How to avoid med errors . . . - page 2

Hello to all on this site! I very often lurk here to find support and understanding, but don't often post because I don't have much to say. Right now I am going through some things and I think I... Read More

  1. by   Lynda Lampert, RN
    Sorry, I didn't see the posts on the second page!

    Finallyat40, I don't get to select my patients. They are always selected for me. I actually requested from a few instructors that I be given patients that were a bit more complex because I enjoy the challenge. I like having to figure things out. Most of the time I can handle them. This time it just didn't work out.

    The good news is that this week and next I will be on a psych unit, so there should be some meds, but not as many complex ones. This, hopefully, should give me some confidence when I have to head back to the medical floor towards the end of the term.

    As for prioritizing, I have decided that my first priority for the day *is* meds. God, why didn't I think of that sooner? It's like, duh! I guess I was just sort of skating and becoming complacent with the fact that I could handle what was coming my way. I guess it is a humbling experience and that's what's really needed for a student. Not that I was pompous, mind you, but I felt confident I could deal with whatever came up.

    *pauses for laughter*

    I will also be meeting with the department head tomorrow to discuss my probation. I don't have a primary instructor in either clinical or lecture. They all sort of rotate -- and we rotate clinical sites about every two weeks. So, I have been told I will get an action plan then. Hopefully this meeting will not be about making me feel worse about what has happened but about using the resources of the school to ensure that these types of mistakes don't happen again.

    So, the "rights", do focused checks three times, and take your time though a million people are screaming at you . . oh, yeah, and make meds a priority. I think I can do these things.

  2. by   Finallyat40
    Quit beating yourself up! You've made a mistake, you accept and readily admit that you made a mistake (which is 90% of the battle as far as I'm concerned) and you're ready to move on and make an action plan for SUCCESS! You're a good student nurse....I can't imagine having to jump between numerous med systems with more than one clinical instructor so that you never are really able to get your groove going....I've been an RN for two years now and that would still probably throw me if it were on a regular basis!

    Enjoy your psych clinicals....I don't think I could ever work it full time, but loved it during school. I'll be thinking of you as you meet with administration and prepare to move forward....years from now, you'll look on this as the learning experience that it is rather than the nightmare you're feeling it is right now!

  3. by   Lynda Lampert, RN
    Thanks, Jaime. I will settle down. Just going to breathe. I actually am looking forward to psych because it was one of my initial interests -- and it may still be a path I want to go down. Just haven't had the experience yet.

    No more beating up, I promise. Only steely eyed determination to make myself the best nurse I can be.

  4. by   lvs2nrs3535
    I am a recent graduate and went through something very similiar. Please, please, before you do anything else, forgive yourself! Remember, tomorrow is a new day, and you get a chance to start over. My second semester was a nightmare, I felt like my instructor truly did not like me, and nothing I could do was right. This made me more nervous, and I made mistakes that were nothing more than nerves. I finally decided, I DID NOT COME THIS FAR TO BE BOOTED OUT BECAUSE OF A SUBJECTIVE OPINION!!!!!!!!!!! I did prove myself to her, and now she is one of my best references.
    This is probably the most stressful time of your life, and you truly have to give yourself a break. Then, you have to listen to the more experienced nurses advice. DONT let anyone rush you. Dont let anyone distract you. If you are anything like myself, it is very hard to feel as if you are brushing off someone, anyone who wants to chat, has questions, ect. But, when you are passing meds, nothing else matter. I remind myself that my patients life is in my hands, (and this is a literal truth), and they deserve nothing less than your full attention. Take a deep breath, or two or three, and remind yourself how hard you have worked to get this far, and do not let anyone or anything deter from what you know you can be. A nurse. I believe that we are so important, and there are so few people who can get through what we do, that we deserve to be proud of what we do, proud of what we went through to get here, and that was my mantra. I want to be a nurse. I will be a nurse. I am nobodys handmaiden. I am my patients lifeline. I am their voice, their advocate, their courage and their strength.
    And, the end of the day, there is nothing more satisfying than knowing that YOU made a difference in someones life.
    You can do it.
    Hang in there.
  5. by   WDWpixieRN
    Quote from Ionafey
    The next week got worse. I have never spiked a bag of IV fluid in my life. We had just learned it in lab and my client needed a new bag of 0.9% NS. I pulled a 1000cc bag that said 0.9% NS, but, unfortunately, I didn't know and didn't notice that it also said 5% dextrose. My instructor was in a hurry. We did not scan the bag like we were supposed to and the wrong bag got hung. Fortunately, the client was not diabetic and his piggyback was mixed in D5, so it was compatible. No harm to the patient, but I felt like I was going to die.
    One day early in our clinicals this semester, my instructor was asking what fluids were running in my pt's IV and I said I thought it was D5"something" (forget now specifically).....but I was looking at the chart and realized it was supposed to be NS....the assigned nurse (young and fairly new RN) was nearby and my instructor asked her what was hanging....she said, "Oh, NS; I hung it yesterday"....I mentioned I could be wrong and just didn't look at it correctly....she ran in to look and sure enough, it was the WRONG solution....again, thank heavens no one was injured....but it just proves that we can all make mistakes...

