How to cope with a drug error - destroyed confidence

[cloverfield]

Hi everyone. I've been an A&E nurse for 5 years without any serious incident - even managed to avoid the plethora of complaints haha!

However recently I made a serious drug error and my confidence to practice has completely been destroyed. In a nutshell, I gave a patient with anaphylaxis a second dose of adrenaline 1:1000(!) as a fast bolus IV injection instead of IM. His ecg was, let's say 'unnerving' for about 5 minutes but then settled back to NSR. I am very well aware that it should only be given IM (I gave the first dose IM) and if given IV you should give 1:10,000 at 1ml/min but I just wasn't concentrating.

The registrar was made aware of the incident directly after I realised I'd done it.

In the past few days, I've realised that doing this has absolutely shattered my confidence and I'm at the stage now where I'm almost terrified to go back and practice. I know that the half life of adrenaline is 2 minutes so any effects were long gone after 10 minutes and there will be no lasting effects. However this isn't the point. What bothers me so much is the fact of what COULD have happened. It could easily have put him into arrest and that's what has left me feeling so bad and so guilty.

Has anyone else experienced what I'm going through? If so, please give me some pointers on how I can get over it because I feel so bad about it and my once exuberant confidence lies in ruins whilst I'm now a bag of nerves even dispensing 2 paracetamol!

[MassED, BSN, RN]

Cloverfield, I provided EPI - IV as ordered - to a woman having an anaphylactic response (to shellfish, I think). It was a small amount, but I was pretty sure that I might have given a higher dose since as I gave it she freaked out, saying it felt like her heart stopped. Mine did too. I grabbed another nurse, her pulse went from 120 or so to 60!!!! I think the doc ordered the wrong amount, since I more than triple check those meds that aren't provided like Dilaudid IV, or the more common stuff we push on a regular basis. That was a terrible (and brilliant) lesson for me - I would double check the doc before I gave what was ordered. I still do that if I don't know if it's a normal dose, or even if I'm unsure, I'll call the pharmacy. I realized that at the time I had to move fast, as likely you did, but rest assured, you have learned a great lesson too. I think it is only natural to second guess yourself and pore over your decisions to find the wrong and try to correct it. You learn from mistakes, that's how we become better nurses. Many of us are perfectionists, so you may try your best and always fail in your own eyes.

[rph3664]

The fact that you are as concerned as you are is an indication of your commitment to provide good care.

You are probably much less likely to make a consequential error now.

9309

The worst drug error I have ever personally witnessed involved a pharmacist and a technician who were probably the best in our facility. Long story made short: A patient got 2 1/2 times the morphine they should have because the tech, the pharmacist, AND the nurse totally missed that everything was wrong about the drip, right down to the bag size.

I could tell when the pharmacist found out about this because he had a little black cloud over his head, which was not like him. I was working a later shift when a nurse other than the one who hung the bag noticed that the patient was excessively sedated, and I was sweating bullets until I saw that it wasn't me who was responsible.

The patient was given Narcan and made a full recovery, and nobody was disciplined.

[rph3664]

As my nursing instructor once said to us as students, "if any nurse said she has never made a med error, she is lying."

Which is true when you think about it. We are human therefore we will make mistakes. Doesn't mean its OK, but it has happened to everyone, they just don't say anything.

I once worked with a pharmacist who had probably never made a med error, because he didn't do anything.

Other people who had worked with him told me the same thing.

:deadhorse

[Roy Fokker, BSN, RN]

When I was a brand new noobie nurse, I worked an ortho floor.

One of my pts. was having nausea. MD had ordered Inapsine... which I gave.

It stopped the nausea....

.... but it also made the pt. VERY, VERY drowsy.

F-R-E-A-K-E-D me out! I was running in there every 15-20 minutes to assess her respiratory status. She was ok - by the end of my shift, she was much more alert.

Throughout the whole incident, my preceptor kept a sharp eye on me but said nothing. At the end of the shift, we debriefed. She asked me what happened to the patient. I confessed that as worried as I was about what had happened; I failed to see anything that I'd done wrong. The dose was correct. The route was correct. Her vitals were stable before administering the drug...

"How fast did you push the drug?"

And then it hit me. In my enthusiasm and haste to provide relief for my patient, I might have pushed the drug a little too fast. And as a new nurse, it slipped my mind that Inapsine tends to cause drowsiness.

Sheepishly, I admitted "Well, I might have pushed it too fast".

"Good."

"Wait. You're not mad? That means you knew! You knew all along?!!"

"Yes. But I wanted you to learn the lesson yourself."

I certainly did. And it's a lesson I never forgot.

Till this day.

The two most important teachers in life are Success and Failure. To grow as a professional (and as a person), it is important that we learn from the both of them - for they both teach us important lessons.

cheers,

[mmutk, BSN, RN, EMT-I]

We all make stupid mistakes, we are only human.

