HELP, 1st Med Error

[newnurseMN2011]

Please give me some good advice:

I work for a great Home Health Agency. I have been with the company for 4 months now and have loved it thus far. I get to make my own schedule, which is great since I have 3 kids at home, the youngest being 4 months old (yes, I went to work when baby was just 1 week old).

Here is the dilemma and worry:

I thought everything was going great. I have been 'upgraded'-though I can't call it a promotion since there was no pay increase or benefits added, 2 times now. I start full-time next week. Well, my boss called me into the office on this past Friday, for what I thought was a working out of my full-time job duties (which will now include more office work along w/ visits), only to find an incident report of a med error for a client I saw for another nurse 2 weeks ago.

The report from the other nurse said I had made 4 dosing errors for this client. I had written in the clients file that 1 of the meds in question the client did not have enough meds to get through to the next week. The client has a dx of paranoid schizophernia, is illiterate and when I looked in this client's file found another report of stating a previous nurse did a supposed med error 3 months ago. This client was visibly upset upon my visit to set up meds d/t an unannounced visit (I couldn't get in contact with client over numerous phone calls to schedule appointment).

When I set up meds, I always have a chart w/ client's current meds which I check against med labels (since we consider these MD orders) and clients name. I always triple check meds and times before, during and after med setup. I don't know how I could have made this mistake (there was 3 days remaining in medication box on client's table when this nurse went to visit).

I wrote a notification for client's MD, and was told by boss that I will be unable to see clients for this nurse until a remedy is figured out and I learn my lesson so this doesn't happen again.

What should I do? Should I quit? Should I be done being an RN? This is my first nursing job and I am devastated thinking I could have put someone's life in jeapordy. I became a nurse to help people, not hurt them. What should I do?

[Double-Helix, BSN, RN]

I having a little bit of a hard time understanding what you did wrong. Did you fill the medication boxes with the wrong dose of medication?

You made a med error. It will happen to practically every nurse at least once in their career. Take ownership for it, help identify what went wrong, and then learn from it. There is no reason for you to quit your job or quit nursing because of a mistake. The patient wasn't even harmed from this error. If you expect yourself to be perfect every day as a nurse then you will be constantly beating yourself up. The fact is that we are human, not robots, and sometimes we miss things.

(By the way, there is no way documentation of a med error should be in a client's chart. So I don't know why you found the incident report in the client's chart, but you should make sure that the home health company does not put your incident report in there.)

[NotReady4PrimeTime, RN]

I'm having trouble seeing what you did wrong here as well. From what I gather, you were required to set up a specific period's worth of medication doses for this client. You documented that there was not enough of one of the medications to finish out the week. (3 days' doses were left.) You filled the medication container (Dosette?) with the meds and signed for them as your agency requires. Where is the error? Are you expected to take repsonsibility for those meds once you've left the client's home? How can you know what happens once you've driven away? And how can it be proven that YOU were the one who made the error, if an error even occurred? Two 'errors' in 3 months for this client - when the usual nurse was absent? And your reprimand included being restricted from seeing clients assigned TO THIS ONE NURSE ONLY? There are lots of holes in this situation.

As Ashley said, EVERY nurse will make at least one error in his or her career. Some of them will result in harm to a patient. Most of them will not. Once the underlying factors that contributed ot the error are identified and resolved, that error should never happen again. But there are always new errors lying in wait. We can't be perfect and we can't be expected to take the blame for every single thing that happens to our patients. An analysis of med errors usually reveals a number of systemic issues that contributed to the ultimate failure whereby a patient was given the wrong dose, the wrong drug, by the wrong route, at the wrong time or whatever the error is. But usually only the last link in the chain, the nurse, is expected to shoulder the responsibility for all the little cracks in the chain.

Chin up, shoulders back, get back in the game. You've already accepted accountability. You've been rapped on the knuckles. Now move on. Put it behind you. Don't quit your job and definitely don't quit nursing! Do document EVERYTHING (using objective language) in every chart you handle. If you see something out-of-the-ordinary at a client's home (such as an inadequate supply of essential medications), report it to your agency while you're still in the home, document that you made the notification and to whom... Protect yourself. And see to it that the incident report is never made part of this gentleman's chart. Those are internal documents and do no ever belong on a chart.

[newnurseMN2011]

Thanks for the advice. I am just worried that this could possibly be my fault, and how could I have overlooked this. I was told that once we leave a client's house we are not responisble for the meds, since there is no way to tell if a client tampers, removes, or adds meds to this. But I was still written up. I don't know what to do. I feel that I let this client down (possibly), yet in the back of my head I am also curious as to if the meds were tampered w/ after I left. There is no way to prove anything, but to learn my lesson to be extra vigilant when filling meds, slow down, keep triple checking, and pray this doesn't happen again.

Yes, this other nurse and I have 'butted' heads a few weeks ago b/c she doesn't like how fast I was moving up w/ the company. My boss told me she use to be in management and to take her w/ a grain of salt, yet I can't help feeling she is trying to undermine me any way she can.

[nurseynursej]

Thanks for the advice. I am just worried that this could possibly be my fault, and how could I have overlooked this. I was told that once we leave a client's house we are not responisble for the meds, since there is no way to tell if a client tampers, removes, or adds meds to this. But I was still written up. I don't know what to do. I feel that I let this client down (possibly), yet in the back of my head I am also curious as to if the meds were tampered w/ after I left. There is no way to prove anything, but to learn my lesson to be extra vigilant when filling meds, slow down, keep triple checking, and pray this doesn't happen again.

Yes, this other nurse and I have 'butted' heads a few weeks ago b/c she doesn't like how fast I was moving up w/ the company. My boss told me she use to be in management and to take her w/ a grain of salt, yet I can't help feeling she is trying to undermine me any way she can.

So what was the actual error? j/w