    I've just decided after reading nightmare stories on these boards to take my time with meds no matter what...if my instructor or anyone else wants to hurry, then THEY can admin the meds...I know I couldn't live with myself if I seriously hurt or killed someone...

    The other important piece of advice is to breathe and think....I see fellow students just stress like crazy over a skill or a med admin while in clinical and they not only drive our instructor nuts, it's kind of crazy to watch...we're students....we shouldn't know everything the first (and maybe the second or third) time we do it...we're learning....but one thing I know is, if someone before me was able to do this, then I probably can too (many, many "someones")....nerves and trembling/stressing doesn't help anything!!

    Hang in there!!
    Last edit by WDWpixieRN on Feb 25, '07
  6. by   future L&Dnurse
    My *first* day of clinicals, I went in to my patient's room to hang up a piggyback. The old piggyback from the day before was still hanging there - completely unused! The nurse the day before (who has been a nurse for more than 20 years, btw) had forgotten to unclamp the tubing.

    My second day of clinicals, my instructor handed me the wrong med to give to my patient. I caught it and we got the right one. I don't know if it was on purpose, to test me, or if she was making a mistake.

    Like everyone else said - slow down. The patient will be okay for 5 minutes while you make sure you've got the meds right. I am doing my first clinicals in inpatient oncology, and all of my patients have been on a ton of meds which can be really intimidating! I have never had a problem asking someone else to double check the meds I'm giving before I give them. I'd rather ask and take 5 more minutes, than not ask and be wrong. And eventually, I assume I won't have to ask as much any more - but if I am just having a frazzled day, I'll still ask even 10 years down the line.

    Slow down, and speak up too. If your instructor is rushing you, phrase it in terms of patient safety. "I understand that this piggyback was supposed to be hung 20 minutes ago, but I don't want to make mistakes. I think it's better for the patient to wait 5 more minutes while I make sure I give them the right medication in the right fluid, rather than rush and make mistakes."
  7. by   cherokeesummer
    My best advice is to take your time and to heck with the rushing. Yes I know instructors have work to do but patient safety is number one. Being rushed is dangerous. Especially when we are new at this!

    The mistake of saying the wrong drug, I'm sure that happens alot but I'm suprised you got written up for saying the wrong long asyou are giving the right drug, and caught your mistake, like oh wait I said hydrocodone but I meant to say hydrocortisone, sorry! I guess they just wanted to keep you on top of the names though.

    At any rate, I think time is probaby the issue here, just try to take the time to double/triple check and make sure you feel comfortable.
  8. by   cherokeesummer
    Hey! We use a MAK too! It does (supposedly anyway) seem to help with avoiding med errors, so far its been helpful in the sense that it tells you if what you scan matches what they need.