I just started working on a new floor 2 weeks ago on a geriatric floor.
Today was a bad day, seems just didn't seem to go the right way. Just "one" of those days, I guess.
I had a new admission from 2 days ago. I had to take VS since he is a new admission. While taking his VS, he tells me he has alot of pain in both arms. (he is also a "confused" patient), I charted his VS, and gave him tylenol 1000mg prn. I immediatedly wrote "09:50, and my initials in the right box.
I went on break, and when I came back......the other nurse asks me if the binder in front of me was my med cardex, I said yes, and she tells me she gave tylenol to another pt, took the new admissions VS and gave him tylenol 1000mg prn at 11:30!!! I was wondering why she was "taking over" my pts. So she repeated all my actions and gave Tylenol to a lady pt.
I told her that I had given him Tylenol at 09:50, she looked concerned and checked and saw that I had in deed given it.
She wrote her intials and the time in the MAR, I charted everything I did in the notes. She charted nothing, except the VS and her initials next to the prn med.
I also found an old nitro patch on the same new admission, that should have been removed last night or the night before, the med error nurse was the one working last evening.
I charted this in the notes, not mentioning any names, just my findings. The patch had no initials or date on it.
When I reported to the evening nurse at 3:30 (quiting time), the evening nurse who seems to think she is the boss and I don't trust her. I told her to be careful with the tylenol for a while since he was given 2 doses in an hour and a half, earlier in the day, and I told her about the old patch.
She insisted that I fill out 2 incident reports, (one for each mistake). She pulled out the forms and even showed me how to fill it out (I am not familiar with their incident report protocols...) I didn't realize I had to fill out this form, cause I have only had "falls" happen, and it is the same form.
It seems like she enjoyed tattle tailing, once the 2 reports were almost filled out, the med error nurse came from behind me and saw the reports, (the evening nurse was not that near us)
I told her that the evening nurse insisted a form be filled out.
(evening nurses are considered "assistant head nurses" and me and the day staff are "team leader nurses")
She seemed pleasant about it and said the evening nurse thinks she is a supervisor, etc. She told me she would deal with her incident report for her mistake, and I should deal with the old nitro patch incident report.
I finished the forms, but only told the head nurse about the old nitro patch, and left. (it turns out this patch was from 2 nights ago, so this nurse was not blamed), assuming the nurse would deal with it, as she said.
The thing is, I felt caught in the middle. I am the patients advocate, I trust and respect the head nurse, but I don't trust the evening nurse or the nurse making med errors on my pt!
I don't like tattle tailing, I don't want to step on anybodies toes, since I am new on the floor.
I am a fairly new grad, and all these nurses in this situation are double my age, and I am worried that even though I didn't do any med error, the blame will be put on me somehow....since I have the least experience. I feel that I shouldn't have left, and I should have seen if that nurse actually gave in the incident report that I filled and/or told the head nurse.
This is really bothering me!
I know the errors are not huge and the meds aren't "dangerous", it is the point. I am not to blame, except for not telling the head nurse...........am I over reacting????
Jan 25, '02
You should fill out an incident report on anything that you did, or you found. But the Tylenol one could be bad...especially if that patient really received 2000mg! First, did you call the doc on that one...that is alot of Tylenol...hopefull that patient doesn't have any renal or hepatic problems that could make worse. I would have filled out two reports...all you are doing is covering your butt here. The incident reports will be gone over with risk management and they will decide if they are worth going over or pursuing.
Jan 25, '02
Stay calm! You did NOTHING wrong. You simply made out the incident report on "what you found." No names mentioned, just the facts...it is considered a med error if the patch is left on the pt when it should have been removed. They should also be dated and initialed. You told the HN about the patch you found and that's all you needed to do. The Tylenol? Well it was the other nurses mistake for not checking to see when the resident rec'd his last dose. Big med error. What if it were a more potent drug?
Don't worry, no mistake on your part. The other nurse had to do the explaining on that one. Hope the doc was notified. No one likes to see their pts over dosed, but when you cut too many corners, mistakes happen.
