Has anyone overmedicated a pt?

allnurses Guide · Jul 2, 2017

Ok so you made a mistake! A big one and a patient might well have died because of it. Rather than hide and run it's time for you to stand up and own it. When you face the world with integrity you have nothing to fear. Will you be written up? Almost certainly!. Have you lost a measure of your co-worker's trust? Absolutely. Could you lose your job? Maybe. But you don't know until it happens. Med errors happen all the time. Any nurse who says they have made one is lying. If you are on orientation you might be let go or have your orientation extended. I doubt that you will lose your license over this especially since it was only your second day as a floor nurse. Unless you did something egregious like falsifying an assessment you will like get some kind of disciplinary action and some reeducation. No one knows for sure. As long as you did not falsify charting, IE.....documenting vital signs you didn't actually take then you may just face a write up with some extra training and move on with your career. It won't help you this time but I do suggest that you seriously consider purchasing malpractice insurance over and above what ever insurance your facility offers. I carry a two million dollar policy which is because I have a kid about ready to go to college and I own two homes both of which I could lose or have to sell if I didn't have this insurance. I have never been sued and don't plan to be but as the saying goes "It's better to have it and not need it, than to need it and not have it.

Never let your being in a hurry be an excuse for sloppy nursing practice. Always assess your patients, LOC, Respiratory effort and rate and pain level before medicating. If it's not time or your assessment indicates it's unsafe at this time then document your findings and hold the medication. You may get a poor satisfaction survey but at least the patient will be alive to complain.

Peace and good luck

Hppy

MelissaC71 · Jul 2, 2017

I did it. We all do it. Mine I can still barely believe it...I was doing an admission on a pt who wasn't mine. She was in incredible pain. I had orders to give her meds so I did. Luckily It was a small dose and I gave it slow. I asked all the right questions before hand. I had done her vitals and was sitting on the side of the bed doing the admission with her and her 8 family members sitting in the room. I had pushed 2.5gm of morphine with 25 of gravol over 7 minutes. She had nothing else on board. I went to ask her a question and she didn't answer me. I turned to look at her and all I saw was her head down and she made that pfthththththt noise like blowing raspberries. My first thought was "oh ****" and with all this family in here. I turned and gave her name a few calls, along with a sternal rub...nada....I said to her daughter as calm as a cucumber "see that panel on the wall there?' "Can you do me a favor and press the blue button?" She did. I was in the process of flattening out the bed and getting O2 on her when doctors and nurses galore ran into the room. A shot of narcan and she was fine. Her family was the nicest ever. All they said was "you were so calm" They have no idea I died internally about 30 times in that 2 minutes......anyways moral of the story, cover your ass. Do the vitals and assessments prior, go back and check if they have had relief from the meds given. If you were covered in the MAR you should be ok. We all make med errors at one time or another. Own it, admit what you did and learn from it. It's one thing to make a mistake and run from it, It's another to take responsibility and learn from it. Most med errors I have come across (reporting wise) are not meant punatively they are meant for all to learn from.

AlabamaBelle · Jul 2, 2017

I once hung a sedative gtt on a child who was intubated and terminal. The medication had been triple concentrated and I did not appropriately check that. It ran at the regular concentration rate. It was not reported as an error, though. The child had her most comfortable night and her parents were overjoyed that we had "found" the dose that worked. She lingered for a about another week, when care was withdrawn. I have made other mistakes, not like that one, but mistakes nonetheless. Own it and learn from it. As has been stated, any nurse who has been practicing any length of time is not being truthful if they say they have never made a mistake!

Sour Lemon · Jul 2, 2017

I was in such a rush to keep up with my tasks...

I learned the hard way to let some of the "tasks" go and focus on the big picture. I can justify skipping an accucheck on an alert, oriented, well-educated diabetic who always has a result between 90 and 110 when I have more urgent things to do. Supervisors will sometimes assign you the work of three individuals. It's just not possible. You will have to cut corners, but cutting the right corners is very important.

It's easy to feel lonely when you make a mistake, but you are not alone. Most people just don't like to advertise their mistakes, so it can seem like they're not making any.

JKL33 · Jul 2, 2017

It'll be okay.

Does your facility have a policy in place that you must medicate (or medicate with opioids) for pain reports greater than 7/10? Despite "pain is what the patient says it is", a clinical assessment of the situation is in order as well as alternative interventions or even contacting the physician if the patient is never getting relief at what s/he would consider a tolerable level. As nurses, we must believe what the patient says about pain, but at the same time I guarantee you will run into trouble administering narcotic after narcotic based solely on a numeric pain rating.

The vitals are important and they might've cued you. On the other hand, if you're right on the verge of giving one dose too many, they might tank right after you've assessed them and left the room, which is why your clinical assessment of the situation is important.

Regarding being written-up: The correct thing to do is for you to fill out whatever your facility's version of an incident report is, since you made an error. You probably would've been able to at least talk this through if you had contacted your clinical support nurse or manager. I would still advise doing that. There's no use feeling sick over it at this point. Just learn and go forward.

Atl-Murse · Jul 2, 2017

I dont see an error here . you gave appropriate meds as ordered. How do you know the episodes was related to meds or somthing else ?

