Made a Med Error in Clinical.. :(

[kringkring5144]

This is one of my rants again.

Yesterday was my last clinical day. I had difficult sleeping the night before.

I got in with a person with diabetes, a UTI with altered mental status.

When administering medications- I forgot I needed to count the medication to make sure it matched the number that was suppose to be given but kept taking it out without properly checking it.

Another incident was I felt really clueless about insulin and the sliding scale concept. I did not know that I was suppose to give Humalog when they were eating. I was confused between sliding scales and the insulin that doesnt have one during meals.

Another incident was the ferrous sulfate which was an administration which could have been in the patient's room so we did not take it out of the drawer. A few moments later when we just gave the patient's medications, I saw that the ferrous sulfate wasnt scanned and I mistakenly thought I gave it.

She told me this was a medication error sicne I failed to remember if I gave it to her or not.

Now she emailed me that she is concered about my performance yesterday and told me I need to do my relfection about it before she finished my evaluation.

Im really nervous that Ill be kicked of the program if I fail this clinical.

How do you keep from feeling calm? I never heard anyone who has failed clinical in the school, but they said they can fail people. I am really worried!

[BuckyBadgerRN, ASN, RN]

Yup. People fail clinicals. In my school I know of students who've failed because of the math exams (we had 3 each clinical rotation, needed an 80% average.), 3 criticals--med errors, patient safety issues, failure to be prepared, not in appropriate uniform, etc. Other reasons exist too.

Please, please, please familiarize yourself with the concept of SS insulin and how it works in regards to meals. This is information you will use every day of any floor nurse career that you'll have. Always, ALWAYS do your 3 checks, that way it will be harder to miss any medications and you won't have to rely on "counting pills". There are much bigger drugs to have forgotten to give than iron, be thankful it wasn't any worse than that. Give serious consideration to what your instructor has emailed you and FOCUS during med passes as though your career depends on it. Because, really, it could

[akulahawkRN, ADN, RN, EMT-P]

Yup. People fail clinicals. In my school I know of students who've failed because of the math exams (we had 3 each clinical rotation, needed an 80% average.), 3 criticals--med errors, patient safety issues, failure to be prepared, not in appropriate uniform, etc. Other reasons exist too.

Please, please, please familiarize yourself with the concept of SS insulin and how it works in regards to meals. This is information you will use every day of any floor nurse career that you'll have. Always, ALWAYS do your 3 checks, that way it will be harder to miss any medications and you won't have to rely on "counting pills". There are much bigger drugs to have forgotten to give than iron, be thankful it wasn't any worse than that. Give serious consideration to what your instructor has emailed you and FOCUS during med passes as though your career depends on it. Because, really, it could

This is very true! While the drug that was forgotten was just iron, it really could have been worse and I would expect that will come up during the OP's review on Wednesday. This really is where the "what if" game does become an issue. The drug itself is immaterial, actually. That was a process failure that just happened to show itself with the iron.

Just about the only way that I can see the OP at least not being exposed to SS insulin much, if at all, is if the concept wasn't brought up in lecture or in clinical to date. This doesn't mean that the error with SS insulin is excusable, just perhaps somewhat mitigated, and understandable if this is actually what happened.

To kringkring5144, if you ever come across a situation, procedure, or medication that you're unfamiliar with, don't just blaze ahead, ask someone about whatever it is. Whenever you come across a "High Alert" medication, or any medication that has, or could have parameters, double check yourself and look closely to be certain that your patient meets all the parameters for giving that medication.

I'm not going to even attempt to guess as to whether or not you'll pass because that is probably already largely decided. I wish the best for you, no matter what the outcome is.

[kringkring5144]

thanks for the input. the only reason I can understand her not passing me is I was not being safe.

I can only hope she knows that I'm aware of this and to take double precaution next time.

[kringkring5144]

Thanks! Im aware of this now!

ll be sure to update about what happens Wednesday.

Right now, there is nothing I can do but hope for the best.

[loriangel14, RN]

What did you not understand about the sliding scale?

TYou really shouldn't move on until you understand how to pass meds.

[kringkring5144]

I was confused between with the one in the morning with her blood sugar and another one that we suppose to be given with the meal.

I was confused since I thought since the sliding scale said we don't need correctional insulin according to her sliding scale.

I understand how to administer meds, the insulin threw me off and I know it was a mistake that I did not really understand it.

[chrisrn24]

Why were you giving so many meds without an instructor??

[CrazyGoonRN]

Ok where was your instructor during all this? This is just as much her fault as it is yours. She should have been with you when all this was happening.

[kringkring5144]

No the instructor supervised me through everything. I asked her about the sliding scale..she was qestionig me because she expected me to know it but she explained it to me anyway and where to look next time in the EPIC hyperspace programming we used at the hospital.

She supervised me when I was taking the medications out the cart.

She supervised me when I administered the medications.

She checked my doses.

She did sometimes let me administer oral medications on my mine my own though when we had it in the room.

She just didn't mention anything to me until she emailed me for my evaluation a day later.

[kringkring5144]

No she supervised me through everything. From the insulin to administration and checking my doses.

She was just questioning me for being confused with the insulin sliding scale.

She just let me administer oral medications on my own

Well I understand now why I won't pass. Thanks for the input.

[kringkring5144]

This is very true! While the drug that was forgotten was just iron, it really could have been worse and I would expect that will come up during the OP's review on Wednesday. This really is where the "what if" game does become an issue. The drug itself is immaterial, actually. That was a process failure that just happened to show itself with the iron.

Just about the only way that I can see the OP at least not being exposed to SS insulin much, if at all, is if the concept wasn't brought up in lecture or in clinical to date. This doesn't mean that the error with SS insulin is excusable, just perhaps somewhat mitigated, and understandable if this is actually what happened.

To kringkring5144, if you ever come across a situation, procedure, or medication that you're unfamiliar with, don't just blaze ahead, ask someone about whatever it is. Whenever you come across a "High Alert" medication, or any medication that has, or could have parameters, double check yourself and look closely to be certain that your patient meets all the parameters for giving that medication.

I'm not going to even attempt to guess as to whether or not you'll pass because that is probably already largely decided. I wish the best for you, no matter what the outcome is.

The last time I went to deal with insulin and the insulin scale was a year ago. We mentioned it again this semester but my teacher pretty much went through it for 5 minutes during lecture and said we don't need to worry about it. It just never crossed my mind until I got someone with diabetes on the last day. Oh well that's all I can say. I told her in my reflection that Im gonna need to touch up on the sliding scale again.

[lmccrn62, MSN, RN]

Medication administration should not be taken lightly especially insulin which can result in a lethal error. As a clinical instructor I would be concerned about this as well. I had a student once tell the wrong blood sugar which resulted in the patient getting too much insulin. Moving forward it had to be downloaded in the MAR before I allowed the to give coverage.

I hope you realize the seriousness of a error and it's potential impact. Think of every patient as your family I bet you will think twice next time.