This one time I accidentally gave a child sux instead of etomidate during a cousious sedation. Just grabbed the wrong bottle. I'll

never do it again. We learn from our mistakes.

[chicagobsn]

I feel your pain! This is something you will never forget, and you will get over it, and you will be that much more cautious with your meds.

When I graduated school, I was working on Tele, and Nitro patch was ordered at 6. Well, 6pm came and I took it out of the pixis and placed it on the pt. About an hour later, the pts blood pressure dropped, not low...but low enough for me to go in and check on her. Well...I assessed her, she was ok, called the doc, said take the nitro patch off. I went into room, took it off...and saw the other patch on! I thought omg, then I looked at the MAR...it was ordered for 0600, NOT 1800! I made out an incident report, cried for days, came back to work and asked for that pt, just so I could watch her like a hawk. Nothin happened to the pt. But I changed forever that day.

We all get busy, we all get the million orders at once, crisis happens around us, we get stressed. But learn to take a deep breath, slow it down and recheck those meds, then recheck them again. Then at the bedside check them again. No matter whats going on at work, no one is responsible for your license but you. So slow down, recheck those meds, check the pt, and take your time. Dont let anyone rush you. I dont care whats goin on, even if its tylenol, I do all my checks..and allergy checks before I give anything. (including a quick yet thorough assessemnt even on those that are in the ER for a hang nail) ya never know what your gonna miss...or find!

Sometimes lessons are learned the hard way. The pt was fine, you will be too. your a good nurse, learn from this and move forward. I will bet you'll never do that again! I know I wont!

[LilgirlRN, ADN, RN]

MOst nurses have made a medication error of some sort. Feel fortunate (I'm sure you do) that you didn't cause any permanent damage. Long ago when I was a new nurse and working in a cardiac unit I gave a little old lady Phenergan 12.5 for nausea. Having been hurt with phenergan myself... it's very caustic and can burn veins, I diluted it with 5 cc NS and pushed it slowly. Even with all these precautions the elderly woman did not do well with phenergan, it almost killed her. Her heart rate dropped, her BP dropped and even her O2 sat dropped. Sometimes no matter what you do bad things still happen. Now that you've had this happen to you, I am sure you will be more careful. I believe that things like this happen to wake us up and to pay attention even whene we've given the drug 1000 times and taken care of the same sort of patient over and over again. You didn't kill the patient accept what has happened and move on. You can't allow the patients to know that you've lost your confidence or they will lose theirs in you. Soldier on!

[queen777]

I feel your pain! This is something you will never forget, and you will get over it, and you will be that much more cautious with your meds.

When I graduated school, I was working on Tele, and Nitro patch was ordered at 6. Well, 6pm came and I took it out of the pixis and placed it on the pt. About an hour later, the pts blood pressure dropped, not low...but low enough for me to go in and check on her. Well...I assessed her, she was ok, called the doc, said take the nitro patch off. I went into room, took it off...and saw the other patch on! I thought omg, then I looked at the MAR...it was ordered for 0600, NOT 1800! I made out an incident report, cried for days, came back to work and asked for that pt, just so I could watch her like a hawk. Nothin happened to the pt. But I changed forever that day.

We all get busy, we all get the million orders at once, crisis happens around us, we get stressed. But learn to take a deep breath, slow it down and recheck those meds, then recheck them again. Then at the bedside check them again. No matter whats going on at work, no one is responsible for your license but you. So slow down, recheck those meds, check the pt, and take your time. Dont let anyone rush you. I dont care whats goin on, even if its tylenol, I do all my checks..and allergy checks before I give anything. (including a quick yet thorough assessemnt even on those that are in the ER for a hang nail) ya never know what your gonna miss...or find!

Sometimes lessons are learned the hard way. The pt was fine, you will be too. your a good nurse, learn from this and move forward. I will bet you'll never do that again! I know I wont!

I think every nurse should have to work in a nursing home first. You would have known that 6AM is the only time a nitro patch is applied, at least for those who get them routinely. I learned more in a nursing home on the subacute floor as far as tests results, taking orders, running the floor, coumadin results, pronouce pt dead, calling families, writing up DNRs, fresh hip & knee replacements just the basic stuff than I ever would have if I had stayed in a hospital cause LPNs can't do any of those things in a hospital. I guess you could say it was like a melting pot of all different types of pts. I had oncology, ortho, skin care and assessment, ABT, central line assessment, ordering meds, receiving meds, admiting pts, sending pts out to a hospital, respiratory pts, all kinds of diabetics, cardiac it really was good training and I thought I would lose my nursing skills by working in a nursing home. Just learning how to assess different conditions is really important. Of course it helped having a boss that had confidence in me too. He said I was better than most his RNs, guess so since I was the only LPN working the floor and desk at times with 60 pts. I loved it though. What helped too was I had already taken all of the RN reqecs which gave me more confidence.