Help a year later and I am still obsessing about my med error

[Nurse1102]

It has been at least a year since my horrible medication error happened, but I am still worried sick over it. I was a brand new nurse at the time, and I was working in the ED with a pt having angioedema from Lisinopril. Had never given Epi except for in codes when given IV. I received a verbal order for 1 of epi IM. I even had the physician beside me at the pyxis telling me to give one of the packages of epi that I was holding in my hand and to give it IM. I even asked him, "you want me to give the whole thing?" he said yes. So I drew up 1mg of the Epi and gave it IM into the patient's thigh.

The physician was a newer one to our hospital, and he assumed the packages were already drawn up for an IM injection. But they were glass vials of 1mg. Seconds later, the physician had put the order in the computer as the standard dose of Epi for an IM injection (0.3 mg)..... It was too late. My knees went weak, I felt the blood leave my face, and my heart dropped. Sickest feeling ever. I cried to the doctor, terrified about what would happen to the patient. My supervisor asked him if he would change his order but he, of course, didn't change his order. I am so worried that the patient will sue. I looked at the Ohio laws, and it says that they have 4 years to file a malpractice lawsuit. I have since left the ED and am now working as a triage nurse in a closed university that offers 24-hour care. I am worried that because I am no longer employed at the hospital that I will be on my own if the patient decides to sue. All my coworkers shared their stories of med errors, and that did help back then. But, here I am still obsessing and worrying that they may still come after me. The patient did have side effects as you can imagine. Tachycardia and tremors. I was so mortified that I didn't tell the patient. The patient and the family were already so high strung I was terrified to say anything. I just stayed in the room monitoring closely. The physician had him admitted to the cardiac unit. I never heard any more about it. I wonder if anyone has ever experienced this before? Has the patient sued a year or years later? What are the chances that they will sue? I know a nurse that gave Epi IV instead of IM... and as far as I know, she was never sued. UGH, its been weighing on me for so long... I wish I could get some answers. Thank you for reading.

[frozenmedic]

Unfortunately, nobody can give you a definite answer about whether or not a patient will sue. The fact that you know another nurse who made an error with Epi is also not helpful as cases may be settled by the hospital before ever involving RN staff, the RN involved may not be allowed to discuss a closed claim they were involved in, or the patient may have never filed a malpractice claim.

Many more errors are made than lawsuits filed, and the magnitude of an error is not the single deciding factor in a patient's behavior. Attitude of the healthcare team is at least as important as any error that occured. Patients are much more likely to bring suits against healthcare providers they dislike, when they feel communication is poor, or they feel like healthcare providers are hiding something from them. Many patients report they sue less for their own financial benefit, instead they want to get answers or to prevent similar errors from happening to others. These are some of the reasons many facilities will now openly admit errors to patients, and offer a sincere apology soon after the error is recognized. It sounds like this didn't happen in your case, and obviously this cannot be changed.

There are different types of malpractice claims, but generally the patient must show that some harm occurred to them because of the malpractice. In this person's case it sounds like they experienced temporary symptoms, and possibly a longer than normal hospital course for their disease process. While in the grand scheme of things, these are relatively modest, temporary harms, the patient can also claim damages for loss of work, "pain and suffering," or any other conceivably related losses. Realistically, you have relatively shallow pockets, and patient's will often choose to sue a hospital or health system in addition to just the individual provider.

The bottom line is you can't change this patient's behavior any more, but you probably need to develop some better strategies for protecting yourself in the future. If you are this worried about this event, you are probably so distracted you're going to make another error.

Consider your own personal malpractice insurance going forward. Your employer's coverage serves them, not you.

[Nurse1102]

Thank you for replying. I really appreciate your thoughts and that you took the time to share your knowledge. I wish I could do something. I wish I could remember thier name so I could reach out and tell them how sorry and ashamed I am.

[Guest219794]

A couple thoughts-

I am pretty sure that whether you are or not still working for the facility will have no bearing on how the hospital deals with this.

To put this into perspective, you were a new nurse following a bad verbal order in an emergency situation. The PT most likely has had no lasting effects. You learned from this mistake.

The error you made is unfortunately pretty common, and represents a huge system issue in your former facility.

The error would have not happened had the hospital done it's job, which would have included training you properly, and taking appropriate safeguards for a high risk medication known to be involved in many errors.

But, what you are now dealing with is anxiety about a lawsuit that may never happen, and if it does, will probably not effect you- other than emotionally.

It might be worth the money to consult an attorney. While I don't think it will make any difference legally at this point, it may help you move on.

[caliotter3]

8 hours ago, Nurse1102 said:

Thank you for replying. I really appreciate your thoughts and that you took the time to share your knowledge. I wish I could do something. I wish I could remember thier name so I could reach out and tell them how sorry and ashamed I am.

