Med error..... Could I lose my license?

Nurses General Nursing

Updated:   Published

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Hi. I have a serious question to ask. OK so. A pt had an order for Dilaudid q6. I thought it was q4 because his oxy was q4. I gave it ONE time four hours apart. Realized my mistake at the end of the shift. Didn't tell anyone. Pt is a-OK, still alive. This happened two weeks ago, and it's been eating me alive bc IDK what to do. It's in the chart that I gave it four hours apart, and the order was q6.

Can I lose my license??

I want to tell my manager. But I'm scared. But it's already done, so I'm either gonna lose my license or not at this point. But can someone with experience please shed some light and perspective on this situation????

Thank you so much in advance. 

Specializes in Critical Care.

This sort of error isn't going to lose you your license; they won't really care to be honest.

Ideally, reporting this to your employer wouldn't come back on you; what should be addressed is the nonsensical orders for q4 hr oxycodone and q 6hr Dilaudid.  (q 4hr oxycodone makes sense; that's how long oxycodone lasts, q 6hr hydromorphone only makes sense if the patient is only expected to have increased pain for 4 of every 6 hours).  If it was deemed necessary to allow for an increase in opiates based on assessment, then the range of the oxycodone should have been increased, not added nonsensical Dilaudid).  

3 Votes

Learn from it, but say nothing. It is inconsequential to bring it up now. Nonetheless, I must question the education or pharmacology knowledge you retained from school if you truly thought such an error would kill your patient; granted, I don't know the dosage, but I can estimate the typical dosage of such an order.

I also agree with whoever said that you should abandon that "my license is on the line" mentality. I hear it frequently, and it just sounds silly. I rarely hear other professions operate from such an inferior complexity. 

8 Votes
Specializes in Cardiac Telemetry, ICU.

Just move on. I know some Florence Nightingales will roll in to encourage you to snitch on yourself, but literally, nothing good will come of it. It'll only make you look suspicious that you waited two weeks to come forward. 

8 Votes
Specializes in Trauma ICU.
Sour Lemon said:

No, you will not lose your license. And I'm going to be the "unethical" one here and suggest that you leave well enough alone. No harm came to the patient, the amounts pulled and administered match, and the patient's chart is documented correctly.

Informing a manager two weeks after the fact seems like a bad idea under these circumstances. And when you drag a third person into a situation like this one, you may obligate them to take action whether they want to or not.

I 100% agree. You will not lose your license, and bringing this up will just make you look bad. I think the most likely worst-case scenario is an audit discovers the error, your manager is notified, and you have a little chat about the five rights. The manager can document that you were "counseled,” and everyone moves on with their lives. As long as it doesn't happen over and over, you will be fine.

1 Votes

I think most of us can say, "Been there, done that," regarding medication errors.   I have nipped the anxiety you're having by owning it & reporting it immediately.  Realize it's a learning opportunity for you.  You're not the first & unfortunately, won't be the last.  I gave an oxycodone 5mg instead of a Dilaudid 2mg years ago, my first shift as a traveler, but still no excuse; I felt like a failure, like a criminal, etc.  I called the doctor & she ended up calming me down, "He's not going to die; he's OK, just monitor him"   I then felt it was only fair to tell the patient he was an attorney of all things!!  He was so understanding.  Owning it when it happens will make you feel better no matter the outcome & your management & co-workers will appreciate your honesty.

1 Votes
JJ1023 said:

I think most of us can say, "Been there, done that," regarding medication errors.   I have nipped the anxiety you're having by owning it & reporting it immediately.  Realize it's a learning opportunity for you.  You're not the first & unfortunately, won't be the last.  I gave an oxycodone 5mg instead of a Dilaudid 2mg years ago, my first shift as a traveler, but still no excuse; I felt like a failure, like a criminal, etc.  I called the doctor & she ended up calming me down, "He's not going to die; he's OK, just monitor him"   I then felt it was only fair to tell the patient he was an attorney of all things!!  He was so understanding.  Owning it when it happens will make you feel better no matter the outcome & your management & co-workers will appreciate your honesty.

LOL. I would've been more concerned about not attenuating his pain with 5mg of oxycodone rather than him dying if he was supposed to get 2 mg of hydromorphone. I think some nurses have misplaced priorities from worrying too much. I don't know if nursing school fosters the inferiority complex or if nursing as a specialty inherently propagates paranoia.

3 Votes

Most nurses with any experience under their belt would have long since lost their license if it were that easy. Haha. You won't lose your license.

Most importantly, the patient was fine. If they had some bad outcome because of your error, then I would be concerned, but they were fine. Also, a q4hr dose is not an unusual order, so it's not like you did something way out of what would be a normal order.

For future reference, though, if you do something like that, again, I would call the doctor who ordered it. There's a good chance they will tell you it's fine, and then you could put in a MAR note, "MD aware of early dose," or something to validate it. I've had docs many times tell me I could give a med an hour or earlier than the PRN order said, and I'd just document it accordingly.

2 Votes
Specializes in Emergency.
kaylee. said:

I Agree with this. At this point, that patient was long gone, and it was over, and he was fine. Going to the manager now will be worse because it seems like you were trying to cover it up. As sour lemon admitted, I will also be the "unethical" one and say that if this DID ever resurface, say you did not realize it was q6. The odds of that happening are slim, but saying you knew would be bad. 
 

As long as you have taken stock and learned something, you can be OK with moving on.