You didn't step on any toes, you did your job! I don't see how they can blame you for doing the right thing. Now whether or not the other nurse turned in her report? Ask the HN. After all you have the right to know b/c it is your pt that she over dosed. If you ask her, she could lie about it and you'd never know whether or not she turned it in. I'd like to give people the benefit of the doubt, but in this case, I wouldn't.
Last edit by night owl on Jan 25, '02
Jan 25, '02
What Owl said.
The finder of the occurrence...fills out the occurrence report. On ours there was a line that you entered the doctor notification and comments. Someone should have notified the doc. Usually the finder does.
You also need to have a chat w/ the HN about what exact person on 2nd shift is the AHN. They can't ALL be.
I have given 1500 mg of APAP many times (at the doctor's request) to older people. I'm not saying I would advise that on ALL patients. I believe it's the total daily max of what 2400 mg that's the problem usually. (?)
You sound like you did well, considering.
Jan 26, '02
Originally posted by P_RN
. I believe it's the total daily max of what 2400 mg that's the problem usually. (?)
You sound like you did well, considering.
The books say for adults not to exceed 4G/day. You gave me a heart attack, PRN!!! lol
Jan 27, '02
A lot of nurses are afraid of incident reports, because they think they have failed by making an error of some kind. Yes mistakes in medications are very common and sometimes can have very bad outcomes. I think however the Tylenol is not going to cause to many problems for your patient.
Filling out incident reports can act as a protection for you and your patients, this because they tend to show trends in problem areas. For example one nurse having to tend to to many patients resulting in mistakes being made because he/she is being rushed.
Hospitals also like to know about things before they hear from a patients law firm. It is a sad fact, but in our profession we are at risk. So, make sure you have good insurance, report all unusual occurances, (even if you think there is no harm done) and make sure you stay current with your knowledge and skills.
Take good care of yourself, how other nurses perform their practice is up to them, but it is your duty to report any mistakes you notice having been made. Make sure when you fill out one of those reports you state only the facts (just like in a patients chart).
Jan 27, '02
I went to the floor on Saturday, to look to see if "the med error" nurse actually took care of her med error. After I filled out the entire incident report, all I had left to do was notify the HN and check off "HN notified", She had told me she would deal with it, since it was her mistake.
I looked in the "doctor folder", (when an incident report is filled out, the doctor has to see it and initial it. The regular doctors are not at the hospital on weekends, so the report is still in his bin)
I saw the incident report exactly how I left it........completed and signed by me, (missing the "HN notified"), she didn't do a thing after I left, she didn't "take care" of it as she said.
So it now appears like I didn't finish up my paperwork, since no one was notified. This is the last time that I ASSUME that someone will fess up to their mistake!
I am sure that it can go "un noticed", since the doctors hardly look when they initial these incident reports, but I am going to tell the HN tomorrow am about the situation, since I think my only mistake was not telling her right after it happened. I know it is late, but I have nothing to hide.
This other nurse graduated a few years ago, but she is approaching retirement, and I know she is mad that because I am working on the floor now, I am "stealing" her extra hours!!!
I don't trust her......it is a gut instinct......
Jan 30, '02
At our hospital, the one that finds the problem fills out the incident report, informs the head nurse and the doctor. The doctor has to fill out a portion that states what he did, then the head nurse fills out an investigation report and sends it to qa. If the head nurse is able to determine who made the error, she fills out a medication error the same day. If not, QA sends a form for the director to investigate by getting the chart and reviewing it. Always call the MD on any error and chart it, facts only. He/she may have wanted an acetaminophen level in for hours, and again four hours later and/or given her a dose of mucomyst since it was an elderly lady. Of course, it may have not been needed at all, but the md needs to make that decision, not the head nurse. Always CYA, don't assume that the other nurse or department will do the right thing. It is NOT tatteling (sp), tell them it is hospital policy and best for the patient. Who knows, this nurse may have made many med errors in the past and needs counseling.
You did good, dont let other nurses intimidate you.