Help!! I failed clinical due to medication error

sweetiepeas · Dec 12, 2009

Did you practice the 6 rights? I knowthey preach it religiously here and for good reason. I am glad that nothing happened to the person. Sorry you are having a hard time but it would be good to think it over and fnd out why you made the mistake and learn from it. Good luck.

CaLLaCoDe, BSN, RN · Dec 12, 2009

It's always good to be on the side of caution. This is a tough lesson to learn, however I'm sure you'd not want to be the night nurse in a fix for low blood pressure concerns. Glad to know your patient pulled through the night! Nursing is a scary business to be in and to get an early heads up of the seriousness of med errors could end up being a blessing rather than a curse when you look at it in retrospect!

caliotter3 · Dec 12, 2009

You need to calm down so you can look at this rationally. Until you can rationally see your mistake and how you will change your behavior to avoid making the same mistake in the future, you will not be able to face up to the committee. Good luck with getting your emotions under control, and moving on with nursing school.

yan2006 · Dec 12, 2009

Thanks for the reply.

I did all the checks. The problem is that I got interrupted on the way to the patient's room. PT came to me to ask me to if I had given patient S narcotics soon, so she can get my patient to do exercise. I told her that my nurse wanted to give the narcotics. By the time I went to patient's room, I gave the meds to S. Although I check the patient's name band, but I did not realize I was supposed to give the meds to S after that incident.

I learned next time i have to write down pt's name on the patch or a paper to remind myself of which patient i need to give the meds to.

Has anyone written a letter to the progression committee before? The following are the things i thought i could include. But i am having difficulty to write a concise summary, because the thing i wrote is like a story so far.

1.

Address the problem/issue

2. Circumstances why you made mistakes

3. Interventions about how to improve

4. Potential for success (student grade)

5. Require permission to take the course again

Thanks very much!

IlovenursingRN · Dec 12, 2009

Did you practice the 6 rights?

Obviously she didn't or she wouldn't have made the error. That's exactly why I love e-mar. (scanning bar codes)!

IlovenursingRN · Dec 12, 2009

I did all the checks.

No you didn't. You have to check the armband at the patient bedside immediately before applying the nitro patch. Learn from your mistake and do your best to move on. I'm sorry it happened to you. I know you're heartbroken over it. Don't let it scare you away from nursing.

Nursey103, ADN, RN · Dec 12, 2009

You don't just check the patient's ID band......you check the patient's ID band to make sure it matches the med sheet. You do this when you're getting the med, before you get in the room, & again before you actually give the med.

Of course there are more "checks" but if you did just this one, you would have not made the error.

Rules are in place for a reason. Don't let this get you down though, hopefully you can learn from this & grow!

About your letter - if you truly understand why you made the mistake (not doing the 7 rights....or doing them half-a$$), you can write your letter. Best thing is to be honest. Admit you made the mistake & explain why. Next time, you will make sure do comply with the 7 rights...& correctly!!

Good luck!

suanna · Dec 12, 2009

We have bar code scanning in place for several years- 20% time the med dosen't scan, 20-30% of the time the pharmacy has entered the meds wrong in the MAR- PRNs as programmed doses, double doses of alternative meds- (ie: "if taking PO change med to x po bid from y every 6hrs") both end up as "must be given" forever- , missed meds with no way of double checking besides looking back over weeks of doctors orders,... Get the picture? Good nursing care will never be replaced by bad software.
Back on topic, I made a significant med error in my senior year- thank goodness the patient wasn't harmed. It made me a MUCH more detail oriented nurse when I did graduate. I honestly think it was the hand of providence letting me make an error as a student to teach me a lesson I may not have learned otherwise.

sunnycalifRN · Dec 12, 2009

Thanks for the reply.
I did all the checks. The problem is that I got interrupted on the way to the patient's room. PT came to me to ask me to if I had given patient S narcotics soon, so she can get my patient to do exercise. I told her that my nurse wanted to give the narcotics. By the time I went to patient's room, I gave the meds to S. Although I check the patient's name band, but I did not realize I was supposed to give the meds to S after that incident.
I learned next time i have to write down pt's name on the patch or a paper to remind myself of which patient i need to give the meds to.
Has anyone written a letter to the progression committee before? The following are the things i thought i could include. But i am having difficulty to write a concise summary, because the thing i wrote is like a story so far.
1.
Address the problem/issue
2.Circumstances why you made mistakes
3.Interventions about how to improve
4.Potential for success (student grade)
5.Require permission to take the course again
Thanks very much!

Well, as you now know, medication errors are serious . . . it's fortunate that your patient recovered. Although you said you performed the six rights of med admin, you did not . . . you need to identify the patient before you administer the medication. I wouldn't write down the patient name on a piece of paper, I would bring a patient label along with medications because you need to identify your patient using two identifiers, full name, DOB, or medical record number

When you explain the error to the committee, don't try to make excuses or blame circumstances, you need to take responsibility for your actions and come up with a plan to avoid future errors.

A couple of suggestions: besides doing the six rights, identifying the patient at the bedside, you should be telling the patient what medications you are giving, and why.

Blackheartednurse · Dec 12, 2009

Wow,sorry this happend to you but then again maybe the punishment you received was to hard...I know at least three cases that happpend in my school (previous graduating class) where t students made medical errors and they passed their clinical. I never made a medical error but I had a close call...I was preparing bunch of meds for one patients and I took them out and one supposed to be split in half and I only realized that right before entering the patient's room.But I had a really awsome teacher who was understanding and gave me a break!

yan2006 · Dec 12, 2009

Thanks to all of you,

I just wanna to say that In Canada there is no "e-mar", at least the hospital I was in did not have "e-mar", plus, we don't typically bring patient's med profile to pt's room. So it is pure memory if you can remember pt's name correctly.

I learned a great lesson from this, but it is upsetting at the same time. I am learning to forgive myself and others, trying to focus on my exams, and trying to move on.

I really appreciate all of your help and suggestions.