Contacting the patient would be the most foolhardy action you could take. The fact that you even consider this course of action shows that this whole affair has affected your judgement. Grab ahold of yourself before you really have something to fall apart over. At this point your obsession is turning you into your own worst enemy. Consult with an attorney, determine whether your malpractice insurance is claims made or occurrence based, and then concentrate on your current practice. Cross your bridges when you get to them.

[JKL33]

Quote

I received a verbal order for 1 of epi IM. I even had the physician beside me at the pyxis telling me to give one of the packages of epi that I was holding in my hand and to give it IM. I even asked him, "you want me to give the whole thing?" he said yes. So I drew up 1mg of the Epi and gave it IM into the patient's thigh.

The physician was a newer one to our hospital, and he assumed the packages were already drawn up for an IM injection. But they were glass vials of 1mg. Seconds later, the physician had put the order in the computer as the standard dose of Epi for an IM injection (0.3 mg)..... It was too late.

If the physician actually stated, "give 1 mg of Epi IM" you can be sure I would have written his order in the chart and signed it off. But I'm not sure if you received that explicit order or if the verbal order you are talking about was basically "give what you're holding in your hand" - which as you know is not a proper order in any situation.

But all of that is beside the point.

I think you need to simply take away whatever you can from the situation that occurred and then move on, period. You are not going to change anything else at this point so it becomes a question of whether it is wise to continue with a decreased quality of life over something that is entirely out of your control (and possibly quite unlikely to ever become a concern).

Learn, and move on. ??

[rn1965, ADN]

Think of the amount of energy you are spending worrying about this situation. It is very likely, since the pt had no long term effects, they are not thinking about it.

Do as other posters have mentioned, consult an attorney and make sure your malpractice insurance is up to date, then.........stop thinking and obsessing over this. Move on and learn from your mistake.

I am sorry that happened to you but you are giving this situation way to much of your time. DO NOT CONTACT THE PT. That would be a HUGE mistake.

Hopefully, an incident report was filed, your charting reflected exactly what happened and now, you can move on.

[RNNPICU, BSN, RN]

Nurse1102:

This incident happened a year ago. You have to learn from it and move on. If you continually obsess about this, you are going to make an even graver mistake.

There is absolutely no reason to contact the patient. How would you even have that information? If you do, it is also illegal for you to have that information as it does not pertain to the care of the patient that occured a year ago. There is no reason to look in the patient's medical record at this point for ANY reason.

PLease talk to someone professionally about this. All of us have made errors and have learned from them, changed our practice and are functioning. Being so focused on something that happened a year ago is taking away all of your concentration from your current practice. Your patients do deserve all of your attention and not someone focused on something that happened a year ago. You are now in a different location, focus on your job now.

[thinbluelineRN, MSN, NP]

Besides getting your own malpractice insurance I think you should also seek some professional help. It's been a year since this incident and I'm sure you have learned from this med error and are extra vigilant but you also should not live in this much anxiety and fear.

[ExperiencedCRNA]

Why is contacting the patient a huge mistake? Most providers dealing with this second victim syndrome want to apologize and it helps to move on. Doesn't the patient have a right to know what happened? I believe most people are forgiving and understanding when someone is honest and sincere.

[ExperiencedCRNA]

I recommend this book for you. It is true that medical error is very common and often goes unreported and not admitted. I believe a lot of providers are suffering because of this. You are one of them and you are not alone. It doesn't matter that that the error was a long time ago or how significant it may have been. For the record, this does not come close to some of the horror stories I have heard, witnessed or personally been involved in. But when it happens to you it feels like the worst thing in the world. I understand. And I understand why you can't just "forget about it and move on". The reason you are obsessed with the error and with tracking down the patient to see how they are doing is because you are a good person, a caring person, a good nurse and one committed to doing the best for her patients.

[RNNPICU, BSN, RN]

1 hour ago, ExperiencedCRNA said:

Why is contacting the patient a huge mistake? Most providers dealing with this second victim syndrome want to apologize and it helps to move on. Doesn't the patient have a right to know what happened? I believe most people are forgiving and understanding when someone is honest and sincere.

The above book is a great read.

First, she would need to go into the medical records to find a contact information at a facility she no longer works at, for an event that happened a year ago. How does she know the patient didn't know what happened? How does she know that others did not go to the patient and explain what happened? There would not be any way for the OP to have contact information. Also, it could look like stalking a patient just for the OP to get closure and ensure the patient isn't going to sue.

It is hard to let go. It is a shame that the facility did not let her know of the outcomes of the patient once they left the ER, or have any follow-up on the incident. Either the ER did not think it was that big of a deal and the patient was fine, or they do not have any debriefing.

Also, the OP is worried about the patient suing, which unfortunately we can not determine.

OP, I do wish you well in your current job and as you continue to heal.