Joy16Sarah · Jul 2, 2017

This is probably a dumb question. I work on a med/surg oncology unit and sometimes float to ortho, but I've never heard of a policy of vitals every time before pain meds. We do frequent vitals after surgery procedures for several hours, but not for pre pain assessments. We do have a sedation score with parameters for administration. Am I missing something? The OP mentioned floating to stepdown, so I assume she was working on a med/surg unit. All I can say is, wow, if you have to get vitals for each pain administration, Im glad I don't have to work there. I have been a nurse for 15 years and wont lie and say I havent cringed a couple times and some doses Ive administered and woke a patient "just in case".

I vaguely remember narcaning with the help of the supervisor when I was a first year nurse working nights and the paitent ended up being fine. Looking back Im sure I was at fault and I was probably ignorant enough not to even consider it my fault. Times were different then-15 yrs ago, if I can say that, and I don't think nurses were scrutinized as heavily for their work and less attention was given to pain issues. I never received any feedback from a supervisor or the hospital in any way. I certainly learned from it though and sympathize with you.

RNperdiem, RN · Jul 2, 2017

I work in trauma, so am familiar with the kinds of medication issues you sometimes face with orthopedic patients. Pain control can be a big problem, and it usually takes powerful narcotics to control the pain. And sometimes there isn't enough pain control in the world to make you pain-free with multiple rib fractures, bilateral femur fractures and a clavicle fracture and still keep you breathing without needing a ventilator.

I am assuming you gave the correct dose in the correct time frame and everything else that was ordered. Sometimes patients do become overmedicated. It is one of those judgement calls nurses have to make of when not to give a pain med- like when the patient can barely stay awake to tell you they have 10/10 pain, their respiratory rate is low to begin with etc.

We have all made medication errors before, so we know the feeling.

TriciaJ, RN · Jul 2, 2017

This is probably a dumb question. I work on a med/surg oncology unit and sometimes float to ortho, but I've never heard of a policy of vitals every time before pain meds. We do frequent vitals after surgery procedures for several hours, but not for pre pain assessments. We do have a sedation score with parameters for administration. Am I missing something? The OP mentioned floating to stepdown, so I assume she was working on a med/surg unit. All I can say is, wow, if you have to get vitals for each pain administration, Im glad I don't have to work there. I have been a nurse for 15 years and wont lie and say I havent cringed a couple times and some doses Ive administered and woke a patient "just in case".
I vaguely remember narcaning with the help of the supervisor when I was a first year nurse working nights and the paitent ended up being fine. Looking back Im sure I was at fault and I was probably ignorant enough not to even consider it my fault. Times were different then-15 yrs ago, if I can say that, and I don't think nurses were scrutinized as heavily for their work and less attention was given to pain issues. I never received any feedback from a supervisor or the hospital in any way. I certainly learned from it though and sympathize with you.

This. On the specialty surgery floor I worked, we mostly had PCAs and did frequent vitals when the patient was immediately postop. Occasionally I was floated to ortho, where for some reason, they hardly ever used PCAs. I was running with syringes of morphine all shift. They also didn't use foleys, so lots of heavy lifting, too. I can't imagine getting a set of vitals before every shot of morphine. The thought of that blows my brain.

By the way, if it was only your second day on the job, didn't you have a preceptor? This is sounding like a thrown-to-the-wolves job.

As for the "error": just make sure you complete the appropriate forms and notify the appropriate people. If they fire you for this consider it a blessing. And no, you won't lose your license. Hang in there. It'll stop haunting you eventually. We've all been there.

bgxyrnf, MSN, RN · Jul 2, 2017

In my case, twice... once as a new new-grad and a complete accident; the other as a newish ED nurse and was partly intentional and partly an accident (that is, I overshot the sedation level while trying to keep a drunk trauma patient on the XR table. Both experiences taught me a great deal and neither had a poor outcome.

The first case was much more dangerous because the patient was not on a monitor and the facility had limited ability for advanced interventions. The latter case was less risky because the patient was being closely monitored and could be readily intubated if needed. In either case, though, I gave more meds than I should have. In one case I was written up, in the other I wasn't.

Both cases, though, made me a much safer nurse.

Cvepo · Jul 2, 2017

A few weeks off orientation, I had a sickle cell patient who had a well documented pain medication plan with a pain management specialist that said, and I quote: 8mg IV Dilaudid (yes, 8) q8h ATC (0800, 1600, 0000), with 4mg IV q4h prn for breakthrough. Mind you, this patient was not admitted on my shift, so he had already received a few doses of the 8 mg. This order was entered by a physician, and verified by a pharmacist before it could be given. Of course I give him his scheduled 8mg IV for his severe sickle cell crisis -- and he's talking, appropriate, and saying he's in 10/10 pain. Well guess what? We were Narcanning him an hour later when he became unresponsive.

I felt awful because I knew 8mg DID NOT seem right. Having complicated surgical patients and sickle cellers often, it was not uncommon on my unit to have 2mg, 3mg, and an occasional 4mg IVP of Dilaudid, but even new I knew it didn't seem right. My preceptor was charge that day, and even she wasn't sure, but agreed that if multiple physicians said it was OK (and this pain care plan the patient had was well documented by a consult note from the pain management provider), I wrongly assumed it was ok. I knew if I called his primary medicine team, they would have just referred me to what pain management had recommended and ordered.

I didn't get in any trouble, at all. But I felt awful. This pain management doc has a reputation locally, and I know that now. Patient wasn't too happy, because his doses all got cut in half. Every now and then I'll see his name on the ED tracking board and it makes me shudder because I can still remember that day! Now I am much more weary with heavy doses of pain medications. I learned and you will too!