Made a big med error as a student... i'm devastated.

[FuturePN]

I almost didn't post on here because I feel so incredibly ashamed, but I feel like it might be good to talk it out.

I'm in a PN program and we're in our last term. My first term I did one med pass. My second term was supposed to be med pass heavy but the instructor I got was brand new and there were a lot of issues (she ultimately was forced to resign at the end of the semester) I only got to pass meds twice with her.

Now it's term 3 (last term) and we all do "leadership" which means that one student is responsible for selecting all of the patients, making the assignments for other students, and then passing all of the meds. this is great experience for the leader but means that the other students dont get to do med passes at all unless until it's their turn for leader. Most students get 4 or 5 patients to do all the meds on, but because I went on a weekend no other students were out on rotations so I had all 8.

I went into it really nervous. I'm a really good student and really wanted to nail this. I was super nervous at first but eventually I got into the swing of it. My instructor watched me pop all the meds for the 4pm round but let me go into the rooms alone which was nice.

For the 8pm meds she watched me draw up 100u of lantus on a pt and administer it since she had never seen me do one before. all was well.

My last pt also needed Lantus. There was an issue with her meds where some meds were in one cart and some were in another, so i got distracted drawing up her Lantus. In any case, i drew it all up and felt confident and went down and gave her all her meds. I stopped by the nurses station where my instructor was to let her know I was giving another insulin and to ask if she wanted to come. she said she was all set.

Afterward, I came back to the nurse's station to document and was feeling over the moon and so relieved.

My nursing instructor just happened to look over my shoulder when i finished documenting and said "she didn't get 100u of lantus" I was so sure. So, So sure. That i proudly pulled up her chart to show her. And then I saw it too... Lantus 100u... ADMINISTER 46 UNITS.

i immediately wanted to die. just wanted to throw up and die.

My nursing instructor calmly said "did you really give her 100u?" and i said yes. she had me give her a glass of apple juice and then she sent the rest of the class down and stayed behind to talk to me. it was really painful. as it should be.

I got home that night and didn't sleep. I was absolutely terrified that she was going to die. Her BS before i gave her the lantus was 305, so there was that. I have never been so absolutely physically ill and devastated in my life.

We had clinicals again the next day and i went in early to take a peek at her chart and see how her night was. No issues, uneventful night, BS was 214 that morning.

I kept it together throughout clinical until our break, at which point i snuck outside to take a little walk and absolutely bawl my eyes out. How could i make such a stupid mistake?????? i did all my checks.... but missed that second line. and i guess 100u made sense to me because the other one i did was 100u. i messed up INSULIN!!!!! how could i mess up INSULIN!?!?!?!?!?!

when i came back from bawling we finished out the night but my instructor could obviously tell i was struggling (but we weren't on the floor at all that day... it was all post conference) She pulled me aside again after everyone left and asked if i was ok and i couldnt stop crying... i felt like such an idiot. but she was extremely kind (which i never would have guessed from her tough teaching style) and said that i made a mistake and that it's ok. the patient is fine and i will never make this mistake again. that i'm a good student and really smart and of course i should still be a nurse. that i will learn from it, the hard way- unfortunately.

I know i couldnt have asked for a better outcome. the patient was fine, i wasn't dismissed from the program, and my instructor was very supportive. i just feel like absolute crap and i just cant get past it. it makes me never want to give meds again. to make myself feel better i started looking up other med errors nurses have made, and instead of feeling like less of an idiot i'm now just horrified by how common it is.

[jschut, BSN, RN]

Eh.... it happens to all of us. Don't let it get to you. You know now, and I can guarantee that you won't make the same mistake again! Kudos to your instructor for using a teachable moment wisely.

Best of luck to you! You will be an awesome nurse!

[Esme12, ASN, BSN, RN]

((HUGS)) We have ALL made mistakes....and learned from them. Trust me you will never make this mistake again.

Now...cry. Take a nice bubble bath. If you are old enough a nice glass of wine or a big bowl full of your favourite treat. Now....move forward...you'll be fine. ((HUGS))

[MikeyT-c-IV]

I made a med error once, too. It was my first day of a PRN job at an endoscopy center. I didn't have any clinical orientation and just "jumped right in" to the job. At my full time job we used 1mg/mL versed, this PRN job used 5mg/mL versed. The lights were already off in the room and I just figured it was the same concentration as what I had been using in the past. Wrong. The patient got 10mg of versed and it should have only been 3mg (The Doc noticed I was giving a lot of versed.) Luckily, I had a long working relationship with the physician and the patient was just fine. Otherwise I could imagine my first day would have also been my last, at best. I learned many things from this experience early in my nursing career, as you, did too.

