I had a BAD day... very bad.

  1. Today was our last day in clinicals. I made my first med error! Before giving ferrous sulfate, lovenex and effexor I failed to take vitals. I was bordering on giving them late for several other reasons, and didn't feel that I needed to take these measurements before administering these particular drugs. I have been written up for it and given a bad mark in patient assessment, medication administration 5 rights, and prioritizing care. Needless to say, being the last day and first error I feel pretty badly! I was doing really well until today and believe me from now on, I am taking vitals first thing regardless! Oh well, I ALMOST made it through first semester. I have a conference tomorrow, and have been told that this will "probably" not fail me out but will be put in my permanent record regardless.

    Here is what happened:
    The meds were due at 0800 and I got out of report at 0730. The patient was asleep so I began looking up the 14 drugs I had to give (3 at 0800 and the other 11 at 0900) and rounding up the labs. The breakfast trays were delivered at 0800, so I went in woke patient and introduced myself, cleaned patient up a bit, and delivered breakfast. The deadline for giving the 0800 meds was 0830.

    The things going on that needed to be done and that made me run behind were: 1) foley bag had been emptied and not capped properly, urine was all over the floor when I got there 2) patient was not wearing an armband so I could not give meds -- had to confirm identity, then get the armband 3) patient had not signed a consent for effexor, and I needed consent before administration (patient declined medication and did not sign consent btw) 4) patient was comfortable, no distress or pain, A & O x 3

    So, I got the meds together (the shot and the iron, plus the effexor and the consent) to present to my instructor for review at 0825 and she dinged me for not doing vitals yet. Because I had not done vitals, the meds were given later than 0830. So, I didn't prioritize correctly, meaning that the meds were late and that was also the 5 rights ding... she also wrote me up for not assessing the patient properly.

    Can anyone tell me how they, as a first semester student, would have handled the no -name patient with a leaking foley any differently? Or would you have just wheeled in the machine over the wet floor and taken the vitals immediately, even though you were only giving iron, an anti-D and lovonox? In any case, I could not have given the meds as I couldn't check the armband and had no clue on how to approach the identity confirmation. Advice appreciated!
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    About Vsummer1

    Joined: Aug '02; Posts: 1,062; Likes: 7


  3. by   memphispanda
    I am only a student myself, however this is my opinion.

    First, you were looking after the patient's safety. Patient safety is always priority--even over meds. At least that is what we have been taught. The wet floor was a fall risk. If you had rolled the BP machine in the urine, the BP machine would have been contaminated and possibly spread infection to other patients. The patient had to have an armband put on before you could do any medications--and really much of anything else. How else would you be able to document you had reason to believe you were assessing a patient rather than some wino who wandered in off the street?

    I also don't understand why the vitals were required for the meds you were giving. We don't have to check vitals unless we are giving BP meds, vasodilators or vasoconstrictors (there may be others that I am not aware of, but it is always on the MAR if we have to check BP first).

    You also were giving the patient the right to refuse medication and that took time.

    I don't see how this was an actual med error. You definitely wouldn't have gotten in trouble with my clinical instructor over how you handled things.
  4. by   Beach_RN

    I can't answer your question or offer you some sound advice... b/c I 'm not even there yet!

    However my friend...... I'm so sorry you had such a terrible day... I hope your conference goes well tomorrow.

  5. by   Vsummer1
    Thank you! I got caught up in the old catch 22 scenario.

    I just did not have enough time to do what I felt needed to be done and still give the meds at the right time. I was hustling as it was. Catching errors is what cost me. Someone else emptied the foley and it had been leaking for some time when I came in... someone else failed to get proper consent for the med... someone else forgot the armband. I caught these errors and made myself late by fixing them!

    But that is NOT listed on the write up I got. Only that I failed to take vital signs, thus was late giving meds and failed assessment and because I was late, it was a prioritizing issue. Three big dings!
  6. by   kittyw
    See if you can't write something to go with your write up to explain what happened. That way other teachers can read what happened and make their own judgement call.

