Help!! I made a medication error!!

JKL33 · Mar 3, 2020

3 hours ago, RN-to- BSN said:
It's common that the nursing STUDENT does not have access to EMR.

It's a common thing, yes, but overall a student not being allowed to have full access to relevant parts of the record and/or not being expected/allowed to document in that record is a newer development. The possibility of a student messing up a record is something that has been an accepted part of the learning process for lots of generations of nurses, and isn't any kind of irredeemable catastrophe.

EMRs have changed things, it's more difficult to give everyone the access they need (and should have)- and keep track of all of that - just due to the logistics. But we manage to keep track of other stuff, like whether or not everyone has had their immunizations and completed their HIPAA training and all of that. So to some extent this is a matter of people unilaterally deciding that allowing students to get functional with EMR use is just more trouble than it's worth.

1 hour ago, turtlesRcool said:
If it's being charted under my name, I'm making damn sure I see it given.

That's part of the problem, though - it shouldn't need to be charted under any staff member's name. Students' actions should be documented by them with the approval and cosignature of their instructor. From the sounds of it we're in a pretty bad place with schools and clinical sites not working together on much of this. Hospitals act as if it doesn't benefit them to have students rotating in their facilities and they're just doing the world a huge inconvenient favor by "allowing" it. Making it the staff nurse's problem, hobbling the learning process by limiting access and privileges and the overall contentious attitude needs to stop. The experiences need to be allowed and they need to be properly proctored by someone for whom that is the primary responsibility.

Kooky Korky, BSN, RN · Mar 3, 2020

You should never be giving meds that you have not poured.

If God Himself tells you to do that, you must verify with Him that the meds are correct. Right pt, right med, right time, right dose, right route.

Whoever handed you those meds and told you to give them to whoever, should not have done that. You should not be required to trust that the other person got it right.

Best wishes.

**CommunityRNBSN, BSN, RN** · Mar 3, 2020

19 hours ago, svicente0520 said:
Update. So I have failed my practicum. I will not be graduating in May as planned. I will be able to retake the semester this Summer. I hope I never make this kind of mistake again. I thank everyone for helping me. I understand I made a mistake but my preceptor only blames me, which is what it is. I'll continue to count my blessings and keep persevering.

I'm so sorry. You will look back at this as just one unfortunate incident in a long nursing career. I'm glad you have a plan to move forward.

TriciaJ, RN · Mar 4, 2020

You said you didn't check identifiers such as the wrist band? When I worked in med-surg my patients often told me I was the only nurse who checked their wrist band when administering meds. I thought they must just not have been noticing when it was done. I mentioned this to a coworker who told me she never checked the wrist band. I was shocked.

I suspect that this is a common corner to cut and you may have witnessed nurses giving meds without checking the wrist band. My advice to you: NEVER skip this step. There are plenty of ways to still make errors but don't let this be one of them. The time you're really swamped and just too busy to check: that's the time you check twice.

I know with no MAR you had nothing to check it against. That's when you pull out your brain sheet and write the name of the patient you are to give the meds to. No wrist band? Ask the patient for his full name and date of birth. In other words, if there is no system for checking, make your own system to make sure the pills are going down the right hatch.

I'm sorry this happened to you. Hang in there.

sleepwalker, MSN, NP · Mar 4, 2020

sorry this happened...

but to play devil's advocate...when I read the OP's statement that the RN stayed behind to talk to the other students I see an over eager student that was supposed to be supervised while giving meds walking into a patient's room and administering meds w/out using proper pt identifiers

Nowhere does OP say that they were told to go ahead and give the meds w/out supervision.

No mention by the OP if they have had any other concerns during this practicum.

Just my 2 cents what I've learned from years of teaching....there's always two sides to a story.

**emergenceRN17, ASN, BSN, RN** · Mar 4, 2020

On 3/2/2020 at 10:48 PM, svicente0520 said:
Update. So I have failed my practicum. I will not be graduating in May as planned. I will be able to retake the semester this Summer. I hope I never make this kind of mistake again. I thank everyone for helping me. I understand I made a mistake but my preceptor only blames me, which is what it is. I'll continue to count my blessings and keep persevering.

