I've already made my first med error (under-dosed a pt. with Fentanyl)..
and I filled out my second OAR today....
I had a pt that I picked up at 7am, who had already been in the ED for 5 hrs or so... long story short, she had ER orders and admitting "holding" orders to float her until she was seen by the doc she was admitted to...
the nurse giving report didn't pass on that said admitting doc had evaluated the pt ( not sure she even knew)....
There was an order sheet with handwritten (LONG) orders, face down, inbetween the registration papers, stapled to the demographic sheets.... that I did not see until I transferred the pt to the floor at THREE PM!
I feel so terrible. I followed the ER holding orders all day.. she didn't get any of her meds... never had any accuchecks.. ugh.
I'm starting to feel as if this job isn't for me.
I filled out an OAR, because the guilt is eating at me. I told another RN that was working with me near that pt (she has been a nurse for 15 years or so) and she said it was fine, do the OAR to cover myself, and send the pt up. (I trust her very much, she's the best nurse in the department).
The patient was pain free, alert, oriented, and comfortable.
Thoughts?
--I'd also like to add: The department has 35 beds... all of which were full.. all wall beds were full... CPR in progress in trauma room... waiting room with at least 15 priority 3's waiting for ER beds.... 15 of the 35 beds are housing "holds" ..... entire hospital is FULL.
Hey - try not to beat yourself up too much. I have worked in the ER in quite a few facilities. I have also made some of the same mistakes you are seeing. The ERs just stay SO busy and the staff stays SO SHORT!!!!, in most places at least. But, you admitted the mistake, In a previous facility, we had a nurse who made the same type of error but wasn't as honest as you. The missed orders snowballed until the patient had a serious incident.
Long story short, you did make an error, then dmitted it and your patient was not harmed. Most of all, you are the type of nurse with a great sense of honesty and that will get you far
I have always worked ER, first thing I do when I take a patient over is go through the entire chart and every piece of paper, PIA yes but this way I know what is with the chart and what isn't. I do not depend on verbal reports as people forget things accidentally and on purpose, yes this does happen. After I look at patients med history, diabetics will always get accuchecks remember: Cardiac patients are almost always on ASA or coumadin, repiratory patients will almost always have SVN's or other treatments and peak flows, remember these are common things to look for and if they are not ordered you should be asking why. If you are holding a patient for any reason always check for orders. If you had the patient for so long I am surprised after your AM assessment that you were not aware of some of the things ordered, usually the patient will be asking for accuchecks and such. Sorry this is long but it does go back to my thinking that new nurses need to spend more tome learning the basics in medsurge before going into specialties such as ER, I know this is not a popular opinion but nursing school does not have enough time to teach all the basic things.
These are all very good points..
I do try my best to think outside the ER "here and now" box and think of what the pt would routinely need after they leave my care,when I know I will be with them for the day...
I did do morning labs and glanced at the glucose, which was fine. I also had her fluid going, got her to her KUB, and irrigated her NGT per the holding orders and surgical consult. .....I also had intentions of getting a fingerstick a few hrs after the labs but I was SO bogged down, and we had no tech in our area.... I still feel really bad
Anyone feel as if it's a system error as well?
I know it's my fault for not scouring the chart, but at the same time.. why should we have to? it wouldn't be so tough for the doctor writing the orders to flag them with even a sticky note or SOMETHING.. instead of screwing up all the papers and leaving them in a messy pile for me to organize, clean up, and carry out.
In the future I will make this a part of my "morning" routine.. just like you said.
I'm also going to be reviewing some of my books from school to refresh me on these topics, since it seems I must be able to function as a floor nurse and an ER nurse simultaneously.
I'm a student nurse currently entering 2nd semester. A nurse once told me "If you make a mistake, make it as right as you can." Not implying you made a mistake, but you did make it right for yourself.
Specializes in med-surg 5 years geriatrics 12 years.
Hey you admitted you goofed and that right there says you're a nurse I would want to work with. Kuddos. We all have met those who screw up regularly and hide it. I still make mistakes at times but work hard never to repeat them.
I do try my best to think outside the ER "here and now" box and think of what the pt would routinely need after they leave my care,when I know I will be with them for the day...
I did do morning labs and glanced at the glucose, which was fine. I also had her fluid going, got her to her KUB, and irrigated her NGT per the holding orders and surgical consult. .....I also had intentions of getting a fingerstick a few hrs after the labs but I was SO bogged down, and we had no tech in our area.... I still feel really bad
Anyone feel as if it's a system error as well?
I know it's my fault for not scouring the chart, but at the same time.. why should we have to? it wouldn't be so tough for the doctor writing the orders to flag them with even a sticky note or SOMETHING.. instead of screwing up all the papers and leaving them in a messy pile for me to organize, clean up, and carry out.
In the future I will make this a part of my "morning" routine.. just like you said.
I'm also going to be reviewing some of my books from school to refresh me on these topics, since it seems I must be able to function as a floor nurse and an ER nurse simultaneously.
The thing is Your always gonna have md's or RT's toss orders anywhere, like I said in my previous post, you have to be accountable as well, knowing the state of the pt when you come onto the shift, I most often will be looking for those orders, and if i know the pt has been referred on, im calling them on the phone asking where the orders are and if someone is going to write them. Normally in a pt that requires immediate intervention you will have STAT orders or they will make u aware of them, but you have to be an advocate for your pt's as well. I know it gets busy in the ED, get sidetracked but you'll get the hang of it. my first week in the ED I bolused a cardiac pt. with a history of chf with 500 cc of ns with 20kcl, it was an order from a med student but i didn't know they were a student. The lady lived but I learned my mistake and i will never do it again. Which brings me to my next point... ahah always put potassium on a pump....
sissiesmama, ASN, RN
1,899 Posts
Hey - try not to beat yourself up too much. I have worked in the ER in quite a few facilities. I have also made some of the same mistakes you are seeing. The ERs just stay SO busy and the staff stays SO SHORT!!!!, in most places at least. But, you admitted the mistake, In a previous facility, we had a nurse who made the same type of error but wasn't as honest as you. The missed orders snowballed until the patient had a serious incident.
Long story short, you did make an error, then dmitted it and your patient was not harmed. Most of all, you are the type of nurse with a great sense of honesty and that will get you far
Good luck!
Anne, RNC