IV MED NOT INFUSED - Advice please!

[teeroze201069]

I work on a med/Surg Neuro and Trauma Unit on Noc shift. It was a Friday night. I received report on a patient at the start of my shift from a Day nurse who had received care of the patient just a couple of hours before the end of Day shift d/t the original nurse getting Flex time. During bedside report I noted the IV infusing was LR @100/hr and IV site was w/o comps and d/t be changed that day. There was also a IVPB med connected to the LR but was not infusing. The reporting nurse stated it was put up by the original nurse. I failed to examine that bag more closely and did not notice it was still full d/t the side facing me had a foil front and was not easily visible. As the night progressed I was very busy with assessments, accuchecks, med pass and prn meds. I also had to personally change and turn 2 incontinent patients twice each, and toilet 2 others because my CNA was extremely busy helping other nurses with admits and discharges as well as assisting other patients. I also had to bladder scan and straight cath one patient. During the course of my shift my Charge nurse notified us that one of us would have to be Flexed home by 00:30 hours d/t low census. I knew I had not been flexed home early in over a month and a half and all of the other nurses had so I volunteered. It was my third night in a row of three very busy days and I welcomed the break. One of the nurses who works part time and is always either requesting the employee call off or volunteering for Flex time seemed a bit peeved with me for volunteering so quickly. I scrambled and struggled to complete my tasks and charting while providing patient care but just never managed to get enough time to start a new IV on this patient. When the time came to give report to the nurse taking over this patient, she immediately noted the now expired IV site and expressed her displeasure over it not having been changed out already. She aslo happened to be the part time nurse who had seemed peeved with me about my volunteering to flex. I apologized and explained that I just didn't have the time to change the IV. She then noted the IVPB that had been put up 15 hours before at 09:30ish hours had not been infused and was disgruntled that I had not noticed it myself and notified the doctor. She made it seem like I was going to get into A LOT of trouble because of it. I admit it. I SHOULD have noticed it. But she made it seem like I was the only one who would get into trouble. Not the original nurse who put the bag up and failed to check that it infused or the reporting nurse who also failed to notice the med had not infused and the bag was still full, just me. She grudginly accepted care of the patient and I gave report of my other patients to other nurses and went home. I just HAVE to know, how much trouble am I in? If I receive disciplinary action that results in termination and/or loss of license but the other 2 nurses don't, what course of action would I have if any?

[RNKPCE]

Take a deep breath............... The nurse who hung and charted the med is first and foremost responsible. Yes the nurse that took over when the original nurse got flexed has some responsibility and so do you. But the nurse whose signed that the med was hung was ultimately responsible. Actually if you noticed it, you'd be the one filling out the medication error report. This is an error of omission and happens often when the roller clamp is not opened when hanging the med. Doubtful anything more than a write-up and conversation will happen to anyone involved. This is not an error to terminate anyone about unless they have an ongoing issues.

[amoLucia]

It was a med error multiple times over and any nurse involved will likely be disciplined. That you were busy doesn't justify your failure to make it a priority to see to it that the issue was remediated. Also all the other steps involved in a med error, paperwork and notifications, should have been initiated.

Bottom line is the pt experienced a continued delay in an important med. And the PMP should have been contacted ASAP for any directions if nec.

PP commented that some possible ongoing issues will prob dictate any disciplinary action. Just know that your responsibility is just that - YOURS. You were not responsible for the other nurses' actions, nor were they in any way responsible for yours. You'll need to acknowledge your error in a responsible manner and articulate how you could have handled things differently.

If things do progress, utilize your union rep for guidance. This is if you have a union. Still, unions are not a defense lawyers. You were involved in an error.

[Julius Seizure]

I just HAVE to know, how much trouble am I in? If I receive disciplinary action that results in termination and/or loss of license but the other 2 nurses don't, what course of action would I have if any?

Just know that your responsibility is just that - YOURS. You were not responsible for the other nurses' actions, nor were they in any way responsible for yours. You'll need to acknowledge your error in a responsible manner and articulate how you could have handled things differently.

If a conversation with management results from them, I would encourage you to leave out any mention of fault on the part of the other two nurses. That doesn't concern you and bringing it up will only look like you are making excuses. Take responsibility for your part and keep your thoughts on the rest to yourself.

[MunoRN, RN]

If your hospital's practices are up to date then there shouldn't be any sort of punishment, but since it sounds as though your hospital still rotates IVs based on how long they've been in place it's possible that they aren't all that up to date with how to handle med errors. Ideally they focus on the root problem, which I'm guessing is that nurses are clamping the secondary tubing, which should never be clamped once it's set-up.