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get kicked off because of med error

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hbahta hbahta (New) New

A medication error was discovered when we were counting narcotics at the end of the shift yesterday. What happened was that I administered Oxycontin 80mg, which was scheduled at 12pm instead of Methadon 5mg at 10am. This happened after I found out that the resident was getting ready to go out, and I rushed and pulled the medication according the EMar but failed to check with eMar if it was the right drug or not. The Md was then notified and ordered to hold the 4pm scheduled Oxycontin and to do Q2 hours vitals until midnight.

Right away I checked the resident's condition, didn't notice any respiratory distress, and vitals were, Bp 100/52, RR 12, po2 92% and pulse was 86.At 10:30pm I call the night shift R.N to follow up on the condition of the resident and he told me she was doing fine. I went in the morning she a signed me new patients, we did our morning med pass and we took a break. when i came back from break I caught he sinking in to my folder to see my report and I wasn't crazy about it, instead I showed her what I wrote she said good i thought you would hid it.

Then when the instructor came they chat for an hour. Then my instructor ask me about it but before I finish she told me to I need to meet with director of nursing. When I went there they were both in in office as walk in I saw the anger in the director's face. I told her she is right to be angry because I didn't do what I my instructors thought me. I took full responsibility for my mistake. But it didn't stop her from blocking me from my graduation this semester which was the next day. I ask her if can retake the clinical again she said to call her when the registration starts. I called and left a message and wrote email after two days she called to tell me I am kicked out of the program.

What am I going to do? I don't think any school will take me for just a clinical or for only one semester.

Edited by TheCommuter
reformatting (paragraphs)

:sorry:This makes me scared. I'm going into lpn school in 3 weeks and now I'm afraid I'm going to give someone the wrong medicine. Don't know if they will take you back. Its all about patient safety. They may see you as a risk. Good luck and best wishes.

CT Pixie, BSN, RN

Has 10 years experience.

My question is how in the heck did the instructor NOT notice the error before you gave it?? When I was in LPN school, during med pass we were not allowed to give any medication without the instructor double/triple checking it before it was given. Same thing happened during my RN program. We were never able to give meds without the instructor double/triple checking it.

TriciaJ, RN

Specializes in Psych, Corrections, Med-Surg, Ambulatory. Has 40 years experience.

I'm not clear on what exactly happened. It seems like you just gave a scheduled dose of Oxycontin 2 hrs early. That shouldn't have been that big a deal for the patient, as long as it was documented and all the checks were done.

What concerns me is that just a few days before graduation, you made a very careless med error involving controlled substances. The error wasn't discovered until the next narc count was off. By this time, it should be deeply ingrained in your brain that you check every med 3 times before it actually goes into the patient. This is not a corner you cut, no matter how pressed you are for time.

Has all your clinical time been exemplary before this one unfortunate error? Or does your instructor have reason to be concerned? I don't know how to help you get back on track. Your best bet might be to meet with the director of your program. Ask for honest feedback about your whole performance, beside the one med error. Ask what you need to do to prove that you take nursing and patient safety seriously. Good luck.

Where was your instructor? I feel like she/he should have noticed it. I mean, you are working under their Licence. Kind of crazy they didn't notice.

I also feel bad they kicked you out for a med error that didn't do any harm and you didn't hide it. Shoot a girl gave a med and the patient was already going down hill that day and she should have held it. Another girl transferred a Pt without a gait belt in front of the state.. Both happened last semester and both girls are about to graduate.

I wouldn't worry about not being able to get in to another school. Could you appeal the decision to be kicked out?

smmctowelie don't be afraid we all make mistakes in life but on your clinical make sure before you give your medication to do your 6 rights and have your preceptor check what medication you are taking out before you open it and do one thing at a time. getting scared is good it will make more careful and it is good to learn from other peoples mistake.

LittleCandles on the last clinical we were on our own with nurses of the facility, my instructor was coming only once a week to see how we were doing. My report from my regular preceptor who had me for tree weeks was all positive but she took two days off. the nurse that came to work those two days was with a part timer. Anyways I administered Oxycontin 80mg at 10 am instead of at 12pm, Methadon 5mg was the one scheduled at 10am and because we didn't find out early enough she took another Oxycontin as scheduled at one o'clock so she could be overdosed but she was doing fine. I don't know if they going to approve my appeal but i will try.

thank you

before that it was all good and you right, I was careless to make such kind of mistake. but this is a mistake not a habit.

Thank you

akulahawkRN, ADN, RN, EMT-P

Specializes in Emergency Department. Has 6 years experience.

Sorry to hear that this bit you, but med errors do happen and they can be very serious. Sometimes it seems that the instructors are "blowing things out of proportion" when what they're really doing is reacting to the worst-case scenario. You see, your patient is used to having opiates in their system, so having that 2nd dose of Oxycontin just 2-3 hours later wouldn't have done much to them. It's the "what if" game that they worry about because any number of things could result in patient harm, up to and including permanent injury or death.

It's not the actual drug they're concerned about... it's the process. They need you to be 100% safe so that when you're loosed on the world, they can say that you were trained to do things a certain way and if you're doing something different, it's not on them... and the way they trained you is a safe way to do it, and will be ever time, if you do it "their" way. If you always do the Rights* and 3 Checks, you'll always be as safe as possible, even if you're slower than others.

*I intentionally left out the number of Rights because I've seen anywhere from 5-8 (or more) Rights as it pertains to medications.

Oxycontin is long acting. So that you gave it at 10, instead of 12, and the resident got another at 1--then she was scheduled to get another one 4 hours later at 1600? (That granted was held, but that is a really close schedule for Oxycontin) Or are we talking about the short acting Oxycodone? But then she also gets Methadone?