A.) I am SO happy to read that you will be able to retake it. Sigh of relief!

B.) I am sorry to hear this happened to you. We were given limited access to the EMR and were NEVER allowed to give a med unless our instructor was right there by our side watching our every move. We were also instructed never to take a med that was not picked by us in the pyxis or drawn up by ourselves.

C.) What about the 5 rights of med administration? I didn't see this mentioned in your post. It is super important and was drilled into our brains during clinical.

D.) Chin up... try to stay positive.

Best wishes to you! I am sure you will do well in the upcoming semester.

turtlesRcool · Mar 6, 2020

On 3/4/2020 at 8:28 AM, sleepwalker said:
but to play devil's advocate...when I read the OP's statement that the RN stayed behind to talk to the other students I see an over eager student that was supposed to be supervised while giving meds walking into a patient's room and administering meds w/out using proper pt identifiers

OP is doing her capstone, which means it's usually just one student nurse, not a group, and the OP says stayed behind to "talk" with other nurses (don't really know why OP wrote "talk" in quotation marks, though). Nowhere are any other students mentioned. And there were no patient rooms. When the ER gets full, it's not uncommon to run out of rooms/bays, and for treatment to take place in hallways. Not ideal by any means, but more understandable that something got lost in the chaos of the ER.

That said, it's important to note that it is precisely when things get hectic and crazy that the 5 rights become most important. If I have a low-key patient assignment, it's far easier to remember which patient is which and who is getting which med and why. It's when I'm moving really fast and being interrupted frequently that it's most important to make sure I follow policy. My patients can start to blur together, especially if I happen to get multiple patients with similar dx.

I had a capstone student with me yesterday, and my best piece of advice to her is that if you use the EMR system as designed (scan patients' bracelets, scan medications, document in real time) it's much harder to make a med error. Not impossible, but much less likely. It's when you start overriding, backcharting, etc. that you open yourself up to errors that you can't justify.

svicente0520 · Mar 7, 2020

12 hours ago, turtlesRcool said:
OP is doing her capstone, which means it's usually just one student nurse, not a group, and the OP says stayed behind to "talk" with other nurses (don't really know why OP wrote "talk" in quotation marks, though). Nowhere are any other students mentioned. And there were no patient rooms. When the ER gets full, it's not uncommon to run out of rooms/bays, and for treatment to take place in hallways. Not ideal by any means, but more understandable that something got lost in the chaos of the ER.
That said, it's important to note that it is precisely when things get hectic and crazy that the 5 rights become most important. If I have a low-key patient assignment, it's far easier to remember which patient is which and who is getting which med and why. It's when I'm moving really fast and being interrupted frequently that it's most important to make sure I follow policy. My patients can start to blur together, especially if I happen to get multiple patients with similar dx.
I had a capstone student with me yesterday, and my best piece of advice to her is that if you use the EMR system as designed (scan patients' bracelets, scan medications, document in real time) it's much harder to make a med error. Not impossible, but much less likely. It's when you start overriding, backcharting, etc. that you open yourself up to errors that you can't justify.

So I put talk in quotations because it was more of gossiping and complaining about the patients. I've seen things that I am sure is illegal and I did go to my actual instructors before hand about my preceptor and the lack of access to emr. I had even told them that it may lead up to an error and low and behold it did. I was told it's full immersion and to just keep going. I am completely responsible for my actions. I have beaten myself up over and over about my error and yes. I wish I had done things differently.

turtlesRcool · Mar 7, 2020

47 minutes ago, svicente0520 said:
So I put talk in quotations because it was more of gossiping and complaining about the patients. I've seen things that I am sure is illegal and I did go to my actual instructors before hand about my preceptor and the lack of access to emr. I had even told them that it may lead up to an error and low and behold it did. I was told it's full immersion and to just keep going. I am completely responsible for my actions. I have beaten myself up over and over about my error and yes. I wish I had done things differently.

