Just realized a Dilaudid waste error. What do I do?!

[michgru8226]

Hi, so I'm a new grad and I've been on the floor for about 3 months. Today, I gave Dilaudid to a pt and I was in a rush...which I know is inexcusable for my mistake. Pt had an unwitnessed waste from previous shifts (not mine) so it also added to my confusion. But anyways, MAR said 0.2 mg but I thought it said 0.4 mg and I showed my witness wasting 0.6 which she typed 0.6 in the Pyxis. I got to pt's room, scanned the med & it said 0.2 mg. That's when I realized oh crap, I had 0.4, but I was in such a rush because the Pa-C was asking it for it quickly and my break relief RN was bugging me to go on my break, it slipped my mind that I needed to grab my witness and waste 0.2. I ended up wasting it in the biohazard bag in the room myself...and administered the correct 0.2 to the pt. The Pa-C was there when I gave it to the pt but didn't see me wasting it because he had the curtain drawn.. Then I forgot about the whole event during my shift and I just remembered. I'm now anxious that it will affect my license or my job due to my careless mistake. Do I need to talk to my manager tomorrow? The problem is that no one saw me wasting that extra 0.2 mg that I had in my syringe. I've never used or experienced any drugs!

[Kooky Korky, BSN, RN]

Tell your boss ASAP, take the chewing out, go on with life.  Forgive  yourself.

Lesson:  Do not let anyone rush you when it comes to YOUR well-being.  PA and relief nurse can just wait til you deal with the stuff you HAVE to deal with.

[JBMmom, MSN, NP]

These things happen. Just own up to it and explain, you should be able to go on with your license and career just fine.

I agree that while it can be difficult to take your time when others are pressuring you for action, you need to take the time you need to keep your patient safe.

If that ever happens again, one thing you could do is to put the 0.2 you were going to administer into a flush and then keep the remaining 0.2 to waste in the original container for a witness.

[JKL33]

Agree with the above. This will show up in pharmacy system as unaccounted-for controlled substance and you don't want that. 

This is a good lesson about what should or should not make us feel pressured. Just because someone wants something doesn't make it an emergency.  Now is a good time to sort of review--if you had accidentally made a worse mistake during this situation would hurrying because of someone else's desires have been worth it? If you were to actually get fired for this (I don't think you will be, this is just a thought exercise), would hurrying have been worth it?

No and no.

It's VERY difficult to stay calm inside and go about the proper methods when someone is pressuring you, especially when you are new and a "delay" (according to someone else) might feel (to you) like incompetence, or like they must think you're incompetent. Resist that kind of negative thinking about what is going to happen if you take the time to do things as they should be done.

If you can integrate the lesson learned here you will be coming out a lot further ahead because many nurses struggle with this unnecessarily.

??

[Roesseba7, BSN]

Unfortunately it happened months ago.  the correct thing to do would be to report it to your supervisor and immediately go to Employee Health for a drug screen in order to get your labs documented as clear.   I was told this by a rehab director as advice.