[Julius Seizure]

As an aside, I could never understand the paranoia about checking insulin with another nurse, especially now that every CNA and her brother can check glucoses at the bedside. If you don't give enough, what happens? The patient gets more. If you give too much, what happens? That's why the goddess gave us orange juice, glucagon, and D50W.

Now, does anybody make you check, say, IV digoxin? Or potassium? What happens if you give too much of those?

See my point?

Dig and KCL are both 2-nurse checks in pediatrics. Not so in adults?

[FuturePN]

I can't tell you how much better you have all made me feel. thank you thank you thank you.

I go back to my first real night of clinicals tonight and i'm so nervous about it. We had class last night and I got my first 78 on an exam in the program... I'm usually a 90's student. siiiiiigh. I need to get my head back on straight and finish strong.

Thank you all again so much for the support!

[saskrn]

The great thing about errors - any errors - is that they're learning moments. If you're anything like me you will never forget this, and you won't make the same error a second time.

[SHGR, MSN, RN, CNS]

OP, you had the right attitude toward your med error- freak out and realize what a big deal it was. That could have been a sentinel event.

However this could be a blessing in disguise. If pt had HS BG of over 300, got 100 units of basal insulin and fasting BG was then over 200, it sounds like their insulin needs are much greater than what is prescribed. You'd have to look at their trends and patterns as well as age and other factors, but it would be a good opportunity for you to call the provider with an SBAR and turn the error into a positive. Learning experience for you, more appropriate diabetes control for the resident.

[norlns24]

My program never allowed a nurse to administer ANY meds (esp. high-alert insulin) without the **direct** supervision of either an RN (during our final semester "leadership" clinical) OR the clinical instructor (all other semesters)....always someone with active licensure. We had to perform the six rights of med administration with instructor or nurse and we were told to never admin. meds w/out a nurse or instructor directly at our side. Administering meds to a patient with the nurse or instructor in the hallway was expressly not allowed and this fact was made abundantly clear to us and reinforced in clinical orientation each semester. Now I see why!

I believe your instructor and the program share some of the blame for this error. I believe my program got it right. I have very little doubt had your instructor been by you side as you completed your six rights and guided you through the actual med admin. (even just to observe as you were indeed in your final semester), this mistake would not have occurred.

Yes, I agree, this experience is a learning moment for you. Also, I know others might argue that in the final semester of nursing school, some level of autonomy is necessary as student nurses are transitioning to professional nurses. However, we all can agree that most nursing skill and practice occurs on the job. School and clinicals offer quite limited opportunities to gain practical experience, which is why most facilities offer residency programs/ orientation periods/ preceptors to new grad nurses in order to further this transition.

I am disappointed the entire focus of this med error appears to have been placed on you. I believe the best institutions and agencies take a global approach to problems and adverse events. By your description of the event, this process did not occur as no one appeared to consider or question the lack of safeguards I have described. Best of luck to you moving forward.

[Emergent, RN]

I'm a little puzzled as to why a nursing instructor thinks giving apple juice the appropriate remedy for too much lantus? That actually shows a disturbing lack of knowledge on her part.

Lantus is slow acting. She should have been helping you look up when it peaks, which if I recall is about 12 hrs. Then a call to the Dr to inform and get orders for frequent blood sugar checks throughout the night.

[CanadianAbroad]

I made a serious med error as a nurse. I will start by saying it was not a normal shift, and we were switching from one nursing home to a new one. We were sending out patients in waves, and I had to do the meds before they left. I remember I gave a schedule narcotic before it was due, and caught myself before sending the patient. I frantically called to the new building to ensure they didn't give it two hours later. We all make med errors and you will make more when you become a nurse. Learn from this experience to be diligent to verify your meds before you give it. Do not stress over it, but learn from it. You are already ahead of the game by being able to learn from this lesson.

[jj224]

Everyone makes a med mistake at some point. You were lucky nothing bad happened and you owned up to it. I guarantee you'll never make that same mistake again. Don't sweat it. You are a student and you instructor should have double checked insulin you drew up insulin. Even in ICU we had to have dual sign off for insulin.