how if this situation, upon review, is still considered a Level 3 (standard of care not met with potential harm to patient), then it can go on to the board of nursing. She didn't seem particularly concerned about it, saying she thought the most that would happen either way would be to get assigned further education (which I'd be fine with -- I'm soaking up as much education as I can). She said to make sure to include in my statement that I was on my orientation. She will take the statement and read it for the review board, I am not to be present.
Has anyone else been through this process? Since the mistake happened 2 months ago and I'm aware that the patient is fine and long ago went back home, I have to admit that I'm very nervous for *myself*. I really pride myself on being a thorough, conscientious nurse (though obviously with much to learn in this new setting) and the error itself was quite a wake-up call that has really made me even more careful with new medications, especially boluses. Having my statement read before a review board so much later after I've already made 3-4 months of changes (review is in November) is anxiety-provoking. My supervisor's calm demeanor about this is comforting but it does make me wonder if maybe I'm missing something here -- what is the worst-case scenario here? Should I be notifying a lawyer? I'm so naive to this type of thing, I've known OF the peer review board but never known anyone to openly talk about being a part of the process. Though I logically understand that this is just "a step in the process" to keeping all patients and nurses safe, I'm also in uncharted waters and feel like I'm walking around with the word "unsafe" tattooed on my forehead. *sigh*
Does anyone have any insight?