Incident report for infiltrated vein?

[09NewGrad]

Hey guys, I'm a new grad and have been off orientation for almost two months and work the night shift (7-7) on a surgical unit. Everything has been going just fine, except the other night when I came into work my preceptor (who I had handed a patient off to the previous night) told me to make sure I pay attention to my patient's IV's because apparently his vein/arm was blown up because of an infiltrated vein. I apologized and told her I was surprised it had happened because the gentleman hadn't complained about the issue. Also, he had been sleeping all night and I didn't think to check his IV again right before patient handoff. She said no big deal, smiled, and shrugged off the issue as if i needn't worry about it.

Today my nurse manager pulled me into her office and showed me that she had written up an incident report on the issue. She told me not to worry about it, that it wouldn't get sent to HR, it would just go in my file, and that basically it was just to protect us in case of a lawsuit. She told me to always make sure I do my morning rounds (which I do) and make sure I watch things like this closer, because patient lawsuits are on the rise. She said not to worry about it and that i'm one of her best nurses, but I was not happy that my former preceptor (whom I thought we were good friends) felt the need to go to the manager and have her look at the man's arm. I feel that it made me look incompetent at my job, which I make patient safety my #1 priority. This is why I'm so bothered by this situation. I never would have gone to the manager had I found her leave a patient with an infiltrated IV. I debated texting her why she felt the need to talk to the manager, but for now I'm leaving it alone.

Also, are incident reports a big deal, as in effecting a future employment opportunity or going on my personal record? I'm trying to use this situation as a learning opportunity to make me a better nurse, but it's really discouraging that I have an incident report this soon in my career. Please offer any insights.

[Blackheartednurse]

Haha,preceptor and a best friend nope that doesnt match..Preceptors are there to report our mistakes...remember it is all big mafia on the unit,trust me I had to learn this the hard way..Whenever I made some mistake (nothing major or life threatening) my "nice" and always smiling preceptor runned to the manager office to report my faults,well I used to take it all to the heart,but now I just stopped basically caring,I know I work my ass off one way or another and I will be making mistakes because I'm in the process of building my basic nursing knowledge,so I'm light on my heart now.

[tokmom, BSN, RN]

Redhaired

Charting is a double edged sword. It can cover you and it can also expose you. My rule of thumb is that I chart as though I know my notes are going to be read in court. Litigation is an industry, pts lawyers are very clever. Law firms actually hire nurses to decipher legal strategies (and read charts) to procecute other nurses and medical facilities. Across the street from my hospital, near the main entrance no less, is a billboard with this, "HAVE YOU BEEN INJURED BY THE NEGLIGENCE OF A DOCTOR, NURSE OR HOSPITAL?"

It then goes on to mention about monetary compensation and provided an 800 number.

Needless to say, this billboard has made me a more careful nurse. It serves as a daily reminder of the legal climate we are providing care in.

That is exactly what I do. Chart like it's being read in court. That's how paranoid I am, and you do have to be careful on what you chart.

Redhairednurse asked what I charted to cover my hiney. Let me preface by saying that at the time I was an LPN (still paranoid, lol) and was being covered by an RN. We both charted on the pt throughout the shift. Charting back then was not charting by exception. It was suppose to be more charting by systems.

Anyway, one evening shift, I had this one pt along with the RN. It's been long enough now, I don't remember all the details, but he died of a fatty embolism. The family sued, because they thought there were signs ahead of time that this man supposedly had experienced and we didn't catch.

The man was fine for me. The assessment was negative. However, what saved my butt of all things, and the RN to, because her charting didn't cover the systems like mine did, was the fact I charted a skin assessment. One of the signs of a fatty embolism is a petechial rash on the upper part of the body. The man coded later in the next shift, and what the attorney was looking for, were signs that I saw this rash and did nothing. But, as they were reading my charting, they saw that I listened to his breath sounds, heart and belly and reported what I heard, which was all normal. The RN backed me on this. I went on to say in MY paper charting was the fact that the skin assessment was negative for any bleeding, bruising or rash to the trunk and extremities.

Now this is something you might not say on a pt with a broken leg. The RN charted pain issues, and CMS/ROM, but didn't go much farther.

My last charting was a half hour before my shift ended. I made one last round on my pt's and signed off to the next shift.

I was so scared to be sitting in front of those attorneys having them rip my charting to threads. Yeah, it was almost an entire progress note long and probably a lot of stupid things in there too, but you never know what small sentence just might save you one day.

I should say that I think about the meds my pt takes and signs of toxicity that might occur and chart that I see nothing of the sort with my pt's. Thinners being a good one. I chart no bruising, bleeding, blood shot eyes or bleeding gums. I chart the INR too. It shows I have looked at it and realize the importance of any of the labs.