First off, the only thing I would see is that she could be in pain due to the continuous nature of the Oxy, and Methadone for more immediate relief.

With that being said, the noon Oxycontin was given at 1 pm, which is an hour after if was to be given (and I know you gave it at 10am, however, even if you had given the correct medication at 10am, this was off by an hour) Mind you that some facilities allow an hour leeway with medications, but with another one at 4pm, I would be wanting to give that med as close to on time as possible.

So seems to be in part a process issue that should be addressed, and hopefully will be. So you gave it at 10, someone else gave it at 1. What is the difference between that and giving at 1pm, then again at 4? Three hour difference either way. Doesn't excuse anything, other than the patient got the med in the same 3 hour time frame as they would have anyways, just early, so on that basis, no patient harm. (although again, I question why oxycontin is given so frequently--but that is neither here nor there at this point).

That your clinical instructor "checks in once a week" is doing a dis-service. To the patients, and to the fact that you are working under her license. I am not sure that this nurse will get dinged for it, however, it was ultimately the licensed nurse's responsibility to ensure safe medication administration.

Going forward, the only thing I can not stress enough is to check and double check the complex pain control patients. And be sure of the med you are giving. Especially sound alikes such as Oxycontin and Oxycodone. And then throwing methadone in the mix. That this patient has powerful medications so close together, any variation could set up for some withdrawal, or inadequate pain control.

The only thing you can do is appeal. And I hope it goes OK for you. To clearly state that you made an error on a complex patient is not a bad thing. And that you have learned and will remember to check for the 7 rights, that you will be mindful of slowing down and looking at what you are giving and when. That you were unsupervised by a clinical instructor on site may be your key to getting into another clinical. That is eye opening. And not safe practice, in my opinion. Be sure in any event to have the school release your transcipts. That way you have them should your appeal not go through. I am really perplexed at this patient's meds to begin with, and I have been doing this a long time. It was a tough case. That you did not have a go to person to talk about this is just wrong.

Best of luck with this, and let us know how it goes.

andreasmom02

Has 7 years experience.

Wow, I'm really sorry... When I was in LPN school, we weren't allowed to give meds, especially narcotics, without an instructor or precepting nurse present. I'm an LPN, but am getting out of floor nursing. Trying to get in to medical coding. I've been an LPN since '08, but medication errors still make me a little nervous. I've never had one, but I am an anxious person, and floor nursing just isn't for me anymore. I hope you get this worked out & are able to attend another school. As long as the patient was ok, they should realize you are a student. Someone should have been with you helping you, in my opinion.

BuckyBadgerRN, ASN, RN

Specializes in HH, Peds, Rehab, Clinical. Has 4 years experience.

Wait. Are you a STUDENT or an actual nurse. I'm confused. If you're a student, why would you have a preceptor? If you're a student, how in the world are you passing such heavy duty narcotics without your instructor or the nurse you're assigned with that day not double checking what you're doing? Was this your first error in a clinical? (back to the if you're a student scenario)

smmctowelie don't be afraid we all make mistakes in life but on your clinical make sure before you give your medication to do your 6 rights and have your preceptor check what medication you are taking out before you open it and do one thing at a time. getting scared is good it will make more careful and it is good to learn from other peoples mistake.

BuckyBadgerRN, ASN, RN

Specializes in HH, Peds, Rehab, Clinical. Has 4 years experience.

Whoa!! Your school has you out at clinical sites with NO instructor present? What kind of facility wants to take on that kind of responsibility? I get a little more frightened with every post you make =(

LittleCandles on the last clinical we were on our own with nurses of the facility, my instructor was coming only once a week to see how we were doing. My report from my regular preceptor who had me for tree weeks was all positive but she took two days off. the nurse that came to work those two days was with a part timer. Anyways I administered Oxycontin 80mg at 10 am instead of at 12pm, Methadon 5mg was the one scheduled at 10am and because we didn't find out early enough she took another Oxycontin as scheduled at one o'clock so she could be overdosed but she was doing fine. I don't know if they going to approve my appeal but i will try.

thank you

ArmaniX, MSN, APRN

Specializes in Critical Care. Has 8 years experience.

I'm surprised so many are surprised that she was at the facility without her instructor? At my school as well, for the very last "clinical/practicum" we would go to the facility alone with an assigned nurse who we would work beside... the actual instructor showed up maybe a total of 3 of the 12 shifts required to check in on our progress. I thought this was a standard practice? This poster was a day away from being able to take her LPN exam.

BuckyBadgerRN, ASN, RN

Specializes in HH, Peds, Rehab, Clinical. Has 4 years experience.

Nope, my instructors were there every minute of every clinical. We were not ALLOWED to be at a clinical site without an instructor. She would divide us up, some would go to same day where there were lots of IV starts, some to ER, etc, but she was ALWAYS in the building with us.

CT Pixie, BSN, RN

Has 10 years experience.

Def not standard practice. In both my LPN and RN schooling our clinical instructor was with us from the beginning of the day to the end. During LPN school for me we couldn't even go to the floor unless the instructor was with us. In RN school we were able to go to the unit and look up info of our patient but we could NOT touch, see or talk to any patient unless our instructor was actually ON the unit (not just in the hospital).

I am still dumbfounded that any student (regardless of whether being watched over by their school clinical instructor or a nurse that they are following) had the ability to pass meds without anyone double checking! Especially narcs! Why did the 'preceptor' not notice the error before it happened??

We are not allowed at clinical sites without an instructor either. We also could not pass meds without instructor or a nurse with us.

That is the state law.

Wow, now we are seeing were there is a big difference in training. It would be interesting to see what schools everyone is in.