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Discussion

incident report

if you commit a medication error because you were distracted over a recent death in your family, should that be put in an incident report. for example the med error should never have happened. i had just come from a funeral from out of town. i mistook a generic med for another. and the names are not even similar. i just looked at the med, thought it was the generic name for the one i was giveing. afterward i realized it was wrong med and informed mom as it was in a home setting. shes a cop got very upset. when i looked it up after . the names were not even similar. all i can say is i was still upset over the loss of a loved one. when i fill out the report, how do i explain any other way for such a stupid error. don't you have to put the reason you think the error occured? do i simply say i was distracted. ?

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    • Featured Replies

    This is a tough one. First off, sorry for your loss. And I would not get too involved in a reason unless you are required to. You gave pt incorrect med. Did it cause harm? I would stick to what you did, how you monitored after, and what you will do in the future to prevent it.

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    • Experts

    I would go with a generic "nurse distracted" or some other similar option. I would not go into too much detail on paper since a. it sounds like you're making excuses even though that may not be your intent, and b. you don't want your grief/personal life to ever be used against you.

    If and when you meet with your NM or QC person to review the error, then you can explain the details if you wish. I personally wouldn't disclose even then, but that is only something you can decide.

    I'm sorry for your loss. Best of luck in dealing with this.

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    • Experts

    Addendum: the only time I'd put a more specific reason for "nurse distracted" on the incident report is if the distraction was due to something that is related to the facility itself and/or is in the facility's control. That way the facility could (possibly) address the matter.

    For example, a very busy medication station, a code happening at the same time you were dealing with the meds, or people ignoring the "quiet zone" around the Pyxis would all be good reasons for you to list for distraction. I wouldn't put down personal reasons.

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    Our incident reports have a specific question: why do you think this error occurred, or what do you think contributed to this error? Perhaps your incident reports have an area like that, or your facility could consider adding one?

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    I am so sorry about your loss. It is easy to get distracted after such a devastating experience but mistakes happen. Some important facts to consider regarding incident reports include documenting known relevant facts in an objective and concise manner, refraining from criticism or placing blame. A medication error is just that.. an error, regardless of the reasons why. Placing blame on yourself is not necessary.

    When you fill out the report, explain the error, describe interventions/actions taken, and the patient's condition after the occurrence. Personal reasons should not be documented.

    Good luck!

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