Are you serious? It doesn't matter if the patient is down the hall or has been gone for a year. It's called "accountability" to your patient and yourself. What's the next thing that will go wrong, but you won't say anything for fear of losing your RN? Horrible advice; the truth always comes out, and when it does, it might not be a big deal, but will you be OK with a lie by omission? I'm sorry, but would you be OK with someone doing this to your loved one and not saying anything? We are the most respected profession in America, and it's not because of the advice you got from these two people who don't practice accountability. Stand on your feet and do what's right; no matter the outcome, at least you can live with yourself, knowing you didn't cover a mistake up. I'm ashamed of what you have been told, and the people who wrote this should be ashamed too.

Specializes in BSN, RN, CVRN-BC.

I was on the peer review committee at my last hospital and can tell you that little gets reported to the board.  Most issues, even a lot of very serious issues, are handled in-house.

We had a blood administration error.  The nurses were given remedial education and tasked with presenting to the entire hospital staff 1 unit at a time and putting together a binder of education on the topic.  The staff nurse complied with all of the requirements and was not reported to the board.  The other nurse was a traveler who did not turn in their binder and comply with the requirements and was reported.

A patient CRF patient in the ICU developed hyperkalemia and died.  We were prepared to handle this in-house in a similar manner, but the nurse refused to knowledge that they did anything wrong.  We reported it to the board.

You can see that only serious incidents get reported to the BON, and frequently, if the nurse admits their mistake, shows contrition, and complies with stipulations from the peer review committee, even serious incidents sometimes do not get the report to the BON.  I believe that the Texas BON has since passed some mandatory reporting standards, but giving a dose of Dilaudid 2 hours earlier isn't going to the board. 

You made a mistake, as all humans do.  Just be more careful in the future.  Frankly, I'm surprised that the computer system didn't throw up a big red flag.  If it did and you over-rode the big red flag, then that is a more serious issue.  These systems are in place for the sake of patient safety.  you override them at the peril of your patient and your license.  Don't override the safety systems without careful consideration.  If you override and don't have a sound rationale for doing so, you could end up explaining yourself to the peer-review committee.  

Specializes in BSN, RN, CVRN-BC.

From the TXBON  Looks like we would have reported both under current rules.

Sec. 301.405. Duty of Person Employing Nurse to Report.

(a) This section applies only to a person who employs, hires, or contracts for the services of a nurse, including:

(1) a health care facility, including a hospital, health science center, nursing home, or home health agency;

(2) a state agency;

(3) a political subdivision;

(4) a school of nursing; and

(5) a temporary nursing service.

(b) A person that terminates suspends for more than seven days, or takes other substantive disciplinary action, as defined by the Board, against a nurse, or a substantially equivalent action against a nurse who is a staffing agency nurse, because the nurse engaged in conduct subject to reporting shall report in writing to the Board:

(1) the identity of the nurse;

(2) the conduct subject to reporting that resulted in the termination, suspension, or other substantive disciplinary action or substantially equivalent action; and

(3) any additional information the Board requires.

(c) If a person who makes a report required under Subsection (b) is required under Section 303.0015 to establish a nursing peer review committee, the person shall submit a copy of the report to the nursing peer review committee. The nursing peer review committee shall review the conduct to determine if any deficiency in care by the reported nurse was the result of a factor beyond the nurse's control. A nursing peer review committee that determines that there is reason to believe that the nurse's deficiency in care was the result of a factor beyond the nurse's control shall report the conduct to the patient safety committee at the facility where the reported conduct occurred, or if the facility does not have a patient safety committee, to the chief nursing officer.

(d) [Repealed by Acts 2007]

(e) The requirement under Subsection (c) that a nursing peer review committee review the nurse and the incident does not subject a person's administrative decision to discipline a nurse to the peer review process.

(f) [Repealed by Acts 2007]

(g) [Repealed by Acts 2007]

(h) [Repealed by Acts 2007]

[Subsections (d), (f), (g), and (h) repealed by Acts 2007 (S.B. 993), 80th Leg., eff. Sept. 1, 2007]

Nursemedic74 said:

Are you serious?  It doesn't matter if the patient is down the hall or has been gone for a year.  It's called "accountability" to your patient and yourself.  What's the next thing that will go wrong, but you won't say anything for fear of losing your RN?  Horrible advice; the truth always comes out, and when it does, it might not be a big deal, but will you be OK with a lie by omission?  I'm sorry, but would you be OK with someone doing this to your loved one and not saying anything?  We are the most respected profession in America, and it's not because of the advice you got from these two people who don't practice accountability.  Stand on your own feet and do what's right; no matter the outcome, at least you can live with yourself knowing you didn't cover a mistake up.  I'm ashamed of what you have been told, and the people who wrote this should be ashamed too. 

Quite the sanctimonious disposition, LOL. I'm sure you go around reporting any iota of discrepancies, bending the rule, or trivial innocuous mistakes. We are far from the most respected profession in the country. Perhaps trusted, but definitely not respected. Evidence of that? Patients are becoming more demanding, ungrateful, and self-negligent, but that's only a point or so of standard deviation from the average American.

1 Votes
Specializes in Emergency.

Please don't presume to know what I do or how I practice. I have 20 years of experience in healthcare as a firefighter, paramedic, flight medic paramedic instructor, and state-appointed council member for our DHS. That was all before I became a nurse. It's attitudes like this that find progress and lead the way to unprofessionalism. 
The nurse asked for advice, and I gave mine.  

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