How bad is this clinical screw up??

Jolie, BSN · Oct 20, 2006

...I should have brought the wrong IV fluid and the unordered SL to the RN's attention by 0800, not at 1300. I was ready to cry, because it just showed what a low level I was functioning at-even though no one was hurt.

I'm not sure I understand the order of events. When you assessed the patient at 0800, and realized that the IVF was not as ordered, why did you not call that to your staff nurse's attention. Even if you knew that D5LR was not compatible with the IV med you would eventually be giving, you should have notified the doctor of the discrepancy at that time. There may have been a reason why s/he preferred D5LR despite the medication incompatibility, (which could have been easily addressed by flushing before and after the IVPB.) I find this issue to be concerning, especially since your instructor seemed to "blow it off". If it had been addressed adequately at the beginning of your shift, I am quite certain that you would have noticed the hep locked IV as well.

Since this patient was quite independent, I suspect that someone hep-locked his IV site to allow him to shower, and simply forgot to re-connect it afterward. It sounds like at least 2 other shifts missed this as well, which doesn't make things right, but does point out the importance of thorough shift checks, which must not be taking place on this unit.

RNSuzq1, RN · Oct 20, 2006

Hi School,

I'm not sure if I understood this correctly. During your am assessment, you saw a bag of fluids hanging and said you checked his IV site and it was good. I'm confused, are you saying that you didn't notice that the tubing wasn't connected to the IV in his arm? If you did check and it was connected, maybe the primary Nurse medlocked him sometime during the day without your knowledge.

Whichever, it was, it was a mistake and mistakes happen - thankfully the patient is ok. Don't give up on yourself or your Nursing Career - the fact that you're acknowledging what happened and asking for help means that you care and want to do better. You're not a Loser, as hard as we all try to do a good job, it can get so busy (and stressful), sometimes things are overlooked - hopefully nothing that will endanger our patients.

I'm a new Nurse and being constantly reminded by seasoned Nurses that we're all human and even they make mistakes sometimes. I guarantee that after this, you'll probably be so anxious about forgetting something, that you'll be doing excellent head to toes from now on to avoid anymore problems. Just learn from this, go on with your Advanced Med-Surg and do your best - I'm sure you'll do fine. Chin-Up, Sue

Please let me know how serious this is-my confidence in my ability to be a good nurse is a bit shaken.
I'm in 3rd (out of 4) semesters, and today was our next to last day of clinical. So far I'm doing great. For the 2nd time only, I took 3 patients and was giving all meds, assessing, plus doing CNA tasks. I had 2 heavy patients, one light one with cellulitis who was completely independent, just in the hospital for his one IVPB q24h. So I assessed him 3rd, checked his IV site was good, asked him if he needed anything, saw he had hours of IV fluid left in his bag, and left. I looked in on him, took his vitals, charted his intake, but didn't do anythign really with him until 1300, his IVPB. I had realized that he had LR hanging instead of the D5LR ordered, but that was okay because the Invanz I was hanging really shouldn't go with D5. I had confirmed that with my teacher. We checked the MAR, primed the IVPB tubing, and entered the room. AND THE GUY WAS SALINE LOCKED!!! That hadn't been ordered, but he confirmed it had been that way for 24 hours! So I flushed it, hooked everything up, and ran my IVPB, but my teacher knew I was a complete loser. I bet she thinks I never even looked at him that day-and even though I did, I'm not sure what's worse: not looking at him at all, or thinking I had assessed him and missing such an obvious thing!!!! I should have brought the wrong IV fluid and the unordered SL to the RN's attention by 0800, not at 1300. I was ready to cry, because it just showed what a low level I was functioning at-even though no one was hurt.
I was stressed, trying to go out of the semester with a bang with 3 patients, 2 of them heavy (p.s., I did good with them). But I feel like such a loser. I know I have to slow down and go back to just doing a head to toe thoroughly on everyone, no matter how healthy looking.
Am I totally not ready to go to Advanced Med-Surg next week? Do any of you do stupid things like this while actually trying to be a good, conscientous nurse?

JentheRN05, RN · Oct 20, 2006

The worst thing is 'thinking' I have an 'easy' patient, so simply checking in on him will do the trick. Truth be known - it is usually your 'easy' patient you'll have problems with. Always seemed this way for me in nursing school.