Chin up, you'll get through it, and be a better nurse for it. Next time you WILL do things differently. It's a hard lesson, but better to learn it now and with no adverse outcomes than get lax later and cause patient harm.

Unfortunately, that "full immersion" is a lsson in real-life situations. Institutions talk a good game about protocols and how things should be done, but they will also create environments that don't support that (short staff, short supplies, problems with computer systems, etc.) and then throw the staff under the bus when something goes wrong. Not all, but many do to different extents. Especially when you're new, it's hard to insist on doing things the right way when the culture of a unit tells you to "just keep going" the way everyone else does.

JKL33 · Mar 9, 2020

On 3/6/2020 at 8:33 PM, svicente0520 said:
So I put talk in quotations because it was more of gossiping and complaining about the patients. I've seen things that I am sure is illegal and I did go to my actual instructors before hand about my preceptor and the lack of access to emr. I had even told them that it may lead up to an error and low and behold it did.

Since you are in the midst of a "learning moment" - - -

Give some thought to the fact that all of our moves and choices sort of culminate into an overall opinion (formed by others) that will be used at some future date to either deal with us mercifully or harshly when the opportunity arises (and it will).

Keep your head down and your nose clean (as they say). Neither ask for trouble nor look for it. This is not meant harshly, but it's very possible that you would be in a different position right now had you used the time you spent reporting your preceptor and airing your other concerns to figuring out how to safely take care of patients despite the obstacles. I tell you this only because your future job is likely to include some of those same elements. Really think this through. We do have an obligation to report safety issues, but there's a fine line there...most of us strike a balance by using great discretion in what we report and complain about; otherwise we could do that all day long and not take care of any patients.

In the future, if there is something that poses a serious threat to your success or to your patients' safety at your practicum, discuss it only in the utmost professional manner with your faculty, and make sure to address it as, "What is the safest way for me to be successful in this situation?" Or, ask legitimate questions that get to the point: "Am I supposed to be able to access the EMR?" [No]. "What process shall I use in place of that?" Etc.

On 3/4/2020 at 8:28 AM, sleepwalker said:
but to play devil's advocate...when I read the OP's statement that the RN stayed behind to talk to the other students I see an over eager student that was supposed to be supervised while giving meds walking into a patient's room and administering meds w/out using proper pt identifiers
Nowhere does OP say that they were told to go ahead and give the meds w/out supervision.

Nah. There are no other students mentioned. And the student's understanding was that s/he was to administer the meds--that's why they were being pulled:

Quote
RN pulled the meds and gave them to me to give.

It seems like the staff RN had the same understanding, since s/he didn't say "Hey...where are you going with those meds?" or "I'll be there to observe you in just a moment..." or anything of that nature.

It's a crappy situation.

caliotter3 · Mar 9, 2020

Just a caveat about your repeat clinical placement. Of course, you are going to be anxious and extra careful. Also keep in mind that it will be known, and discussed to some extent, that you are repeating. Some situations are supportive of a repeat student being successful and some situations are supportive of a repeat student 'failing'. Two of my peers had to repeat their final clinical placement in order to graduate. Both of them failed. One was told by the precepting nurse that they were told to insure that she fail. The other was in turmoil because he could not understand why his preceptor was treating him the way that she did. A third individual failed after they reported the unprofessional behavior of the clinical instructor. All three situations, if taken at face value, depict "foregone conclusion" teaching/supervision/precepting, etc.. Stacked deck if you will. Not saying this to put the fear of the Almighty into you, but to give you time to calmly think of the ways you are going to make certain that you do succeed. If you are allowed to give input, it would stand to reason that you go to a different facility, with a different supervising instructor, and a different preceptor. Minimum. Best wishes and good luck.

rockchickrn, BSN · Mar 21, 2020

I am so sorry. Chin up, retake the semester. You’ve got this!