I got wrote up for the first time today. I had a patient on a heparin drip in prep for surgery tomorrow morning. I work the 7am-7pm shift.
At 6:15pm, the ortho (bone) surgeon visited as I was working on a new surgical admit that was puking all over the place. He wrote some orders that I never saw regarding the heparin drip. At 6:55pm, the anesthesiologist visited and mentioned he'd like the drip turned off at 2:30am if okay with the cardiologist. I wrote the order in the computer. As an afterthought, and in a huge hurry to get my work done and report off, I accidentally wrote the order in the pt's roommate's chart (wrong chart).
It is worth mentioning that we double chart physician orders where I work. Once in the chart, and once in the computer. We just started doing this last week. We never used paper charts for verbal or telephone physician orders up until just recently. The physicians still write in the charts though.
I reported off to the oncoming nurse and explained in extreme detail what needed to be done with the heparin drip.
At 8:30pm my coworker called and basically said, "Hey the ortho doc wrote an order to turn off the drip at midnight. And I made a bunch of phone calls to the cardiologist. Then I noticed that you had written the order from the anesthesiologist in the wrong chart."
Oops...
I say,
A)The patient's roommate wasn't even on a heparin drip, so I'm comfortable that no one was ever in any danger due to my error. (we get patients on heparin drips on our floor like once a month at the most)
B)I never saw, acknowledged, nor signed off on the ortho doc's order. The HUC processed the order and in the chaos of the end of shift she didn't communicate it to me.
C)I was doing what the anesthesiologist (a physician) ordered me to do..
I guess that doesn't matter that I ordered everything correctly in the computer. The computer is where the real work gets done anyways, the written charts are just a papertrail (as of last week). Because I'm being written up over it. Coworker says, "This isn't something we can just walk away from here."
At my facility, an error (or, rather, set of errors) such as the OP described would result in an incident report, which my facility (and I think most, these days) explicitly states is not a disciplinary tool. We still tend to say, "I got written up," but it's actually the incident that gets written up. Of course, I can say from personal experience that it still feels like I got written up when it's pretty clear that I was (at least partly) to blame for the incident. Fortunately, my NM is pretty good about using such errors as a teaching opportunity.
In the situation the OP describes, it's pretty clear he made a mistake and owns up to it. Also that he recognizes how to avoid it in the future. But he also describes what seems to me more of a system error, in that an order was written and entered that he never saw. Also, two different orders on the same med by two different docs is a problem that could lead to a more serious outcome, someday. As is usually the case, it appears to fall to nursing to catch and resolve such mistakes, but it would obviously be better if they didn't occur.
This appears to me to be a clear example of a situation in which a mentality of simply pinning the blame on the nurse would overlook a more serious breakdown in communication. I would hope the OP's administrators don't fall into that trap.
If the anesthesiologist wanted the drip turned off at 2:30...and he/she was present on the floor, then why didn't he/she write the order? Then you wouldn't have been in the position to make a mistake when you were trying to juggle your 6 (or whatever) other patients at shift change.
Is not the real problem that you were overworked ,I noticed you mentioned from 7am to 7pm;who would'nt be in a hurry to get the heck out of work after ten hours;but those higher-ups will never see it that way;is'nt that the real issue.If you were not so overworked after ten hours putting up that hostile environment you probably would never made that error in the first place,my sympaties are with you,you poor cotchie cotchie!
The important thing is how did your NM handle it? Did he/she recognize that you usually don't make mistakes and this is a learning situation? I have been written up once and that's how my NM handled it so I am not upset over it any more. If she had not handled it properly, I would have been looking for another job.
OK, I just hate the terminology "written up." At our facility, we are trying to get away from that language. Yes, it is documented but not in a punitive fashion. *Everyone* at some point makes errors! It is important to catch them and look into the processes that caused them to occur but in order to really fix things, the punitive nature of it must be removed. Of course, there are the more egregious errors that DO require a disciplinary process (diverting meds, deliberately falsifying records such as med administration, etc.). But honest-to-god errors that don't represent gross negligence or incompetence need to be looked into, the individual needs to know about it and look into how it happened and what to do for it to not happen again but it shouldn't be the traditional "write-up." In my humble opinion.
I'm sorry it happened that way for you. But you're right -- you'll never make that mistake again.
Actually he pulled me aside and said, "hey I heard you wrote an order in the wrong chart. :D"
I said, "Yea, it will never happen again. I'm a dork :saint:"
He said, ":chuckle Okay. btw you interested in getting some free CEUs at (some conference)?"
And that was pretty much the end of it.
To the above poster, you're correct, written up is a bad term to use (in that it has such negative connotations) but at the same time it really fits. Considering a copy of the incident report ends up in your personnel file at some point.
Also, the same day I talked to the NM, I happened to notice one of my coworkers, quite the saintly RN, accidentally write an order in the wrong chart and the secretary handed it back to her to correct. I threatened to write my coworker up if the secretary didn't do it (jokingly).
nursemike, ASN, RN
1 Article; 2,362 Posts
At my facility, an error (or, rather, set of errors) such as the OP described would result in an incident report, which my facility (and I think most, these days) explicitly states is not a disciplinary tool. We still tend to say, "I got written up," but it's actually the incident that gets written up. Of course, I can say from personal experience that it still feels like I got written up when it's pretty clear that I was (at least partly) to blame for the incident. Fortunately, my NM is pretty good about using such errors as a teaching opportunity.
In the situation the OP describes, it's pretty clear he made a mistake and owns up to it. Also that he recognizes how to avoid it in the future. But he also describes what seems to me more of a system error, in that an order was written and entered that he never saw. Also, two different orders on the same med by two different docs is a problem that could lead to a more serious outcome, someday. As is usually the case, it appears to fall to nursing to catch and resolve such mistakes, but it would obviously be better if they didn't occur.
This appears to me to be a clear example of a situation in which a mentality of simply pinning the blame on the nurse would overlook a more serious breakdown in communication. I would hope the OP's administrators don't fall into that trap.