I was way ahead of my class taking more than the required from second year on. (wasn't supposed to take more than 1 up until 3rd class of third year) But I was confident in my abilities, so my instructor would make sure i had a hard patient and a 'walkie talkie'. I remember several times where it was my 'walkie talkie' that got me in more problems than my 'hard' patients.

I am sure you overlooked it. I would've too, he's an easy patient, just in for iV ATBX so no biggie.

But you did screw up, if I remember correctly I had the same thing happen once. I thought a patient had IV fluids running, the machine was on, just not hooked up and since he was a walkie talkie I thought it wasn't a big deal.

Your instructor is likely disappointed in your observational skills. But I think I would tell her, that 'it's my fault, I was thinking he was an easy patient, I didn't assess him well enough - although I swore I saw it running - accept full responsibility, I assure you this won't happen again'. If you accept your responsibility in this and you learned from it that's all you can do. I highly doubt any major repercussions will come of it. No harm was done and your confidence may be shaken. Just let it be a lesson and move on. Just remember this not ALL 'walkie talkies' are as they appear. Always check all of your lines - and if it helps you to remember to do so, mark them with tape or something. That way you KNOW you didn't miss something

RGN1 · Oct 20, 2006

At the end of the day you are a student & you're there to learn. I'm surprised you had patients all on your own but that may be because I'm comparing with UK training. Here a student would not be allowed to be in sole charge of any patient & would always work with an RN even if she was right at the very end of her training.

I expect you've already learned a heap from this incident so put it down to experience & take what you need to from it without beating yourself up over it.

firstyearstudent · Oct 21, 2006

Your clinical instructor didn't think this was a big deal, right? Why don't you trust him or her. It doesn't seem like all that big of a deal to me, either, frankly. It sounds like you feel very responsible, which is great, but perhaps too responsible. You are still a student...

I am a student and, for better or worse, I don't take too much responsibility for my patients at this point. I would have went straight to the RN. "Why is the patient running RL when the order is saline?" I am constantly asking questions (and sometimes annoying them. Sorry!) "Is so and so still NPO? Should I take the tray out of his room? How do I get these dirty sheets to the soiled linen room? Is it okay to take the MAR into the room if my patient is on isolation? How many mls should be in this flush?"

I do not come off looking like a stellar clinical student. On the other hand, I feel like I don't take anything for granted. If I don't understand anything, I ask, even if it makes me look stupid.

**canoehead, BSN, RN** · Oct 21, 2006

I think it is a signifigant error, but not because of any harm that came to the patient. If you thought the IV was hooked up you should have seen the tubing when you checked the site, the fluid should have been dripping and the pump should have been on. Lots of visual cues that you "saw" because that's what you were expecting to see. Try not to assume anything when you do the initial assessment, you need to draw your own conclusions, not affirm what someone else said. Down the road small changes like work of breathing, or skin color will be your first cues of trouble and you will need to see them.

luv2shopp85 · Oct 22, 2006

At the risk of sounding like a complete and total idiot... what do you mean he was saline locked? I don't understand.

PANurseRN1 · Oct 22, 2006

I don't understand this scenario at all.

all4schwa · Oct 22, 2006

the mistake was your initial asessment. the guy confirmed that he had been saline locked for over 24 hours. the nurse doing the ivpb the day before probably saline locked him when she realized the wrong fluids were running and went to get a new bag. she dropped the ball, night shift missed it and you didn't assess the iv site in your inital assessment. You would have seen that there was no line of fluids running from it. which also means you didn't assess the time and date on the iv line (often due to be changed on days).

None of this is a big deal in the scheme of things and should in no way, shape or form should shake your confidence in yourself to be a good nurse.

LoriAlabamaRN · Oct 22, 2006

Are you sure that you had checked his IV site that morning? Or oculd you have forgotten to check his, perhaps confused it with another patient's site? The reason I am asking is because it would be pretty hard to check an IV site for patency and not notice that it was just a saline lock.

smk1, LPN · Oct 22, 2006

If you checked his site you woud have seen that he was saline locked or still hooked up to the IV. So when you went in there in the morning he probably was hooked up to the IV. My thoughts are that he wanted to get up and go out or shower etc.. and the nurse took him off the IV and put him on a lock and didn't hook it back up because she/he figured you would take care of it when he got back.