    Sorry for the crudy day!!!
  7. by   Rena RN 2003
    does your school require you to sign your write ups? does it give you the opportunity to give your side of the story?

    if so, i wouldn't sign anything until you had written your version so that that also goes into your perm. record.

    and i'm sorry you had a sucky day. and i agree with the above poster, those weren't things you would have been written up for in my program either.
  8. by   Vsummer1
    Thanks for all your advice!

    Yes, it did give me all of 5 lines to put my response, as well as another space to tell how I could "improve". I don't recall exactly what I wrote, at the time I was a bit upset. I remember that I couldn't fit all I wanted to say into it.

    Perhaps I should request a copy though, and keep a copy of this post.

    In the long run, I am hoping it comes to nothing as all my previous clinicals have been fine. It was just today. Funny, as today's patient care wasn't as difficult as some of my others were. If those meds had just been ordered for 0900 I would have been golden! Or IF I had woke the patient up at 0730, or IF the armband had been there, or the consent had been signed previously etc. etc.

    THE SEMESTER IS OVER so at least I don't have to go to clinical tomorrow still upset.
  9. by   Mkue
    (((Val))), sorry this happend today, keep your chin up!

  10. by   boggle
    In the real world, or the world I live in at least, you would:

    do everything you described,

    maybe ask the tech for some help,

    get your am vitals,

    give the med late,

    then chart ," 0700 med delayed r/t consent not signed. Pt informed, consent signed, med given at 0745." or something like that.

    If the med or patient's condition had been urgent, you would have thrown the blanket down on the puddle or swam through it and cared for the patient.

    Sorry everything fell apart for you so early in the morning. Just remember, in the real world....stuff happens! At least you had your priorities/safety straight!
  11. by   emily_mom
    I think you were very wise to make a remark on your write up form. I would also keep something in writing for your own personal use, and in case this comes up again. We have always been told that we have an hour leeway in meds, but maybe something you gave at 0800 had and effect on one of the 0900 meds.

    I also think you have your safety priorities in line here. While your med was late, you had plenty of reasons that it was so. Was there another student that could have helped clean up the mess while you dealt with the other messes? We all help each other out.

    Things will get better. Just put this one behind you, and you will be fine!!! Don't bring it up; we all make mistakes!!

  12. by   FullMoonMadness
    Ive never heard of neeeding a consent for effexor. But, relax in knowing that this is not the last time in your career that a med will be given late.If everything was controlled by the nurse,then these things would not happen, but that is just fantasy world.
  13. by   KRVRN
    Your instructor should have at least pointed out what you did right. Unless this pt pulled his own armband off and lost it somewhere recently, you caught a major detail that who knows how many shifts of nurses should already have noticed and corrected. How long before was the effexor ordered? Should consent already have been gotten? You were right to get it and not cut corners and give it without consent.

    Absolutely, there are meds you wouldn't give without taking vitals... BP meds for example. But since other things needed priority, your meds were late. It happens. I'm sorry you feel so terrible about it. I know I would have too, but feel good that you paid attention to detail and caught something that most likely was overlooked by several nurses before (the armband).
  14. by   Furball
    A med given more than 30 minutes late? Excuse me...


    Welcome to the REAL world of nursing.

    Imagine having, say, 7 pts. They ALL have 5-12 meds due at 9am. Most have BP meds and IV abx ect. It is PHYSICALLY IMPOSSIBLE to give meds EXACTLY on time. I would try to start giving 9 o'clocks at 8:30 and feel like I did a darn good job if finished by 9:30., considering CONSTANT interruption, "I need ice water, I have to use the BR NOW, I need to speak to DR Whoozywhzzit NOW, the doc in room 8 needs assist at bedside NOW, critical lab on the phone NOW, relatives on the phone NOW.... missing meds?(I would run to the pharmacy, which is 9 floors down and through a LONG winding hallway, instead of waiting the usual 3 hrs for the med to arrive) USUALLY I would finish up meds at around 10:00-10:30.

    Are you sweating yet?