Made a mistake!!

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I feel so bad. I found out last week that I made a medication error on an MAR. I reported it to my supervisor and everything but I still feel so bad. This poor man was over medicated for 2 weeks. Luckily it wasn't a medication that would hurt him, but if it were any other of his medication it could have been bad. I will never ever forget how it felt to find that error and know that the staff administer too much medication because of me! I could have died. Please tell me I am not the only one who has goofed up. I know I have learned from this one!:no:

Specializes in LTC/Rehab,Med/Surg, OB/GYN, Ortho, Neuro.

Mistakes have, do, and will happen. It's an unfortunate truth. Fortunately, this one did not result in a terrible situation. You will now be more vigilant when it comes to your meds and orders. That to me is a great outcome.

Quick story.

I was working per diem in a LTAC. I had a pt one night that was to get 500mg of some bp med (forget which, I just remember the 5 100mg tabs I had to pull). His wife was there and refused the meds, stating that it was too much, it wasn't what he was taking at home, she didn't know why the doc had changed it. His bp was a little elevated, and I did push for him to at least take the dose he took at home (300mg), and she agreed to that (he let her do all the talking and make decisions for those of you wondering. Sure you've met that kind before).

Anyway, that night, I did my chart checks. Mind you, this was my first time w/ this pt, and he had already been there for close to 5 weeks. His original admit order said 500mg, then the next day, the doc came in and lowered it to 300mg. The order was stamped that it had been sent to pharmacy, but it was never corrected. I wrote up every person that for five weeks, 2 times a day, gave the wrong dose, and wrote up pharmacy as well. I showed the DON the next morning all the write-ups, told her I really didn't want to write anyone up, I did it more for show, so she could see how bad that one error was.

This resulted in a new policy that each shift is to do a chart check (as only night shift was doing chart checks), and the orders will be checked by offgoing/oncoming nurse when giving report.

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Specializes in Rehab, Med Surg, Home Care.
I feel so bad. I found out last week that I made a medication error on an MAR. I reported it to my supervisor and everything but I still feel so bad. This poor man was over medicated for 2 weeks. Luckily it wasn't a medication that would hurt him, but if it were any other of his medication it could have been bad. I will never ever forget how it felt to find that error and know that the staff administer too much medication because of me! I could have died. Please tell me I am not the only one who has goofed up. I know I have learned from this one!:no:

Yep, that's why we need to check and re-check each other. Sounds like you were the one who noticed the incorrect dose-how many nurses gave it incorrectly over the course of those two weeks?

Unfortunately, we're all only human. I've found and corrected many errors made by others and have had more than a few corrected or luckily, prevented by double-checking with my colleagues. You'll never make that same error again, still, keep up the vigilance.

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((hugs)) YOU ARE SO NOT ALONE.. And you learned from it. try not to let it shake you fear is a really bad place to operate from.. Just the fact you care proves you are a caring nurse!

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Specializes in Cardiac Telemetry, ED.

I made my first med error the other night. Gave an antiarrhythmic three hours early. No harm was done, IR was filled out, MD notified. What's odd to me is that it was a quiet shift and I was not in a hurry. You'd think I would have made this mistake during one of those crazy busy shifts.

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Specializes in Gerontology.

Errors I have made:

Hung wrong IV fluid

Forgot to turn on clamp for antibiotics - all antibiocs I hung that am - about 5! Lesson learned - always wait that extra 30 seconds to see if piggyback is dripping.

Gave meds to wrong pt.

Missed meds.

Gave wrong dose.

So you see- we all make errors.

I've been in nursing 20+ years and still occasionally make an error - most recent - gave Tyl #3 instead of #2 - realized error just as pt swallowed -(excuse me sir, please vomit that back out right now! LOL)

So don't be hard on yourself. Learn from it, move on. The next error you make will be completely different.

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Specializes in PCU, Home Health.

And heck- it is good that you feel bad about a mistake. I know nurses who don't care that they messed up. Kind of 'oh well'.:smokin:

And not to tell tales- but I know of a nurse- who took staples out of a patient head 5 days early. The brain surgeon she called simply said to her "Wow, that's not cool" and arranged for a PA to steri strip the incision. I seem to remember she sat in the nurses station and cried because she was so upset.

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I think I vomited after I made my med error. It's kinda like falling off of a bike...it not a matter of IF you will fall, it's a matter of WHEN will you fall. I never, ever thought I would stop feeling the guilt. I have stopped feeling the guilt, and actually am now glad I made the error that I did. It caused no harm and because of it, I REALLY triple check all of my med's before I administer them. It is natural to feel so badly. The pt survived, you will survive and go on to be a better nurse because of it...;-)

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Specializes in Med-Surge.

When I was a new grad, I gave Dilaudid for Morphine to an elderly man. I got so upset. I hyperventalated and my mom had to drive me home from work. Needless to say, I quit hospital nursing and I now work in dialysis. We do not give narcotics. (Thank God!)

I remeber my supervisor telling me, "Girl, if these walls could talk...."

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Specializes in ICU, ER.

Every time you catch yourself making a mistake, think about the ones you didn't catch.

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Specializes in Cardiac Telemetry, ED.

I really wasn't too freaked out about my med error, because it was just a few hours early, I'm familiar with the drug, the dosage was still within safe range, and the patient suffered no drop in heart rate or blood pressure. In fact, it probably did him a bit of good to get it a few hours early. I wasn't too nervous about calling the doctor either, because we have really wonderful docs who, for the most part, treat the nurses with a great deal of respect and kindness. This doc was no exception.

My first fall, on the other hand, was horrible. I felt so sick to my stomach over it, I wanted to just go home right then. I felt like the worst nurse in the history of the world. I am so much more careful because of it, though.

I view these experiences as rites of passage. We all must go through them, and come out stronger and better because of them.

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Specializes in ER, TRAUMA, MED-SURG.
I feel so bad. I found out last week that I made a medication error on an MAR. I reported it to my supervisor and everything but I still feel so bad. This poor man was over medicated for 2 weeks. Luckily it wasn't a medication that would hurt him, but if it were any other of his medication it could have been bad. I will never ever forget how it felt to find that error and know that the staff administer too much medication because of me! I could have died. Please tell me I am not the only one who has goofed up. I know I have learned from this one!:no:

PLEASE DON'T think that you are the only nurse that has made a med error. I have been a nurse for only 17 years and I know I have made my share of them, some small, some not so small. You did the right thing in reporting it. Be proud of yourself for that! And, Tazzi is an excellent resource person. Listen to her!!

Anne, RNC:yeah:

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Specializes in ER, TRAUMA, MED-SURG.
Errors I have made:

Hung wrong IV fluid

Forgot to turn on clamp for antibiotics - all antibiocs I hung that am - about 5! Lesson learned - always wait that extra 30 seconds to see if piggyback is dripping.

Gave meds to wrong pt.

Missed meds.

Gave wrong dose.

So you see- we all make errors.

I've been in nursing 20+ years and still occasionally make an error - most recent - gave Tyl #3 instead of #2 - realized error just as pt swallowed -(excuse me sir, please vomit that back out right now! LOL)

So don't be hard on yourself. Learn from it, move on. The next error you make will be completely different.

Pepper the cat - you read my mind! I have also made the same errors you have - hung the wrong IVF, forgetting to unclamp the IVPB abx, gave med to wrong pt, gave wrong dose. And the nurse that boasts that she/he has NEVER made a med error is either fibbing, or is fresh out of school and has NEVER touched a med!

Anne, RNC:D

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