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Discussion

I made my first med error today

Every day when I get report I write the most current set of vital signs on my report sheet so I have them handy. Well when passing meds I looked at my report sheet and the vitals were fine so I pulled the meds. After giving Atenolol and Lisinopril I realized that the Patient's BP was 88/ 60. I had written another patients blood pressue under his name on my sheet. His pressure dropped to 80/60 and wouldn't rise after a 500cc NS bolus. No one gave me a hard time about it, and my the end of my 12 hr shift his pressure was up to 100/70. I'm really kicking myself. It's my fault I should have looked at the chart and saw the vitals were low and taken my own set before giving the meds, but I didn't. Now I'm having a tough time getting over it. I've been an LPN since January and this is the first time I've done something like this. How do you put that past you?

~Kristy

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The biggest lesson you should learn is how easy it is to make a mistake, so yu won't do it again. Be grateful that the patient didn't suffer any long lasting harm and move on, being ever more alert...

Every day when I get report I write the most current set of vital signs on my report sheet so I have them handy. Well when passing meds I looked at my report sheet and the vitals were fine so I pulled the meds. After giving Atenolol and Lisinopril I realized that the Patient's BP was 88/ 60. I had written another patients blood pressue under his name on my sheet. His pressure dropped to 80/60 and wouldn't rise after a 500cc NS bolus. No one gave me a hard time about it, and my the end of my 12 hr shift his pressure was up to 100/70. I'm really kicking myself. It's my fault I should have looked at the chart and saw the vitals were low and taken my own set before giving the meds, but I didn't. Now I'm having a tough time getting over it. I've been an LPN since January and this is the first time I've done something like this. How do you put that past you?

Kristy

The biggest thing is is the lasting impression that it made on you. I have done this and many others have also gone through the mind set that you experiencing. Go on from here and I know that you will be ok just from the way you are telling it.

Just think of how much worse this could have turned out. I'd be worried if this didn't bother you. Yes, it was a mistake, but you're human. Judging by the impact this has had on you, I think you've learned your lesson. take care.

I had a med error once and I remember how horrible I felt. Still remember it which is a good thing. I am glad the patient was fine. It tends to stay with you for a long time.

Learning is what nursing is about, don't beat yourself up but now you be more careful. I think most of us have.

renerian

What have you learned, and what will you do different next time. Then put away the "should haves" and move on. It hurts to make a med error and in time you'll stop obssessing about it. Best wishes.

Glad to hear everythinng turned out to be okay at the end. Best wishes :)

Hi Kristy,

I remember my first one too, it felt awful, I was mortified. But then I calmed down and did what every good nurse should, call the doc. It was a good experience, the doc actually thanked me for having the courage to report the error, I was shocked. I remember my heart was beating so fast, but I guess being honest is the best thing to do in this situation, because the mistake needs to be delt with. The resident lives on, unharmed from my mistake...It also happened to my preceptor on my first day of internship (she had 20 yrs exp) but she did the right thing too(she was an inspiration). And I learned to quadruple-check my meds

I remember making my first med error as an L.P.N., and my first one as a student R.N. I was absolutely terrified both times...even more so as a student, for I feared that I was going to get a U in clinicals...and I was in my Senior rotation. Fortunately my patient had no adverse effects, and my instructor was very supportive and understanding, and she congratulated me on my honesty and professionalism in reporting the error. Whew! (wiping brow). :uhoh3:

Like others on this thread, we have ALL made med errors at one time or another...and look at it as a wakeup call and learning experience.

Every day when I get report I write the most current set of vital signs on my report sheet so I have them handy. Well when passing meds I looked at my report sheet and the vitals were fine so I pulled the meds. After giving Atenolol and Lisinopril I realized that the Patient's BP was 88/ 60. I had written another patients blood pressue under his name on my sheet. His pressure dropped to 80/60 and wouldn't rise after a 500cc NS bolus. No one gave me a hard time about it, and my the end of my 12 hr shift his pressure was up to 100/70. I'm really kicking myself. It's my fault I should have looked at the chart and saw the vitals were low and taken my own set before giving the meds, but I didn't. Now I'm having a tough time getting over it. I've been an LPN since January and this is the first time I've done something like this. How do you put that past you?

~Kristy

You have to accept that you're human - that's how you can get passed it. Also, just learning from your mistake is another way to get passed it.

Every day when I get report I write the most current set of vital signs on my report sheet so I have them handy. Well when passing meds I looked at my report sheet and the vitals were fine so I pulled the meds. After giving Atenolol and Lisinopril I realized that the Patient's BP was 88/ 60. I had written another patients blood pressue under his name on my sheet. His pressure dropped to 80/60 and wouldn't rise after a 500cc NS bolus. No one gave me a hard time about it, and my the end of my 12 hr shift his pressure was up to 100/70. I'm really kicking myself. It's my fault I should have looked at the chart and saw the vitals were low and taken my own set before giving the meds, but I didn't. Now I'm having a tough time getting over it. I've been an LPN since January and this is the first time I've done something like this. How do you put that past you?

~Kristy

We are all human and unfortuneatly these things happen. The best thing you can do is to use this as a learning experience so you don't repeat the same mistake in the future.

You are concentrating on one med error. What about the thousands of meds that you passed successfully. I don't mean to minimize the danger of errors, but consider it on a percentage basis.

hey! my med error in school: double dose of lasix! yikes! my preceptor was like " she looks a little puffy, you prob. helped her out!" well my instructor didnt see it that way! i got a verbal warning (thank God) and filled out an incident report. and i felt horrible....could not turn the tears off! guilt! overload! lol... but like you, i think those of us that are seriously impacted by our errors (meds or not) will make a true effort in the future. those that blow them off (meds or not, lol) are the ones we are fearful for. you did great. you were honest, and you will be more careful! that is what it is all about! but if you are going to keep tabs of your errors! please in some little tucked away place keep tabs of your triumphs, too!! how many people did you smile at that same day, and they smiled back???? you rock babe! proud of you! ang

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